1
|
Pacheco-Brousseau L, Stacey D, Desmeules F, Ben Amor S, Lambert D, Tanguay E, Hillaby A, Bechiau C, Charette M, Poitras S. Instruments to assess appropriateness of hip and knee arthroplasty: a systematic review. Osteoarthritis Cartilage 2023:S1063-4584(23)00701-X. [PMID: 36898655 DOI: 10.1016/j.joca.2023.02.077] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To assess criteria and psychometric properties of instruments for assessing appropriateness of elective joint arthroplasty (JA) for adults with primary hip and knee osteoarthritis (OA). METHODS A systematic review guided by Cochrane methods and PRISMA guidelines. Studies were searched in five databases. Eligible articles include all study designs developing, testing, and/or using an instrument to assess JA appropriateness. Two independent reviewers screened and extracted data. Instruments were compared with Hawker et al. JA consensus criteria. Psychometric properties of instruments were described and appraised guided by Fitzpatrick's and COSMIN approaches. RESULTS Of 55 instruments included, none met all Hawker et al. JA consensus criteria. Criteria the most met were pain (n = 50), function (n = 49), quality of life (n = 33), and radiography (n = 24). Criteria the least met were clinical evidence of OA (n = 18), expectations (n = 15), readiness for surgery (n = 11), conservative treatments (n = 8), and patient/surgeon agree benefits outweigh risks (n = 0). Instrument by Arden et al. met the most criteria (6 of 9). The most tested psychometric properties were appropriateness (n = 55), face/content validity (n = 55), predictive validity (n = 29), construct validity and feasibility (n = 24). The least tested psychometric properties were intra-rater reliability (n = 3), internal consistency (n = 5), and inter-rater reliability (n = 13). Instruments by Gutacker et al. and Osborne et al. met the most psychometric properties (4 of 10). CONCLUSION Most instruments included traditional criteria for assessing JA appropriateness but did not include a trial of conservative treatments or shared decision-making elements. There was limited evidence on psychometric properties.
Collapse
Affiliation(s)
- L Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - D Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.
| | - F Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montréal, Canada.
| | - S Ben Amor
- Telfer School of Management, University of Ottawa, Ottawa, Canada.
| | - D Lambert
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - E Tanguay
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - A Hillaby
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - C Bechiau
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.
| | - M Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - S Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| |
Collapse
|
2
|
Lewis K, Nair K, Armstrong A, Lauck S, Stacey D, Forman J, Birnie D, Healey J, Krahn A, McGillion M, Schwalm J, Carroll S. FACTORS INFLUENCING PATIENT DECISION AID USE FOR IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR DECISIONS IN THREE CANADIAN ACADEMIC HOSPITALS. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.211] [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: 11/02/2022] Open
|
3
|
Huntington B, Bernardo TM, Bondad-Reantaso M, Bruce M, Devleesschauwer B, Gilbert W, Grace D, Havelaar A, Herrero M, Marsh TL, Mesenhowski S, Pendell D, Pigott D, Shaw AP, Stacey D, Stone M, Torgerson P, Watkins K, Wieland B, Rushton J. Global Burden of Animal Diseases: a novel approach to understanding and managing disease in livestock and aquaculture. REV SCI TECH OIE 2021; 40:567-584. [PMID: 34542092 DOI: 10.20506/rst.40.2.3246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Investments in animal health and Veterinary Services can have a measurable impact on the health of people and the environment. These investments require a baseline metric that describes the burden of animal health and welfare in order to justify and prioritise resource allocation and from which to measure the impact of interventions. This paper is part of a process of scientific enquiry in which problems are identified and solutions sought in an inclusive way. It poses the broad question: what should a system to measure the animal disease burden on society look like and what value would it add? Moreover, it aims to do this in such a way as to be accessible by a wide audience, who are encouraged to engage in this debate. Given that farmed animals, including those raised by poor smallholders, are an economic entity, this system should be based on economic principles. These poor farmers are negatively impacted by disparities in animal health technology, which can be addressed through a mixture of supply-led and demand-driven interventions, reinforcing the relevance of targeted financial support from government and non-governmental organisations. The Global Burden of Animal Diseases (GBADs) Programme will glean existing data to measure animal health losses within carefully characterised production systems. Consistent and transparent attribution of animal health losses will enable meaningful comparisons of the animal disease burden to be made between diseases, production systems and countries, and will show how it is apportioned by people's socio-economic status and gender. The GBADs Programme will produce a cloud-based knowledge engine and data portal, through which users will access burden metrics and associated visualisations, support for decisionmaking in the form of future animal health scenarios, and the outputs of wider economic modelling. The vision of GBADs, strengthening the food system for the benefit of society and the environment, is an example of One Health thinking in action.
Collapse
|
4
|
Rushton J, Huntington B, Gilbert W, Herrero M, Torgerson PR, Shaw APM, Bruce M, Marsh TL, Pendell DL, Bernardo TM, Stacey D, Grace D, Watkins K, Bondad-Reantaso M, Devleesschauwer B, Pigott DM, Stone M, Mesenhowski S. Roll-out of the Global Burden of Animal Diseases programme. Lancet 2021; 397:1045-1046. [PMID: 33549170 DOI: 10.1016/s0140-6736(21)00189-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Affiliation(s)
- J Rushton
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L3 5RF, UK.
| | - B Huntington
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L3 5RF, UK; Pengwern Animal Health Ltd, Wallasey Village, UK
| | - W Gilbert
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L3 5RF, UK
| | - M Herrero
- CSIRO Agriculture and Food, St Lucia, QLD, Australia
| | - P R Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - A P M Shaw
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L3 5RF, UK; A P Consultants, Andover, UK
| | - M Bruce
- School of Veterinary Medicine, Centre for Animal Production and Health, Murdoch University, Murdoch, WA, Australia
| | - T L Marsh
- Paul G Allen School for Global Animal Health, Allen Center, School of Economic Sciences, Washington State University, WA, USA
| | - D L Pendell
- Department of Agricultural Economics, Kansas State University, Manhattan, KS, USA
| | - T M Bernardo
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - D Stacey
- School of Computer Science, University of Guelph, Guelph, ON, Canada
| | - D Grace
- Food and Markets Department, Natural Resources Institute, Faculty of Engineering and Science, University of Greenwich, Chatham Maritime, UK; International Livestock Research Institute, Nairobi, Kenya
| | - K Watkins
- FoodFirst LLC, Indianapolis, IN, USA
| | - M Bondad-Reantaso
- Fisheries Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | | | - D M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - M Stone
- OIE World Organisation for Animal Health, Paris, France
| | | |
Collapse
|
5
|
Jain M, Chkipov P, Stacey D, Posner G, Bacal V, Chen I. Assessing Readability and Quality of Online Patient Directed Information on Hysterectomies. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.283] [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: 11/29/2022]
|
6
|
Boland L, Brosseau L, Caspar S, Graham ID, Hutchinson AM, Kothari A, McNamara K, McInnes E, Angel M, Stacey D. Reporting health research translation and impact in the curriculum vitae: a survey. Implement Sci Commun 2020; 1:20. [PMID: 32885181 PMCID: PMC7427883 DOI: 10.1186/s43058-020-00021-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/10/2020] [Indexed: 11/12/2022] Open
Abstract
Background Increasingly, health researchers must demonstrate the impact and real-life applications of their research. We investigated how health researchers with expertise in knowledge translation report research translation activities and impact on their curriculum vitae (CV). Methods We conducted a cross-sectional survey of health researchers with expertise in knowledge translation as we anticipated best practices in CV reporting from this specialized group. Our survey asked participants about their reporting of research translation and impact activities on their CVs, intention to report, and barriers and facilitators to reporting such activities on their CVs. We calculated univariate descriptive statistics for all quantitative data. Linear regression models determined predictors of researchers’ intention to report research translation and impact activities on their CVs. We analyzed open-ended qualitative responses using content analysis. Results One hundred and fifty-three health researchers responded to the survey (response rate = 29%). Most respondents were Canadian, were female, and had a doctoral degree. Eighty-two percent indicated they reported at least one research translation and/or impact indicator on their CVs. Of those, health researchers commonly reported the following: advisory/regulatory committee membership related to research program (83%), research translation award(s) (61%), and academic performance assessments (59%). Researchers least commonly indicated the following: citation metric scores (31%), summaries of impact (21%), and requests to use research materials and/or products (19%). Fewer than half of the health researchers intended to report knowledge translation (43%) and impact (33%) on their CVs. Strong beliefs about capabilities and consequences of reporting research translation and/or impact were significant predictors of intention. Main barriers were as follows: CV templates do not include research translation and impact activities, participants perceived employers do not value research translation and impact activities, and lack of metrics to evaluate research translation and impact. Ninety-six percent were unaware of a CV template formatted to include research translation and/or impact reporting. Conclusions Knowledge translation and impact indicators on the CV are inconsistently reported by our sample of health researchers. Modifiable barriers should be addressed to support more consistent reporting of such activities, including providing a CV template that includes research translation and impact as well as clear metrics to quantify them.
Collapse
Affiliation(s)
- L Boland
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada.,School of Health Studies, Western University, 1151 Richmond Street, London, ON N6A 3K7 Canada
| | - L Brosseau
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8M5 Canada
| | - S Caspar
- Faculty of Health Sciences-Therapeutic Recreation Program, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4 Canada
| | - I D Graham
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health Faculty of Medicine, University of Ottawa, 307D-600 Peter Morand Cresent, Ottawa, ON K1G 5Z3 Canada.,School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - A M Hutchinson
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC Australia.,Monash Health, Clayton, VIC Australia
| | - A Kothari
- School of Health Studies, Western University, 1151 Richmond Street, London, ON N6A 3K7 Canada
| | - K McNamara
- School of Medicine, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - E McInnes
- Nursing Research Institute St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Daniel Mannix Building, Australian Catholic University Fitzroy, Fitzroy, VIC Australia
| | - M Angel
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - D Stacey
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada.,School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| |
Collapse
|
7
|
Trenaman L, Stacey D, Bryan S, Payne K, Hawker G, Bansback N. Long-term effect of patient decision aids on use of joint replacement and health care costs. Osteoarthritis Cartilage 2020; 28:819-823. [PMID: 32173628 DOI: 10.1016/j.joca.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Shared decision-making supported by patient decisions aids may improve care and reduce healthcare costs for persons considering total joint replacement. Observational studies and randomized controlled trials (RCTs) have evaluated the short-term impact of decision aids on uptake of surgery and costs, however the long-term effects are unclear. This analysis aimed to evaluate the effect of patient decision aids on 1) use of joint replacement up to 7-years of follow-up, and 2) osteoarthritis-related health system costs. METHODS 324 participants in a Canadian RCT with 2-years follow-up who were randomized to either a decision aid (n = 161) or usual care (n = 163) had their trial and health administrative data linked. The proportion undergoing surgery up to 7-years were compared using cumulative incidence plots and competing risk regression. Mean per-patient costs were compared using two sample t-tests. RESULTS At 2-years, 119 of 161 (73.9%) patients in the decision aid arm and 129 of 163 (79.1%) patients in the usual care arm had surgery. Between two and 7-years, 17 additional patients in both the decision aid (of 42, 40.4%) and usual care (of 34, 50.0%) arms underwent surgery. At 7-years, patients exposed to decision aids had a similar likelihood of undergoing surgery (HR = 0.92, 95% CI:0.73 to 1.17, p = 0.49) and mean per-patient costs ($21,965 vs $23,681, incremental cost: -$1,717, 95% CI:-$5,631 to $2,198) compared to those in usual care. CONCLUSIONS This is the first study to assess the long-term impact of decision aids on use of joint replacement and healthcare costs. These results are not conclusive but can inform future trial design. CLINICAL TRIAL REGISTRATION The full trial protocol is available at ClinicalTrials.Gov (NCT00911638).
Collapse
Affiliation(s)
- L Trenaman
- University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - D Stacey
- University of Ottawa, Ottawa, Canada
| | - S Bryan
- University of British Columbia, Vancouver, Canada
| | - K Payne
- The University of Manchester, Manchester, UK
| | - G Hawker
- The University of Toronto, Toronto, Canada
| | - N Bansback
- University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada.
| |
Collapse
|
8
|
Squires JE, Simard SN, Asad S, Stacey D, Graham ID, Coughlin M, Clemons M, Grimshaw JM, Zhang J, Caudrelier JM, Arnaout A. Exploring reasons for overuse of contralateral prophylactic mastectomy in Canada. ACTA ACUST UNITED AC 2019; 26:e439-e457. [PMID: 31548812 DOI: 10.3747/co.26.4951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/02/2023]
Abstract
Background Contralateral prophylactic mastectomy (cpm) in women with known unilateral breast cancer (bca) has been increasing despite the lack of supportive evidence. The purpose of the present study was to identify the determinants of cpm in women with unilateral bca. Methods This qualitative descriptive study used semi-structured interviews informed by the Theoretical Domains Framework. We interviewed 74 key informants (surgical oncologists, plastic surgeons, medical oncologists, radiation oncologists, nurses, women with bca) across Canada. Interviews were analyzed using thematic analysis and an analysis for shared and discipline-specific beliefs. Results In total, 58 factors influencing the use of cpm were identified: 26 factors shared by various health care professional groups, 15 discipline-specific factors (identified by a single health care professional group), and 17 factors shared by women with unilateral bca. Health care professionals identified more factors discouraging the use of cpm (n = 26) than encouraging its use (n = 15); women with bca identified more factors encouraging use of cpm (n = 12) than discouraging its use (n = 5). The factor most commonly identified by health care professionals that encouraged cpm was lack of awareness of existing evidence or guidelines for the appropriate use of cpm (n = 44, 75%). For women with bca, the factor most likely influencing their decision for cpm was wanting a better esthetic outcome (n = 14, 93%). Conclusions Multiple factors discouraging and encouraging the use of cpm in unilateral bca were identified. Those factors identify potential individual, team, organization, and system targets for behaviour change interventions to reduce cpm.
Collapse
Affiliation(s)
- J E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - S N Simard
- Bloomberg School of Nursing, University of Toronto, Toronto, ON
| | - S Asad
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - D Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - I D Graham
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - M Coughlin
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - M Clemons
- Department of Medicine, University of Ottawa, Ottawa, ON.,Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON.,Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - J M Grimshaw
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON.,Department of Medicine, University of Ottawa, Ottawa, ON
| | - J Zhang
- Department of Plastic Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON
| | - J M Caudrelier
- Department of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON
| | - A Arnaout
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON.,Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON
| |
Collapse
|
9
|
Jibb LA, Stacey D, Carley M, Davis A, Graham ID, Green E, Jolicoeur L, Kuziemsky C, Ludwig C, Truant T. Research priorities for the pan-Canadian Oncology Symptom Triage and Remote Support practice guides: a modified nominal group consensus. ACTA ACUST UNITED AC 2019; 26:173-182. [PMID: 31285662 DOI: 10.3747/co.26.4247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The pan-Canadian Oncology Symptom Triage and Remote Support (costars) team is studying how to improve the quality and consistency of cancer symptom management. Methods A 1-day invitational meeting was held 24 October 2017 in Ottawa, Ontario, to review the current evidence from costars projects and to establish research priorities for a future largescale implementation study. The meeting included 36 participants who were clinicians from adult oncology, pediatric oncology, and homecare; policymakers from national, provincial, and regional organizations; researchers; and a patient. Half the day involved summarizing evidence from four costars studies and experiences with implementing the costars symptom practice guides. The second half of the day used a modified nominal group technique to generate research questions within small groups, presentation of research questions to all participants, and two rounds of voting to reach consensus on research priorities. Results Participants proposed 4 research categories:■ User-centred augmentation to enhance usability (for example, designing a mobile costars solution)■ Outcome measurement (for example, determining key competencies for clinicians)■ Regular renewal of costars to keep pace with evolving evidence (for example, updates for novel therapies)■ Integration into clinical practice (for example, meaningful engagement of patients and caregivers in study design). Conclusions Across categories, the top 3 priorities were effect on health services use, competency development, and a mobile costars solution. Future research will address identified priorities, reflecting the needs and perspectives of diverse stakeholders. Stakeholder collaboration will continue to guide our approach to operationalizing this priority research agenda.
Collapse
Affiliation(s)
- L A Jibb
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON
| | - D Stacey
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - M Carley
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A Davis
- Washington State University College of Nursing, Vancouver, WA, U.S.A
| | - I D Graham
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON.,Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - E Green
- The Ottawa Hospital, Cancer Program, Ottawa, ON
| | - L Jolicoeur
- The Ottawa Hospital, Cancer Program, Ottawa, ON
| | - C Kuziemsky
- Telfer School of Management, University of Ottawa, Ottawa, ON
| | | | - T Truant
- BC Cancer, Education and Innovation, Vancouver, BC
| |
Collapse
|
10
|
Squires JE, Stacey D, Coughlin M, Greenough M, Roberts A, Dorrance K, Clemons M, Caudrelier JM, Graham ID, Zhang J, Varin MD, Arnaout A. Patient decision aid for contralateral prophylactic mastectomy for use in the consultation: a feasibility study. Curr Oncol 2019; 26:137-148. [PMID: 31043816 PMCID: PMC6476460 DOI: 10.3747/co.26.4689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Rates of contralateral prophylactic mastectomy (cpm) continue to rise internationally despite evidence-based guidance strongly discouraging its use in most women with unilateral breast cancer. The purpose of the present study was to develop and assess the feasibility of a knowledge translation tool [a patient decision aid (da)] designed to enhance evidence-informed shared decision-making about cpm. Methods A consultation da was developed using the Ottawa Patient Decision Aid Development eTraining in consultation with clinicians and knowledge translation experts. The final da was then assessed for feasibility with health care professionals and patients across Canada. The assessment involved a survey completed online (health care professionals) or by telephone (patients). Survey data were analyzed using descriptive statistics for closed-ended questions and qualitative content analysis for open-ended questions. Results The 51 participants who completed the survey included 39 health care professionals and 12 patients. The da was acceptable; 88% of participants viewed it as having the right amount of information or slightly more or less information than they would like. Almost all participants (98%) felt that the da would prepare patients to make better decisions. The aid was perceived to be usable, with 73% of participants stating that they would be willing to use or share the da. Conclusions The cpm patient da developed for the present study was viewed by health care professionals and patients across Canada to be acceptable and usable during the clinical consultation. It holds promise as a knowledge translation tool to be used by clinicians in consultation with women who have unilateral breast cancer to enhance evidence-informed and shared decision-making with respect to undergoing cpm.
Collapse
Affiliation(s)
- J E Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - D Stacey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - M Coughlin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
| | - M Greenough
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - A Roberts
- Breast Surgical Oncology Unit, The Ottawa Hospital, Ottawa, ON
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - K Dorrance
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
| | - M Clemons
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON
- Department of Medicine, University of Ottawa, Ottawa, ON
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON
| | - J M Caudrelier
- Department of Radiation Medicine, The Ottawa Hospital, Ottawa, ON
| | - I D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON
| | - J Zhang
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, ON
- Department of Plastic Surgery, The Ottawa Hospital, Ottawa, ON
| | - M Demery Varin
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - A Arnaout
- Breast Surgical Oncology Unit, The Ottawa Hospital, Ottawa, ON
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON
| |
Collapse
|
11
|
Kelly F, Liska C, Morash R, Hu J, Carroll SL, Shorr R, Dent S, Stacey D. Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review. Chronic Illn 2019; 15:3-26. [PMID: 28927284 DOI: 10.1177/1742395317731608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Shared medical appointments are group appointments, with an optional individual consultation, for patients diagnosed with chronic illnesses. Shared medical appointments improve diabetes management, but little is known about their use for other illnesses. The objective was to determine the effect that shared medical appointments have on patients with a physical chronic illness, healthcare providers, and the healthcare system. METHODS A systematic review was conducted searching databases from January 1970 to September 2016. Eligible trials evaluated shared medical appointments for patients with a homogeneous chronic illness, excluding diabetes and mental illness. Screening, data extraction, and risk of bias were conducted independently by two authors. Analysis was descriptive. RESULTS Of 2364 citations, nine randomized trials were included. Shared medical appointments were evaluated for cardiovascular illnesses (four studies), breast cancer, chronic kidney disease, Parkinson's disease, stress urinary incontinence, and carpal tunnel syndrome. Compared to usual care, no negative effects on patient quality of life, knowledge and satisfaction were reported. One study reported no difference in healthcare provider satisfaction. Another study showed fewer hospital admissions for patients who attended shared medical appointments. DISCUSSION Few rigorous studies evaluated the use of shared medical appointments for chronic illnesses. Overall, there appears to be no patient harms. Further studies should include more objective outcomes and larger sample sizes.
Collapse
Affiliation(s)
- F Kelly
- 1 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,2 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - C Liska
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - R Morash
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - J Hu
- 1 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - S L Carroll
- 4 School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - R Shorr
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - S Dent
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - D Stacey
- 1 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,2 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
12
|
Ludwig C, Renaud J, Barbera L, Carley M, Henry C, Jolicoeur L, Kuziemsky C, Patry A, Stacey D. Factors influencing the use by radiation therapists of cancer symptom guides: a mixed-methods study. Curr Oncol 2019. [DOI: 10.3747/co.26.4198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Radiation therapists play an important role in helping patients to safely manage and triage potentially life-threatening symptoms. The purpose of the present study was to assess factors influencing the use by radiation therapists of evidence-informed symptom practice guides for patients experiencing cancer treatment–related symptoms.Methods In a mixed-methods descriptive study guided by the Knowledge-to-Action framework, interviews and a barriers survey were conducted. Two independent reviewers conducted a content analysis of interview transcripts. Barriers survey data were analyzed using frequency distributions and univariate descriptive statistics. Open-ended data from the surveys underwent content analysis and were triangulated with interview findings.Results Of 90 radiation therapists approached, 58 completed the survey (64%), and 14 were interviewed. Of the 98% who reported providing symptom management to patients undergoing radiation treatment, 53% used evidence-informed practice guidelines. Radiation therapists had moderate moral norms (4.6 of 7) and beliefs about the consequences of using costars (pan Canadian Oncology Symptom Triage and Remote Support) practice guides (4.8), but neutral intention (3.4) and beliefs about their own capabilities (3.9). Environmental barriers included lack of time (2.0), lack of access (2.5), and neutral organizational support (3.0). Radiation therapists identified a need for training (5.5). Common unique barriers to practice guide use were lack of time during radiation treatments, unclear fit with scope of practice, disparate focus on site-specific symptoms, and lack of medication knowledge.Conclusions The symptom practice guides were perceived by the radiation therapists to benefit patients, enhance their own knowledge of symptom management, and promote consistent practice. Additional work is required to identify the scope of practice of radiation therapists within the interprofessional team.
Collapse
|
13
|
Ludwig C, Renaud J, Barbera L, Carley M, Henry C, Jolicoeur L, Kuziemsky C, Patry A, Stacey D. Factors influencing the use by radiation therapists of cancer symptom guides: a mixed-methods study. Curr Oncol 2019; 26:56-64. [PMID: 30853800 PMCID: PMC6380628 DOI: 10.3747/co.25.4198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 01/01/2023] Open
Abstract
Background Radiation therapists play an important role in helping patients to safely manage and triage potentially life-threatening symptoms. The purpose of the present study was to assess factors influencing the use by radiation therapists of evidence-informed symptom practice guides for patients experiencing cancer treatment-related symptoms. Methods In a mixed-methods descriptive study guided by the Knowledge-to-Action framework, interviews and a barriers survey were conducted. Two independent reviewers conducted a content analysis of interview transcripts. Barriers survey data were analyzed using frequency distributions and univariate descriptive statistics. Open-ended data from the surveys underwent content analysis and were triangulated with interview findings. Results Of 90 radiation therapists approached, 58 completed the survey (64%), and 14 were interviewed. Of the 98% who reported providing symptom management to patients undergoing radiation treatment, 53% used evidence-informed practice guidelines. Radiation therapists had moderate moral norms (4.6 of 7) and beliefs about the consequences of using costars (pan-Canadian Oncology Symptom Triage and Remote Support) practice guides (4.8), but neutral intention (3.4) and beliefs about their own capabilities (3.9). Environmental barriers included lack of time (2.0), lack of access (2.5), and neutral organizational support (3.0). Radiation therapists identified a need for training (5.5). Common unique barriers to practice guide use were lack of time during radiation treatments, unclear fit with scope of practice, disparate focus on site-specific symptoms, and lack of medication knowledge. Conclusions The symptom practice guides were perceived by the radiation therapists to benefit patients, enhance their own knowledge of symptom management, and promote consistent practice. Additional work is required to identify the scope of practice of radiation therapists within the interprofessional team.
Collapse
Affiliation(s)
- C Ludwig
- School of Nursing, University of Ottawa, Ottawa, ON
| | | | - L Barbera
- Department of Radiation Oncology, University of Toronto, Toronto, ON
- Department of Radiation Oncology, Odette Cancer Centre, Toronto, ON
| | - M Carley
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - C Henry
- Telfer School of Management, University of Ottawa, Ottawa, ON
| | | | - C Kuziemsky
- Telfer School of Management, University of Ottawa, Ottawa, ON
| | - A Patry
- The Ottawa Hospital, Ottawa, ON
| | - D Stacey
- School of Nursing, University of Ottawa, Ottawa, ON
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| |
Collapse
|
14
|
Breau RH, Kumar RM, Lavallee LT, Cagiannos I, Morash C, Horrigan M, Cnossen S, Mallick R, Stacey D, Fung-Kee-Fung M, Morash R, Smylie J, Witiuk K, Fergusson DA. The effect of surgery report cards on improving radical prostatectomy quality: the SuRep study protocol. BMC Urol 2018; 18:89. [PMID: 30340572 PMCID: PMC6194548 DOI: 10.1186/s12894-018-0403-y] [Citation(s) in RCA: 4] [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: 03/29/2018] [Accepted: 10/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background The goal of radical prostatectomy is to achieve the optimal balance between complete cancer removal and preserving a patient’s urinary and sexual function. Performing a wider excision of peri-prostatic tissue helps achieve negative surgical margins, but can compromise urinary and sexual function. Alternatively, sparing peri-prostatic tissue to maintain functional outcomes may result in an increased risk of cancer recurrence. The objective of this study is to determine the effect of providing surgeons with detailed information about their patient outcomes through a surgical report card. Methods We propose a prospective cohort quasi-experimental study. The intervention is the provision of feedback to prostate cancer surgeons via surgical report cards. These report cards will be distributed every 3 months by email and will present surgeons with detailed information, including urinary function, erectile function, and surgical margin outcomes of their patients compared to patients treated by other de-identified surgeons in the study. For the first 12 months of the study, pre-operative, 6-month, and 12-month patient data will be collected but there will be no report cards distributed to surgeons. This will form the pre-feedback cohort. After the pre-feedback cohort has completed accrual, surgeons will receive quarterly report cards. Patients treated after the provision of report cards will comprise the post-feedback cohort. The primary comparison will be post-operative function of the pre-feedback cohort vs. post-feedback cohort. The secondary comparison will be the proportion of patients with positive surgical margins in the two cohorts. Outcomes will be stratified or case-mix adjusted, as appropriate. Assuming a baseline potency of 20% and a baseline continence of 70%, 292 patients will be required for 80% power at an alpha of 5% to detect a 10% improvement in functional outcomes. Assuming 30% of patients may be lost to follow-up, a minimum sample size of 210 patients is required in the pre-feedback cohort and 210 patients in the post-feedback cohort. Discussion The findings from this study will have an immediate impact on surgeon self-evaluation and we hypothesize surgical report cards will result in improved overall outcomes of men treated with radical prostatectomy. Electronic supplementary material The online version of this article (10.1186/s12894-018-0403-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- R H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - R M Kumar
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
| | - L T Lavallee
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - I Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - C Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Horrigan
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - S Cnossen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - R Mallick
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - D Stacey
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - R Morash
- The Ottawa Hospital Cancer Program, Ottawa, Canada
| | - J Smylie
- The Ottawa Hospital Cancer Program, Ottawa, Canada
| | - K Witiuk
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - D A Fergusson
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| |
Collapse
|
15
|
Kelly F, Carroll S, Carley M, Dent S, Shorr R, Hu J, Morash R, Stacey D. SYMPTOM PRACTICE GUIDE FOR TELEPHONE ASSESSMENT OF PATIENTS WITH CANCER TREATMENT-RELATED CARDIOTOXIC DYSPNEA: ADAPTATION AND EVALUATION OF ACCEPTABILITY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
16
|
Kelly F, Carroll SL, Carley M, Dent S, Shorr R, Hu J, Morash R, Stacey D. Symptom practice guide for telephone assessment of patients with cancer treatment-related cardiotoxic dyspnea: Adaptation and evaluation of acceptability. Cardiooncology 2017; 3:7. [PMID: 32154002 PMCID: PMC7048126 DOI: 10.1186/s40959-017-0026-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/06/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with cancer treatment-related cardiotoxicity, which may manifest as heart failure (HF), can present with dyspnea. Nurses frequently assess, triage and offer self-care strategies to patients experiencing dyspnea in both the cardiology and oncology settings. However, there are no known tools available for nurses to manage patients in the setting of cancer treatment-related cardiotoxicity. The objective of this study was to adapt and evaluate the acceptability of an evidence-informed symptom practice guide (SPG) for use by nurses over the telephone for the assessment, triage, and management of patients experiencing dyspnea due to cancer treatment-related cardiotoxicity. METHODS The CAN-IMPLEMENT© methodology guided this descriptive study. A systematic search was conducted in four databases to identify cardio-oncology and HF guidelines and systematic reviews. Screening was conducted by two reviewers, with data extracted into a recommendation matrix from eligible guidelines and systematic reviews on: assessment criteria, medications, and/or self-care strategies to manage dyspnea. Healthcare professionals with an expertise in oncology and/or cardiology were recruited using purposeful and snowball sampling. Evaluation of acceptability of the adapted SPG was gathered through semi-structured interviews and a survey with open- and closed-ended questions. Quantitative findings and participant feedback from the interviews and the open-ended survey questions were analyzed descriptively. RESULTS Of 490 citations, seven HF guidelines were identified. Evidence from these guidelines was added to the original SPG. Eleven healthcare professionals completed the interview and acceptability survey. The adapted SPG was iteratively revised three times during the interviews. The original SPG was adaptable, and participants indicated the adapted SPG was comprehensive, easy to follow, and would be useful in clinical practice. CONCLUSIONS This study highlights the lack of knowledge tools and available clinical practice guidelines to guide healthcare professionals to assess, triage and/or offer self-care strategies to patients with cancer treatment-related cardiotoxic dyspnea. Moreover, most nurses require assistance to differentiate among the various causes of dyspnea from oncology treatment in order to triage severity appropriately. Further research should focus on evaluating the validity of the adapted SPG in clinical practice.
Collapse
Affiliation(s)
- F. Kelly
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H M5 Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Room 1280, Box 201B, Ottawa, Ontario K1H 8L6 Canada
| | - S. L. Carroll
- School of Nursing, McMaster University, 1280 Main Street West, Room HSC2J40, Hamilton, Ontario L8S 4K1 Canada
| | - M. Carley
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Room 1280, Box 201B, Ottawa, Ontario K1H 8L6 Canada
| | - S. Dent
- The Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H M5 Canada
| | - R. Shorr
- The Ottawa Hospital General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - J. Hu
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H M5 Canada
| | - R. Morash
- The Ottawa Hospital General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - D. Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H M5 Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Room 1280, Box 201B, Ottawa, Ontario K1H 8L6 Canada
| |
Collapse
|
17
|
Trenaman L, Stacey D, Bryan S, Taljaard M, Hawker G, Dervin G, Tugwell P, Bansback N. Decision aids for patients considering total joint replacement: a cost-effectiveness analysis alongside a randomised controlled trial. Osteoarthritis Cartilage 2017. [PMID: 28624294 DOI: 10.1016/j.joca.2017.05.022] [Citation(s) in RCA: 26] [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] [Indexed: 02/02/2023]
Abstract
BACKGROUND Shared decision-making (SDM) is a key priority to improve patient-centred care, and can play an important role in helping patients decide whether to undergo total joint arthroplasty (TJA). Patient decision aids can support SDM; however, they may incur an upfront cost. We aimed to estimate the health and economic effects of patient decision aids for TJA. METHODS A cost-effectiveness analysis of a randomised controlled trial (RCT) with 2-year follow-up. 343 patients were recruited from two orthopedic screening clinics in Ottawa, Canada. Patients were randomized to either a patient decision aid plus surgeon preference report (decision aid) or usual care. Primary outcomes were costs (in 2014 CAD$), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Costs were calculated by multiplying self-reported resource use by unit costs. QALYs were calculated by mapping the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to EuroQol 5-Dimension (EQ-5D) health utilities. Costs and QALYs were discounted at 5%. Multiple imputation was used to handle missing data, and bootstrapping was used to estimate uncertainty. RESULTS The sample comprised 167 intervention and 167 control group patients. The decision aid arm had fewer surgeries over the 2-year period thereby incurring a negative incremental cost of -$560 (95% CI: -$1358 to $426) per patient while providing 0.05 (95% CI: -0.04 to 0.13) additional QALYs per patient. Consequently, the decision aid arm was dominant. CONCLUSION The use of a patient decision aid was associated with fewer health care costs, while producing similar health outcomes. CLINICAL TRIAL REGISTRATION NUMBER CT00911638 (clinicaltrials.gov).
Collapse
Affiliation(s)
- L Trenaman
- University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada; Arthritis Research Canada, Richmond, Canada
| | - D Stacey
- University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - S Bryan
- University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada
| | - M Taljaard
- University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - G Hawker
- University of Toronto, Toronto, Canada; Women's College Hospital, Toronto, Canada
| | - G Dervin
- University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - P Tugwell
- University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - N Bansback
- University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada; Arthritis Research Canada, Richmond, Canada.
| |
Collapse
|
18
|
Stacey D, Pritchard C. An ecological study of excess winter mortality in England and deprivation. Public Health 2016; 141:207-209. [PMID: 27932002 DOI: 10.1016/j.puhe.2016.09.023] [Citation(s) in RCA: 2] [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: 07/13/2016] [Revised: 09/06/2016] [Accepted: 09/18/2016] [Indexed: 10/20/2022]
Affiliation(s)
- D Stacey
- Lincolnshire County Council, County Offices, Newland, Lincoln, LN1 1YL, UK.
| | - C Pritchard
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| |
Collapse
|
19
|
Stacey D, Redlich R, Büschel A, Opel N, Grotegerd D, Zaremba D, Dohm K, Bürger C, Meinert SL, Förster K, Repple J, Kaufmann C, Kugel H, Heindel W, Arolt V, Dannlowski U, Baune BT. TNF receptors 1 and 2 exert distinct region-specific effects on striatal and hippocampal grey matter volumes (VBM) in healthy adults. Genes Brain Behav 2016; 16:352-360. [PMID: 27528091 DOI: 10.1111/gbb.12318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/20/2016] [Accepted: 08/10/2016] [Indexed: 12/23/2022]
Abstract
Tumour necrosis factor alpha (TNFα) has been implicated in the pathophysiology of neurodegenerative and neuropsychiatric disease, with research highlighting a role for TNFα in hippocampal and striatal regulation. TNFα signals are primarily transduced by TNF receptors 1 and 2 (TNFR1 and TNFR2), encoded by TNFRSF1A and TNFRSF1B, which exert opposing effects on cell survival (TNFR1, neurodegenerative; TNFR2, neuroprotective). We therefore sought to explore the respective roles of TNFR1 and TNFR2 in the regulation of hippocampal and striatal morphology in an imaging genetics study. Voxel-based morphometry was used to analyse the associations between TNFRSF1A (rs4149576 and rs4149577) and TNFRSF1B (rs1061624) genotypes and grey matter structure. The final samples comprised a total of 505 subjects (mean age = 33.29, SD = 11.55 years; 285 females and 220 males) for morphometric analyses of rs1061624 and rs4149576, and 493 subjects for rs4149577 (mean age = 33.20, SD = 11.56 years; 281 females and 212 males). Analyses of TNFRSF1A single nucleotide polymorphisms (SNPs) rs4149576 and rs4149577 showed highly significant genotypic associations with striatal volume but not the hippocampus. Specifically, for rs4149576, G homozygotes were associated with reduced caudate nucleus volumes relative to A homozygotes and heterozygotes, whereas for rs4149577, reduced caudate volumes were observed in C homozygotes relative to T homozygotes and heterozygotes. Analysis of the TNFRSF1B SNP rs1061624 yielded a significant association with hippocampal but not with striatal volume, whereby G homozygotes were associated with increased volumes relative to A homozygotes and heterozygotes. Our findings indicate a role for TNFR1 in regulating striatal but not hippocampal morphology, as well as a complementary role for TNFR2 in hippocampal but not in striatal morphology.
Collapse
Affiliation(s)
- D Stacey
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - R Redlich
- Department of Psychiatry, University of Münster, Münster
| | - A Büschel
- Department of Psychiatry, University of Münster, Münster
| | - N Opel
- Department of Psychiatry, University of Münster, Münster
| | - D Grotegerd
- Department of Psychiatry, University of Münster, Münster
| | - D Zaremba
- Department of Psychiatry, University of Münster, Münster
| | - K Dohm
- Department of Psychiatry, University of Münster, Münster
| | - C Bürger
- Department of Psychiatry, University of Münster, Münster
| | - S L Meinert
- Department of Psychiatry, University of Münster, Münster
| | - K Förster
- Department of Psychiatry, University of Münster, Münster
| | - J Repple
- Department of Psychiatry, University of Münster, Münster
| | - C Kaufmann
- Department of Psychiatry, University of Münster, Münster
| | - H Kugel
- Department of Clinical Radiology, University of Münster, Münster
| | - W Heindel
- Department of Clinical Radiology, University of Münster, Münster
| | - V Arolt
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - U Dannlowski
- Department of Psychiatry, University of Münster, Münster.,Department of Psychiatry, University of Marburg, Marburg, Germany
| | - B T Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
20
|
Carroll S, Embuldeniya G, Pannag J, Lewis K, McGillion M, Stacey D. The Challenge of Values-Elicitation: Understanding How Patients’ Values Guide Decision-making in the Context of Implantable Cardioverter Defibrillators. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
21
|
Abdulnour J, Stacey D, Dionne IJ, Brochu M, Doucet É, Prud’homme D. Vasomotor symptoms and cardiometabolic risk factors in menopausal women: a MONET Group study. Climacteric 2016; 19:381-6. [DOI: 10.1080/13697137.2016.1191459] [Citation(s) in RCA: 2] [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] [Indexed: 10/21/2022]
Affiliation(s)
- J. Abdulnour
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Institut de recherche de l’Hôpital Montfort, Ottawa, ON, Canada
- Behavioral and Metabolic Research Unit, University of Ottawa, Ottawa, ON, Canada
| | - D. Stacey
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, ON, Canada
| | - I. J. Dionne
- Faculté des sciences de l’activité physique, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Centre on Aging, Social Services and Health Centre-University Institute of Geriatrics of Sherbrooke, QC, Canada
| | - M. Brochu
- Faculté des sciences de l’activité physique, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Centre on Aging, Social Services and Health Centre-University Institute of Geriatrics of Sherbrooke, QC, Canada
| | - É. Doucet
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Behavioral and Metabolic Research Unit, University of Ottawa, Ottawa, ON, Canada
| | - D. Prud’homme
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Institut de recherche de l’Hôpital Montfort, Ottawa, ON, Canada
| |
Collapse
|
22
|
Stacey D, Taljaard M, Dervin G, Tugwell P, O'Connor AM, Pomey MP, Boland L, Beach S, Meltzer D, Hawker G. Impact of patient decision aids on appropriate and timely access to hip or knee arthroplasty for osteoarthritis: a randomized controlled trial. Osteoarthritis Cartilage 2016; 24:99-107. [PMID: 26254238 DOI: 10.1016/j.joca.2015.07.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/09/2015] [Accepted: 07/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of patient decision aids (PtDA) compared to usual education on appropriate and timely access to total joint arthroplasty in patients with osteoarthritis. METHOD A randomized controlled trial (RCT) with patients undergoing orthopedic screening. Control and intervention arms received usual education; intervention arm also received a PtDA and a surgeon preference report. Wait times (primary outcome) were described using stratified Kaplan-Meier survival curves with patients censored at the time of death or loss to follow-up, and multivariable Cox proportional hazards regression. Secondary outcomes were compared using stratified Cochran-Mantel-Haenszel chi-squared tests. RESULTS 343 patients were randomized to intervention (n = 174) or control (n = 169). The typical patient was 66 years old, retired, living with someone, and 51% had high school education or less. The intervention was associated with a trend towards reduction in wait time (hazard ratio (HR) 1.25, 95% confidence interval (CI) 0.99-1.60, P = 0.0653). Median wait times were 3 weeks shorter in intervention than in control at the community site with no difference at the academic site. Good decision quality was reached by 56.1% intervention and 44.5% control (Relative risk (RR) 1.25; 95% CI 1.00-1.56, P = 0.050). Surgery rates were 73.2% intervention and 80.5% controls (RR 0.91: 95% CI 0.81-1.03) with 12 intervention (7.3%) and eight control participants (4.9%) returning to have surgery within 2 years (P = 0.791). CONCLUSION Compared to controls, decision aid recipients had shorter wait times at one site, fewer surgeries, and were more likely to reach good decision quality, but overall effect was not statistically significant. TRIALS REGISTRATION The full trial protocol is available at ClinicalTrials.Gov (NCT00911638).
Collapse
Affiliation(s)
- D Stacey
- University of Ottawa, Faculty of Health Sciences, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada.
| | - M Taljaard
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada; University of Ottawa, Department of Epidemiology and Community Medicine, Canada.
| | - G Dervin
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada.
| | - P Tugwell
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada; University of Ottawa, Department of Epidemiology and Community Medicine, Canada.
| | - A M O'Connor
- University of Ottawa, Faculty of Health Sciences, Canada.
| | - M P Pomey
- University of Montréal, School of Public Health, Canada.
| | - L Boland
- University of Ottawa, Faculty of Health Sciences, Canada.
| | - S Beach
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada.
| | - D Meltzer
- University of Chicago, Department of Medicine, USA.
| | - G Hawker
- University of Toronto, Faculty of Medicine and Women's College Hospital, Canada.
| |
Collapse
|
23
|
Lewis K, Stacey D, Boland L, Carroll S, Sikora L, Birnie D. RISKS AND BENEFITS OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR REPLACEMENT: A SYSTEMATIC REVIEW. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
24
|
Dannlowski U, Grabe HJ, Wittfeld K, Klaus J, Konrad C, Grotegerd D, Redlich R, Suslow T, Opel N, Ohrmann P, Bauer J, Zwanzger P, Laeger I, Hohoff C, Arolt V, Heindel W, Deppe M, Domschke K, Hegenscheid K, Völzke H, Stacey D, Meyer Zu Schwabedissen H, Kugel H, Baune BT. Multimodal imaging of a tescalcin (TESC)-regulating polymorphism (rs7294919)-specific effects on hippocampal gray matter structure. Mol Psychiatry 2015; 20:398-404. [PMID: 24776739 DOI: 10.1038/mp.2014.39] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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] [Received: 09/26/2013] [Revised: 02/09/2014] [Accepted: 03/17/2014] [Indexed: 02/07/2023]
Abstract
In two large genome-wide association studies, an intergenic single-nucleotide polymorphism (SNP; rs7294919) involved in TESC gene regulation has been associated with hippocampus volume. Further characterization of neurobiological effects of the TESC gene is warranted using multimodal brain-wide structural and functional imaging. Voxel-based morphometry (VBM8) was used in two large, well-characterized samples of healthy individuals of West-European ancestry (Münster sample, N=503; SHIP-TREND, N=721) to analyze associations between rs7294919 and local gray matter volume. In subsamples, white matter fiber structure was investigated using diffusion tensor imaging (DTI) and limbic responsiveness was measured by means of functional magnetic resonance imaging (fMRI) during facial emotion processing (N=220 and N=264, respectively). Furthermore, gene x environment (G × E) interaction and gene x gene interaction with SNPs from genes previously found to be associated with hippocampal size (FKBP5, Reelin, IL-6, TNF-α, BDNF and 5-HTTLPR/rs25531) were explored. We demonstrated highly significant effects of rs7294919 on hippocampal gray matter volumes in both samples. In whole-brain analyses, no other brain areas except the hippocampal formation and adjacent temporal structures were associated with rs7294919. There were no genotype effects on DTI and fMRI results, including functional connectivity measures. No G × E interaction with childhood maltreatment was found in both samples. However, an interaction between rs7294919 and rs2299403 in the Reelin gene was found that withstood correction for multiple comparisons. We conclude that rs7294919 exerts highly robust and regionally specific effects on hippocampal gray matter structures, but not on other neuropsychiatrically relevant imaging markers. The biological interaction between TESC and RELN pointing to a neurodevelopmental origin of the observed findings warrants further mechanistic investigations.
Collapse
Affiliation(s)
- U Dannlowski
- 1] Department of Psychiatry, University of Münster, Münster, Germany [2] Department of Psychiatry, University of Marburg, Marburg, Germany
| | - H J Grabe
- 1] Department of Psychiatry, University Medicine Greifswald, HELIOS-Hospital Stralsund, Stralsund, Germany [2] German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - K Wittfeld
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - J Klaus
- Department of Psychiatry, University of Münster, Münster, Germany
| | - C Konrad
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - D Grotegerd
- Department of Psychiatry, University of Münster, Münster, Germany
| | - R Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | - T Suslow
- 1] Department of Psychiatry, University of Münster, Münster, Germany [2] Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - N Opel
- Department of Psychiatry, University of Münster, Münster, Germany
| | - P Ohrmann
- Department of Psychiatry, University of Münster, Münster, Germany
| | - J Bauer
- Department of Psychiatry, University of Münster, Münster, Germany
| | - P Zwanzger
- Department of Psychiatry, University of Münster, Münster, Germany
| | - I Laeger
- Department of Psychiatry, University of Münster, Münster, Germany
| | - C Hohoff
- Department of Psychiatry, University of Münster, Münster, Germany
| | - V Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - W Heindel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - M Deppe
- Department of Neurology, University of Münster, Münster, Germany
| | - K Domschke
- Department of Psychiatry, University of Würzburg, Würzburg, Germany
| | - K Hegenscheid
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - D Stacey
- Discipline of Psychiatry, School of Medicine, University of Adelaide: North Terrace, Adelaide, SA, Australia
| | | | - H Kugel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - B T Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide: North Terrace, Adelaide, SA, Australia
| |
Collapse
|
25
|
Carroll S, McGillion M, Healey J, Foster G, Browne G, Sum C, Stacey D, Thabane L. ENGAGING PATIENTS AND FAMILIES DURING DEVELOPMENT OF A PATIENT DECISION AID (PTDA) FOR AN IMPLANTABLE DEFIBRILLATOR - ACCEPTABILITY RESULTS. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
26
|
Lewis K, Stacey D, Matlock D. PATIENTS’ PERSPECTIVES ON ICD DECISION-MAKING FROM IMPLANTATION TO END-OF-LIFE: AN INTEGRATIVE REVIEW. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
27
|
Carroll S, McGillion M, Stacey D, Healey J, Browne G, Thabane L, Arthur H. Achieving Consensus About Content to Include in a Decision Aid for Implantable Defibrillator Candidates: Use of the Delphi Process. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.633] [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: 11/30/2022] Open
|
28
|
Stacey D, Carley M, Harrison M. 054 Transforming Evidence From Multiple Guidelines Into User Friendly Clinical Practice Tools For Remote Cancer Treatment-Related Symptom Management: The Costars Project. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.85] [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: 11/03/2022]
|
29
|
Bissonnette J, Woodend K, Davies B, Stacey D, Knoll GA. Evaluation of a collaborative chronic care approach to improve outcomes in kidney transplant recipients. Clin Transplant 2013; 27:232-8. [DOI: 10.1111/ctr.12068] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - K. Woodend
- Faculty of Health Sciences; School of Nursing; University of Ottawa; Ottawa; ON; Canada
| | | | | | | |
Collapse
|
30
|
Verma S, Paquet L, Stacey D, Davis I, Bedard M, Lowry S, Ianni L. P3-08-04: “How Important Is This for Me?” – The Role of Necessity Beliefs as Determinants of Breast Cancer Prevention Intentions among High-Risk Women. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-08-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Women at elevated risk for breast cancer (BC) face complex risk management decisions. Understanding the determinants of pre-counselling risk management intentions would be useful to clinicians in helping high-risk women make their decisions. Across several medical conditions, the Necessity-Concerns Framework (NCF) has emphasized the role of patient’ beliefs about interventions offered to them as central to decision-making. In the NCF, beliefs are conceptualized as perceived personal need for an intervention (necessity) and as concerns about its perceived negative effects. To date, the NCF has not been applied to investigate decision-making in the high-risk setting. Our objective was to use the NCF to describe the risk management beliefs of high-risk women prior to initial consultation. The relative importance of BC fear, perceived susceptibility to BC and necessity-concerns beliefs in predicting prevention intentions was also examined.
Methods A survey was sent to patients prior to their first risk consultation. BC fear was assessed with Champion BC Fear Scale and perceived susceptibility was measured by asking women to rate their likelihood of developing BC (0 =definitely will not get it to 100=definitely will get it). For each of screening, lifestyle modifications, pharmacoprevention (PP) and prophylactic surgery (PS), women rated (1=strongly disagree to 5=strongly agree) their need for the option (e.g., my health in the future will depend on this option, this option will protect me from becoming worse), and its negative consequences (e.g. I worry about the long-term effects of this option, this option will disrupt my life). Intentions were assessed by asking how strongly (1=definitely not to 5=Definitely Yes) they intended to adopt each option. The planned sample size is 100 women and recruitment is on-going. We report data from 44 women who have completed the questionnaire.
Results: The majority intended to adopt screening (92%) and lifestyle (91%) compared to PP (23%) or PS (18%). Screening and lifestyle were associated with stronger intentions, higher perceived need, and lower concerns than PP and PS (all t-tests, p <0.0001). Hierarchical regression analyses revealed that perceived need predicted intentions for each option (all ps < 0.005, except for screening, p < .1) whereas concern beliefs were only correlated with PP intentions (β=-.398, p < .005). Fear of BC was related to PP intentions (β=.401, p < .005) and to intentions to remain smoke-free (β=-.341, p < .05). Perceived susceptibility did not contribute to intentions.
Conclusions Our preliminary findings are promising and suggest that the NCF is useful for understanding decision-making in the high-risk setting. The findings emphasize the importance of necessity beliefs in BC risk management decisions. For the group as whole, across each risk management option, the strongest predictor of intentions was a women's perception of her personal need for the option. Concerns about negative effects and BC fear played only a minor role and perceived susceptibility did not predict intentions. These observations stress the importance of making screening or prevention recommendations hand in hand with the individual beliefs and concerns.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-08-04.
Collapse
Affiliation(s)
- S Verma
- 1The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Carleton University, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| | - L Paquet
- 1The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Carleton University, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| | - D Stacey
- 1The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Carleton University, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| | - I Davis
- 1The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Carleton University, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| | - M Bedard
- 1The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Carleton University, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| | - S Lowry
- 1The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Carleton University, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| | - L Ianni
- 1The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Carleton University, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
31
|
Schwalm J, Stacey D, Pericak D, Natarajan M. 716 Vascular access options in coronary angiogram procedures: Randomized controlled trial of a patient decision aid. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.591] [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: 10/16/2022] Open
|
32
|
Abstract
OBJECTIVE Using an interview-guided survey, our descriptive study aimed to document the extent to which cancer patients perceive they are involved in making treatment decisions and the factors that influence patient involvement. PATIENTS AND METHODS Our study enrolled patients from a Canadian ambulatory oncology program who were undergoing chemotherapy or radiation therapy, or both, for cancer. The adapted Control Preferences Scale was used to survey perceived and preferred roles in decision-making. The study survey also included items from the Decisional Conflict Scale and the Preparation for Decision-Making Scale. RESULTS Of 192 participants, 98 (51%) perceived that they were offered treatment choices. Of those 98, 47 (48%) thought that the options were presented equally. Compared with the patients not offered choices, those who were given choices were less passive (4% vs. 29%, p < 0.001) and more satisfied (100% vs. 95%, p < 0.03) in decision-making. Participants whose preferred and perceived roles were different would have preferred more involvement in decision-making. To attain the preferred involvement, patients wanted to receive more information on treatment options, to be given a choice, to have more discussion with the health care team, and to have providers better listen to their needs. CONCLUSIONS Only half of surveyed patients thought that they were offered choices for their cancer treatment. When offered choices, patients were more active in decision-making. Further initiatives are required to determine approaches for supporting patients with cancer so that they can be more involved in decision-making.
Collapse
Affiliation(s)
- D Stacey
- School of Nursing, University of Ottawa, Ottawa, ON.
| | | | | |
Collapse
|
33
|
Abstract
The study's purpose was to explore the decision-making needs of patients considering treatment options for their depression. Semi-structured interviews were guided by the Ottawa Decision Support Framework. Of 94 participants, 67 were uncertain about their decision. Common decisions identified were whether or not to take medications, attend support groups, undergo electroconvulsive therapy, and location of care. Those feeling certain were more likely to have made a decision (RR 1.37; 95% CI: 1.05, 1.78). However, 40 patients who had 'made a decision' in the recent past were uncertain about their decision. Compared with those who were certain, the uncertain group felt less informed (2.65 vs. 1.64; P < 0.001), less supported (2.63 vs. 1.88; P < 0.001) and less clear about how they valued the benefits and risks of options (2.57 vs. 1.69; P < 0.001). Other influential factors included concerns about confidentiality, distress from depression, embarrassment, panic attacks and lack of energy. Few patients wanted to defer decision making to their physician (n = 8) or family (n = 1). To support decision making, participants identified the need for: discussions with their psychiatrist, nurse or family doctor; access to printed information; and information provided by health professionals and health societies.
Collapse
Affiliation(s)
- D Stacey
- School of Nursing, University of Ottawa, Ottawa, ON, Canada.
| | | | | | | | | | | | | |
Collapse
|
34
|
Majowicz SE, McNab WB, Sockett P, Henson TS, Doré K, Edge VL, Buffett MC, Fazil A, Read S, McEwen S, Stacey D, Wilson JB. Burden and cost of gastroenteritis in a Canadian community. J Food Prot 2006; 69:651-9. [PMID: 16541699 DOI: 10.4315/0362-028x-69.3.651] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [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: 01/21/2023]
Abstract
This study estimated the health burden and costs associated with gastroenteritis in the City of Hamilton (Ontario, Canada). The number of cases, number of different resource units used, and cost per resource unit were represented by probability distributions and point estimates. These were subsequently integrated in a stochastic model to estimate the overall burden and cost in the population and to depict the uncertainty of the estimates. The estimated mean annual cost per capita was Can dollar 115. The estimated mean annual cost per case was Can dollar 1,089 and was similar to other published figures. Gastroenteritis represented a significant burden in the study population, with costs high enough to justify prevention efforts. These results, currently the most accurate available estimates for a Canadian population, can inform future economic evaluations to determine the most cost effective measures for reducing the burden and cost of gastroenteritis in the community.
Collapse
Affiliation(s)
- S E Majowicz
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada N1G 2W1.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Majowicz SE, Doré K, Flint JA, Edge VL, Read S, Buffett MC, McEwen S, McNab WB, Stacey D, Sockett P, Wilson JB. Magnitude and distribution of acute, self-reported gastrointestinal illness in a Canadian community. Epidemiol Infect 2004; 132:607-17. [PMID: 15310162 PMCID: PMC2870141 DOI: 10.1017/s0950268804002353] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [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: 11/06/2022] Open
Abstract
To estimate the magnitude and distribution of self-reported, acute gastrointestinal illness in a Canadian-based population, we conducted a retrospective, cross-sectional telephone survey of approximately 3500 randomly selected residents of the city of Hamilton (Ontario, Canada) from February 2001 to February 2002. The observed monthly prevalence was 10% (95 % CI 9.94-10.14) and the incidence rate was 1.3 (95 % CI 1.1-1.4) episodes per person-year; this is within the range of estimates from other developed countries. The prevalence was higher in females and in those aged < 10 years and 20-24 years. Overall, prevalence peaked in April and October, but a different temporal distribution was observed for those aged < 10 years. Although these data were derived from one community, they demonstrate that the epidemiology of acute gastrointestinal illness in a Canadian-based population is similar to that reported for other developed countries.
Collapse
Affiliation(s)
- S E Majowicz
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
O'Connor AM, Stacey D, Entwistle V, Llewellyn-Thomas H, Rovner D, Holmes-Rovner M, Tait V, Tetroe J, Fiset V, Barry M, Jones J. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2003:CD001431. [PMID: 12804407 DOI: 10.1002/14651858.cd001431] [Citation(s) in RCA: 435] [Impact Index Per Article: 20.7] [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: 01/28/2023]
Abstract
BACKGROUND Decision aids prepare people to participate in preference-sensitive decisions. OBJECTIVES 1. Create a comprehensive inventory of patient decision aids focused on healthcare options. 2. Review randomized controlled trials (RCT) of decision aids, for people facing healthcare decisions. SEARCH STRATEGY Studies were identified through databases and contact with researchers active in the field. SELECTION CRITERIA Two independent reviewers screened abstracts for interventions designed to aid patients' decision making by providing information about treatment or screening options and their associated outcomes. Information about the decision aids was compiled in an inventory; those that had been evaluated in a RCT were reviewed in detail. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data using standardized forms. Results of RCTs were pooled using weighted mean differences (WMD) and relative risks (RR) using a random effects model. MAIN RESULTS Over 200 decision aids were identified. Of the 131 available decision aids, most are intended for use before counselling. Using the CREDIBLE criteria to evaluate the quality of the decision aids: a) most included potential harms and benefits, credentials of the developers, description of their development process, update policy, and were free of perceived conflict of interest; b) many included reference to relevant literature; c) few included a description of the level of uncertainty regarding the evidence; and d) few were evaluated. Thirty of these decision aids were evaluated in 34 RCTs and another trial evaluated a suite of eight decision aids. An additional 30 trials are yet to be published. Among the trials comparing decision aids to usual care, decision aids performed better in terms of: a) greater knowledge (WMD 19 out of 100, 95% CI: 13 to 24; b) more realistic expectations (RR 1.4, 95%CI: 1.1 to 1.9); c) lower decisional conflict related to feeling informed (WMD -9.1 of 100, 95%CI: -12 to -6); d) increased proportion of people active in decision making (RR 1.4, 95% CI: 1.0 to 2.3); and e) reduced proportion of people who remained undecided post intervention (RR 0.43, 95% CI: 0.3 to 0.7). When simpler were compared to more detailed decision aids, the relative improvement was significant in: a) knowledge (WMD 4 out of 100, 95% CI: 3 to 6); b) more realistic expectations (RR 1.5, 95% CI: 1.3 to 1.7); and c) greater agreement between values and choice. Decision aids appeared to do no better than comparisons in affecting satisfaction with decision making, anxiety, and health outcomes. Decision aids had a variable effect on which healthcare options were selected. REVIEWER'S CONCLUSIONS The availability of decision aids is expanding with many on the Internet; however few have been evaluated. Trials indicate that decision aids improve knowledge and realistic expectations; enhance active participation in decision making; lower decisional conflict; decrease the proportion of people remaining undecided, and improve agreement between values and choice. The effects on persistence with chosen therapies and cost-effectiveness require further evaluation. Finally, optimal strategies for dissemination need to be explored.
Collapse
Affiliation(s)
- A M O'Connor
- School of Nursing and Faculty of Medicine, University of Ottawa, C4 Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Murphy J, Stacey D, Crook J, Thompson B, Panetta D. Testing control of radiation-induced diarrhea with a psyllium bulking agent: a pilot study. Can Oncol Nurs J 2002; 10:96-100. [PMID: 11894282 DOI: 10.5737/1181912x10396100] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [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: 11/05/2022] Open
Abstract
Sixty cancer patients who were undergoing radiation therapy to the pelvis of at least 4,000 cGy in 20 fractions over four weeks were randomized to take or not take Metamucil. Results were analyzed for the presence of radiation-induced diarrhea in two groups: patients taking Metamucil (n = 30) or not taking Metamucil (n = 30). The Murphy Diarrhea Scale was developed to assist in the synthesis of data collected in daily patient-reported diaries. Results were analyzed using ANOVA F-tests. Metamucil significantly decreased the incidence (p = 0.049) and severity (p = 0.030) of diarrhea and showed a strong trend in reducing the use of anti-diarrhea medication (p = 0.062). According to this pilot study, Metamucil was an effective method of controlling radiation-induced diarrhea. Results of this pilot study have implications for clinical practice and nursing research.
Collapse
Affiliation(s)
- J Murphy
- Ottawa Hospital-General Campus, Ottawa, Ontario
| | | | | | | | | |
Collapse
|
38
|
Abstract
A sister and brother with developmental delay, hirsutism and variable nail hypoplasia are described. The facial features of these sibs are striking. We postulate that this represents a new syndrome, the inheritance of which is unknown.
Collapse
Affiliation(s)
- H Stewart
- Department of Medical Genetics and Regional Genetics Service, St Mary's Hospital, Manchester, UK
| | | | | | | | | |
Collapse
|
39
|
O'Connor AM, Fiset V, DeGrasse C, Graham ID, Evans W, Stacey D, Laupacis A, Tugwell P. Decision aids for patients considering options affecting cancer outcomes: evidence of efficacy and policy implications. J Natl Cancer Inst Monogr 2000:67-80. [PMID: 10854460 DOI: 10.1093/oxfordjournals.jncimonographs.a024212] [Citation(s) in RCA: 179] [Impact Index Per Article: 7.5] [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: 11/13/2022] Open
Abstract
Some cancer screening and treatment decisions are not clear cut because outcomes are uncertain or options have different benefit/risk profiles. "Decision aids" have been developed as adjuncts to counseling so that patients can learn about benefits and risks, can consider their personal values, and can participate with their practitioner in decision making. The purpose of this paper is to review published evidence about the efficacy of decision aids focused on cancer outcomes and to outline research and dissemination issues. Studies evaluating cancer-related decision aids demonstrate that they are acceptable to patients and help those who are uncertain at baseline to make choices. They also increase the likelihood that choices are based on better knowledge, realistic expectations of outcomes, and personal values. Decision aids reduce some dimensions of decisional conflict, and their effect on decisions is variable. Few studies examine the downstream effects of decision aids on long-term persistence with choices, regret, and quality of life. The differences between simpler and more intensive methods of decision support appear to be negligible in terms of knowledge and satisfaction as well as variable in terms of decisions and decisional conflict. However, more intensive methods are superior in terms of user acceptability and of the extent to which choices are based on realistic expectations and personal values. The clinical importance of these differences and the cost-effectiveness remain to be established. On the basis of this review, several recommendations for research are made, and dissemination issues are identified.
Collapse
Affiliation(s)
- A M O'Connor
- A. M. O'Connor, School of Nursing and Faculty of Medicine, University of Ottawa, Ottawa Hospital, Ontario, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Logan J, De Grasse CE, Stacey D, Fiset V, Fawcett L. Oncology nursing education within a supportive care framework: an evidence-based undergraduate course. Can Oncol Nurs J 2000; 9:64-70. [PMID: 10703295 DOI: 10.5737/1181912x926466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 11/05/2022] Open
Abstract
Addressing supportive care needs of individuals affected by cancer is a crucial role for oncology nurses. If these needs are not identified and addressed, then individuals and their families risk experiencing biopsychosocial distress. This paper describes how a group of interested nurses with research and/or cancer knowledge developed, implemented and evaluated an evidence-based university undergraduate course in oncology nursing. The purposes of this course are to provide nurses with specialized knowledge about supportive care in oncology throughout the cancer care continuum and to assist registered nurses in preparing for oncology nursing certification. Theoretical, practical and research-based issues related to the scope of supportive care are incorporated into the assessment, nursing diagnosis, planning and evaluation of client care.
Collapse
Affiliation(s)
- J Logan
- University of Ottawa School of Nursing, Ontario
| | | | | | | | | |
Collapse
|
41
|
Stacey D. Coping with fatigue: an education session for cancer patients. Can Oncol Nurs J 1998; 8:S15. [PMID: 9832719] [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: 02/09/2023] Open
|
42
|
Stacey D, Fawcett L. Telephone triage: an important role for oncology nurses. Can Oncol Nurs J 1997; 7:178-9. [PMID: 9325730] [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: 02/05/2023] Open
|
43
|
Shu J, Hitomi M, Stacey D. Activation of JNK/SAPK pathway is not directly inhibitory for cell cycle progression in NIH3T3 cells. Oncogene 1996; 13:2421-30. [PMID: 8957084] [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: 02/03/2023]
Abstract
In this study the induction of stress activated protein kinase (SAPK) activity by protein synthesis inhibitors was shown not to inhibit cellular proliferation. Anisomycin induced strong SAPK activity at non-inhibitory concentrations for either protein or DNA synthesis, while the other two inhibitors, emetine and cycloheximide, blocked cell cycle progression without strong SAPK induction. With all three inhibitors, the induction of SAPK activity was always accompanied by protein synthesis inhibition to some extent. Stimulation of mRNA expression of the genes c-jun, c-fos and c-myc correlated well with SAPK induction, but not with cell cycle inhibition. With concentrations of each inhibitor able to block DNA synthesis, no induction of message for the cyclin dependent kinase inhibitor waf-1 was observed; while induction of gadd45 message indicated that the cells might be responding to growth-arrest or DNA damage. The inability of microinjected E2F/DP1 transcription factor proteins to overcome the inhibition of DNA synthesis induced by protein synthesis inhibitors indicate that blockage of an early event in cell cycle progression had occurred. These results indicate that the SAPK induction by protein synthesis inhibitors has no proliferative consequences.
Collapse
Affiliation(s)
- J Shu
- The Cleveland Clinic Foundation Research Institute, Department of Molecular Biology, Ohio 44195, USA
| | | | | |
Collapse
|
44
|
Gordon DM, Duffy PE, Heppner DG, Lyon JA, Williams JS, Scheumann D, Farley L, Stacey D, Haynes JD, Sadoff JC, Ballou WR. Phase I safety and immunogenicity testing of clinical lots of the synthetic Plasmodium falciparum vaccine SPf66 produced under good manufacturing procedure conditions in the United States. Am J Trop Med Hyg 1996; 55:63-8. [PMID: 8702024 DOI: 10.4269/ajtmh.1996.55.63] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 02/01/2023] Open
Abstract
Two clinical lots of alum-adsorbed SPf66 vaccine produced in the United States were evaluated in separate, open-label, Phase I clinical trials involving 15 healthy, malaria-naive, 18-45-year old men and women. Subjects received 2 mg doses subcutaneously in alternate arms at 0, one, and six months. Safety was assessed by monitoring local and systemic reactions and laboratory parameters. The most common side effects were erythema and local tenderness at the site of injection, which increased in frequency with subsequent doses of vaccine. These local reactions were considered mild and resolved within 24-48 hr. Eleven of 14 volunteers who received all three doses of vaccine seroconverted by enzyme-linked immunosorbent assay. The distribution of high, medium, and low nonresponders was comparable with that seen in trials of Colombian-produced vaccine. One high responder developed antibodies reactive with asexual stage parasite antigens by immunofluorescence and immunoblot. The results indicated that at full adult doses, SPf66 of U.S. origin is mildly reactogenic and induces immune responses similar to those reported for SPf66 of Colombian origin.
Collapse
Affiliation(s)
- D M Gordon
- Department of Immunology, Walter Reed Army Institute of Research, Washington, District of Columbia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Morcos P, Thapar N, Tusneem N, Stacey D, Tamanoi F. Identification of neurofibromin mutants that exhibit allele specificity or increased Ras affinity resulting in suppression of activated ras alleles. Mol Cell Biol 1996; 16:2496-503. [PMID: 8628317 PMCID: PMC231238 DOI: 10.1128/mcb.16.5.2496] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [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] [Indexed: 02/01/2023] Open
Abstract
Neurofibromin plays a critical role in the downregulation of Ras proteins in neurons and Schwann cells. Thus, the ability of neurofibromin to interact with Ras is crucial for its function, as mutations in NF1 that abolish this interaction fail to maintain function. To investigate the neurofibromin-Ras interaction in a systematic manner, we have carried out a yeast two-hybrid screen using a mutant of H-ras, H-rasD92K, defective for interaction with the GTPase-activated protein-related domain (GRD) of NF1. Two screens of a randomly mutagenized NF1-GRD library led to the identification of seven novel NF1 mutants. Characterization of the NF1-GRD mutants revealed that one class of mutants are allele specific for H-raSD92K. These mutants exhibit increased affinity for H-raSD92K and significantly reduced affinity for wild-type H-ras protein. Furthermore, they do not interact with another H-ras mutant defective for interaction with GTPase-activating proteins. Another class of mutants are high-affinity mutants which exhibit dramatically increased affinity for both wild-type and mutant forms of Ras. They also exhibit a striking ability to suppress the heat shock sensitive traits of activated RAS2G19v in yeast cells. Five mutations cluster within a region encompassing residues 1391 to 1436 (region II). Three NF1 patient mutations have previously been identified in this region. Two mutations that we identified occur in a region encompassing residues 1262 to 1276 (region I). Combining high-affinity mutations from both regions results in even greater affinity for Ras. These results demonstrate that two distinct regions of NF1-GRD are involved in the Ras interaction and that single amino acid changes can affect NF1's affinity for Ras.
Collapse
Affiliation(s)
- P Morcos
- Department of Microbiology and Molecular Genetics, University of California, Los Angeles 90095-1489, USA
| | | | | | | | | |
Collapse
|
46
|
Mehdi B, Stacey D, Harauz G. A hierarchical neural network assembly for classification of cervical cells in automated screening. Anal Cell Pathol 1994; 7:171-80. [PMID: 7848875] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Experiments are described using artificial neural networks to classify cells imaged in cervical smears according to their degree of abnormality. This problem of classification was broken into 3 subtasks, each of which an independent back-propagation neural network was trained to solve. Input patterns were fed to the first network for classification of the cells as essentially normal or abnormal and then, depending on the outcome of the classification, a second stage was invoked for classifying the cell as (i) normal or mildly dysplastic, or (ii) moderately or severely dysplastic. It is shown that the correct choice of normalization of input data, as well as the use of a hierarchy of neural networks, each optimised for a specific subtask of the whole classification process, yields a predictive value hitherto unattained by automated systems.
Collapse
Affiliation(s)
- B Mehdi
- Department of Computing and Information Science, College of Biological Science, University of Guelph, Ontario, Canada
| | | | | |
Collapse
|
47
|
Skinn B, Stacey D. Establishing an integrated framework for documentation: use of a self-reporting health history and outpatient oncology record. Oncol Nurs Forum 1994; 21:1557-66. [PMID: 7816681] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE/OBJECTIVES To describe the development and implementation of a succinct documentation system that provides all oncology team members with a quick and systematic approach to gathering information for care planning. DATA SOURCES Published articles and books. DATA SYNTHESIS The Nursing Documentation Committee at the Ottawa Regional Cancer Centre designed and implemented a self-reporting health history (SRHH) that provides baseline data for care planning and an outpatient oncology recore (OOR) that provides ongoing documentation of all patient assessment findings and subsequent care. The OOR combines flowsheet and progress note documentation on one form. These tools are used by all members of the oncology team. CONCLUSIONS Through consistent use of the SRHH and OOR, quality of documentation has increased and nursing time spent on charting has decreased, thus enabling the oncology team to focus on direct patient care activities. Furthermore, enhanced communication among members of the oncology team has resulted in improved continuity of patient care. IMPLICATIONS FOR NURSING PRACTICE The SRHH and OOR are time-efficient and cost-effective tools that can assist nurses in meeting legal, professional, and accreditation documentation standards.
Collapse
Affiliation(s)
- B Skinn
- Ottawa Regional Cancer Centre, Ontario, Canada
| | | |
Collapse
|
48
|
Browne M, Howard C, Jolleys G, Stacey D. Letter to the Editor. J Microsc 1994. [DOI: 10.1111/j.1365-2818.1994.tb04791.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
49
|
DiBattiste D, Golubic M, Stacey D, Wolfman A. Differences in the interaction of p21c-Ha-ras-GMP-PNP with full-length neurofibromin and GTPase-activating protein. Oncogene 1993; 8:637-43. [PMID: 8437847] [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: 01/30/2023]
Abstract
Neurofibromin, the product of the neurofibromatosis type 1 gene, was found to form a stable complex with immobilized p21c-Ha-ras-GMP-PNP (a non-hydrolyzable GTP analog). This complex, detectable as early as 30 min after addition of crude brain extract, is extremely stable, with less than 50% dissociating after 5 h at 4 degrees C. We interpret this to suggest that the dissociation of full-length neurofibromin from p21c-Ha-ras-GMP-PNP is tightly linked to the hydrolysis of GTP to GDP. Failure to remove a significant proportion of the bound neurofibromin in the presence of EDTA and GDP implies that the binding of neurofibromin to p21c-Ha-ras-GMP-PNP results in the ras protein becoming resistant to guanine nucleotide exchange. Under conditions in which neurofibromin quantitatively binds to p21c-Ha-ras-GMP-PNP, we were unable to detect a complex between p21c-Ha-ras and GAP (GTPase-activating protein). The failure to detect GAP binding to immobilized p21c-Ha-ras-GMP-PNP cannot be explained by the known differences in affinities of the GAP-related domain of neurofibromin and GAP for p21c-Ha-ras-GTP. GAP is, however, able to interact biochemically with immobilized p21c-Ha-ras, suggesting a difference in the interaction between GAP and neurofibromin with p21c-Ha-ras-GMP-PNP.
Collapse
Affiliation(s)
- D DiBattiste
- Department of Vascular Cell Biology and Atherosclerosis, Cleveland Clinic Foundation, Ohio 44195
| | | | | | | |
Collapse
|