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Adolph L, Mann A, Liu XQ, Roberts L, Robinson C, Popowich S, Dean E, Kean S, Fischer G, Altman AD. Follow-up of women with cervical adenocarcinoma in situ treated by conization: A single centre clinical experience. Gynecol Oncol 2024; 187:74-79. [PMID: 38733955 DOI: 10.1016/j.ygyno.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Hysterectomy has been the historical gold standard final step in the treatment algorithm of adenocarcinoma in situ (AIS) recommended by most North American colposcopy guidelines. AIS disproportionately affects young childbearing age women, therefore a fertility sparing treatment option is desirable. Our study examines the impact of conservative treatment of AIS with conization followed by serial surveillance. METHODS A retrospective chart review was completed of patients treated for AIS from 2006 to 2020. Charts were identified by pathologic diagnosis of AIS on cervical and uterine specimens. Charts were excluded if AIS was not treated with conization, if AIS was not confirmed on initial conization specimen, or if invasive disease was found at initial conization. RESULTS 121 patient charts were analyzed. Median age of patients at first conization and hysterectomy was 34.8 and 40.9, respectively. First conization was by Cold Knife Cone in 58% of patients, and by Loop Electrosurgical Excisional Procedure in 42% of patients. Median follow-up period in our study was 609 days. 5% of patients had recurrence, with only one patient who recurred as cancer. One case of recurrence had a positive initial conization margin. Median time to recurrence was 700 days. 47% of patients underwent eventual hysterectomy. Residual AIS was found in 23% of hysterectomy specimens. Adenocarcinoma was diagnosed on hysterectomy specimen in four patients. CONCLUSION Our study demonstrates the oncologic safety of treating AIS with conization and serial surveillance. Routine hysterectomy completed as a part of the AIS treatment algorithm, as in current clinical guidelines, is unnecessary.
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Affiliation(s)
- L Adolph
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - A Mann
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - X Q Liu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - L Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - C Robinson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - S Popowich
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - E Dean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - S Kean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - G Fischer
- Department of Pathology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - A D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Dean E. Academy of Plant-based Physical Therapy: overdue to address a nutrition crisis with a transformative population approach. J Phys Ther Sci 2023; 35:645-658. [PMID: 37670763 PMCID: PMC10475644 DOI: 10.1589/jpts.35.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/09/2023] [Indexed: 09/07/2023] Open
Abstract
This timely evidence synthesis supports the need for an Academy of Plant-based Physical Therapy. Given epidemiological and empirical evidence and the profession's values and practice scope, the time has come for a specialty of plant-based physical therapy based on population health principles. This review connects these factors. Non-communicable diseases (NCDs) are largely nutrition-related resulting from unnatural elements of our diet (i.e., heart disease, several cancers, hypertension, stroke, diabetes, obesity, gastrointestinal diseases, autoimmune diseases, renal disease, and Alzheimer's disease). Most adults, even children, have NCD risk factors or manifestations. Alternatively, plant-based nutrition can prevent, manage, as well as potentially reverse these diseases, as well as augment conventional physical therapy outcomes by reducing inflammation and pain. Proposed competencies for plant-based physical therapists include high-level competency in health and NCD risk assessments/evaluations, to establish population health-informed nutrition needs for maximal health, healing and repair, in turn, function and wellbeing; and assessment of patients' nutrition-related knowledge, beliefs/attitudes, self-efficacy, and readiness-to-change. Population-informed nutritional counseling is initiated as indicated. An Academy of Plant-based Physical Therapy could advance the profession globally at this point in history and also serve as a role model to other health professions through practicing evidence-based, plant-based nutrition built upon population health principles.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine,
University of British Columbia: Friedman Bldg, Rm 212 2177 Webrook Mall, Vancouver, BC,
V6T 1Z3, Canada
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3
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Dean E. Future-proofing the profession: physiotherapists' perceptions of their current and emerging role. Physiotherapy 2023; 120:26. [PMID: 37364443 DOI: 10.1016/j.physio.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/02/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212, Friedman Building, 2177 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 1Z3.
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Dean E. On "Storm Clouds on the Horizon: The 3 Perils of Unconstrained Academic Growth in Physical Therapist Education." Deusinger SS, Landers MR. Phys Ther. 2022;102:pzac046. https://doi.org/10.1093/ptj/pzac046. Phys Ther 2023; 103:7071626. [PMID: 37249535 DOI: 10.1093/ptj/pzad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/02/2023] [Accepted: 01/16/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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5
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Dean E. Softening the Sanctuary. Am J Med 2023; 136:e34. [PMID: 36707221 DOI: 10.1016/j.amjmed.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Elizabeth Dean
- Professor Emeritus, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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6
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Leiser S, Huang S, Miller H, Beydoun S, Dean E, Choi H, Bhat A, Howington M. CONVERGENT CELL NONAUTONOMOUS PATHWAYS REWIRE METABOLISM TO SLOW AGING. Innov Aging 2022. [PMCID: PMC9766087 DOI: 10.1093/geroni/igac059.1733] [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: 12/24/2022] Open
Abstract
An organism’s ability to perceive and respond to changes in its environment is crucial for its health and survival. Our approach to identify molecular mechanisms of aging is to focus on common mechanisms downstream of multiple pathways. This approach led to our discovery of a gene, flavin-containing monooxygenase (fmo)-2, that is both necessary and sufficient to increase lifespan and healthspan downstream of several longevity interventions, including dietary restriction and hypoxia. Surprisingly, we also find that in both hypoxia and dietary restriction models, fmo-2 is induced by cell non-autonomous signaling pathways, consistent with the worms’ perceiving the stress (e.g. low oxygen, lack of food) and changing physiology as a result. Our current work focuses on 1) the signaling networks that regulate stress perception and integrate multiple signals to change physiology, and 2) the mechanism of FMO-2-mediated longevity. Our new data suggest that these cell non autonomous networks pathways utilize both overlapping and distinct signaling mechanisms to converge on upregulation of the same gene. They also suggest that these pathways can be manipulated by small molecule drugs to increase lifespan by “tricking” the organism into activating stress response networks. We further find that FMO enzyme expression has a drastic effect on endogenous metabolism, primarily through tryptophan and one carbon metabolism. Ultimately, we aim to leverage our results in a translational framework to identify key signals, genes, and mechanisms where organisms respond to the perception of environmental stress to improve health and slow aging.
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Affiliation(s)
- Scott Leiser
- University of Michigan, Ann Arbor, Michigan, United States
| | - Shijiao Huang
- University of Michigan, Ann Arbor, Michigan, United States
| | - Hillary Miller
- University of Michigan, Ann Arbor, Michigan, United States
| | - Safa Beydoun
- University of Michigan, Ann Arbor, Michigan, United States
| | - Elizabeth Dean
- University of Michigan, Ann Arbor, Michigan, United States
| | - Hyo Choi
- University of Michigan, Ann Arbor, Michigan, United States
| | - Ajay Bhat
- University of Michigan, Ann Arbor, Michigan, United States
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Dean E, Lomi C. On "Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure." Shoemaker MJ, Dias KJ, Lefebvre KM, Heick JD, Collins SM. Phys Ther. 2020;100:14-43. https://doi.org/10.1093/ptj/pzz127; and on "A Knowledge Translation Framework for Optimizing Physical Therapy in Patients With Heart Failure." Dias KJ, Shoemaker MJ, Lefebvre KM, Heick JD. Phys Ther. 2021;101:pzab079. https://doi.org/10.1093/ptj/pzab079. Phys Ther 2022; 102:6675560. [PMID: 36006038 DOI: 10.1093/ptj/pzac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/09/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Constantina Lomi
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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8
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Besse B, Awad M, Forde P, Thomas M, Goss G, Aronson B, Hobson R, Dean E, Peters J, Iyer S, Conway J, Barrett J, Cosaert J, Dressman M, Barry S, Heymach J. OA15.05 HUDSON: An Open-Label, Multi-Drug, Biomarker-Directed Phase 2 Study in NSCLC Patients Who Progressed on Anti-PD-(L)1 Therapy. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.074] [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]
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Dean E. Physical therapists as leaders rather than followers with reference to clinical practice guidelines for management of individuals with heart failure - an editorial/commentary. Physiother Theory Pract 2022; 38:1579-1580. [PMID: 35912503 DOI: 10.1080/09593985.2022.2106917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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10
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Dean E, Lomi C. A health and lifestyle framework: An evidence-informed basis for contemporary physical therapist clinical practice guidelines with special reference to individuals with heart failure. Physiother Res Int 2022; 27:e1950. [PMID: 35467065 PMCID: PMC9539698 DOI: 10.1002/pri.1950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/26/2022] [Indexed: 12/18/2022]
Abstract
Background and purpose This study proposes contemporary physical therapist clinical practice guidelines (CPGs) with special reference to heart failure (HF) be grounded in an evidence‐informed integrative health and lifestyle framework to not only better reflect the totality and weighting of the literature, but also in the interest of superior patient, clinical, and economic outcomes. Methods As an illustration, a health and lifestyle framework is described to underpin, thereby complement, recently published physical therapist CPGs for individuals with HF. Results The case for the framework, an alternative to a single‐disease biomedical perspective, is consistent with 21st century professional and epidemiologic indicators. Four themes that emerged from the HF CPGs and further support such a framework, emerged that is, limitations of conventionally constructed CPGs; physical therapists' scope of practice as “health” professionals; “best” practice in an era of NCDs including HF; and superior economic benefit. Discussion A health and lifestyle framework underpinning contemporary physical therapist CPGs will enable clinicians to better appreciate the power of lifestyle change in maximizing the health of the heart, its healing and repair, and in mitigating and reversing signs and symptoms of cardiac dysfunction. Further, a focus on health and lifestyle will augment the benefits of the core, evidence‐based, key action statements related to exercise in the HF CPGs.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Constantina Lomi
- Women´s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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11
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Dean E, Olsén MF. A health and lifestyle framework for management of post covid-19 syndrome based on evidence-informed management of post-polio syndrome: a narrative review. European Journal of Physiotherapy 2021. [DOI: 10.1080/21679169.2021.2000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Post Polio Clinic, University of British Columbia, Vancouver, Canada
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Leiser S, Choi H, Miller H, Bhat A, Howington M, Dean E, Huang S. Mechanisms of Cell Non-Autonomous Longevity Regulation. Innov Aging 2021. [PMCID: PMC8680976 DOI: 10.1093/geroni/igab046.2560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
An organism’s ability to respond to stress is crucial for long-term survival. These stress responses are coordinated by distinct but overlapping pathways, many of which also regulate longevity across taxa. Our previous work identified a cell non-autonomous signaling pathway led by the hypoxia-inducible factor and resulting in induction of flavin-containing monooxygenase-2 (fmo-2) to promote health and longevity. Our current work identifies a distinct cell non-autonomous pathway downstream of dietary restriction (DR) that also relies on fmo-2 induction to promote health and longevity. We now find that these cell non-autonomous pathways can be mimicked by small molecule interventions that increase longevity by inducing fmo-2. Based on the commonalities of these pathways, we hypothesized that fmo-2, a classically annotated xenobiotic enzyme, might play a key endogenous role in responding to metabolic stress. Our resulting data, using metabolic profiling and further epistatic analysis, both support this hypothesis and link fmo-2’s mechanism to modifications in one-carbon metabolism (OCM), a key intermediate pathway consisting of the folate and methionine cycles. Using mathematical modeling and a labeled metabolomics approach, we were able to further identify the likely mechanism of fmo-2-mediated metabolic effects and connect them to both OCM and downstream components. We propose that fmo-2 is induced cell non-autonomously to modify systemic metabolism and longevity, and that fmo-2 is a key member of a conserved metabolic stress response.
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Affiliation(s)
- Scott Leiser
- University of Michigan, Ann Arbor, Michigan, United States
| | - Hyo Choi
- University of Michigan, Ann Arbor, Michigan, United States
| | - Hillary Miller
- University of Michigan, Ann Arbor, Michigan, United States
| | - Ajay Bhat
- University of Michigan, University of Michigan, Michigan, United States
| | | | - Elizabeth Dean
- University of Michigan, University of Michigan, Michigan, United States
| | - Shijiao Huang
- University of Michigan, University of Michigan, Michigan, United States
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Kim R, Kwon M, An M, Kim ST, Smith SA, Loembé AB, Mortimer PGS, Armenia J, Lukashchuk N, Shah N, Dean E, Park WY, Lee J. Phase II study of ceralasertib (AZD6738) in combination with durvalumab in patients with advanced/metastatic melanoma who have failed prior anti-PD-1 therapy. Ann Oncol 2021; 33:193-203. [PMID: 34710570 DOI: 10.1016/j.annonc.2021.10.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Modulating the DNA damage response and repair (DDR) pathways is a promising strategy for boosting cancer immunotherapy. Ceralasertib (AZD6738) is an oral inhibitor of the serine/threonine protein kinase ataxia telangiectasia and Rad3-related protein, which is crucial for DDR. PATIENTS AND METHODS This phase II trial evaluated ceralasertib plus durvalumab for the treatment of patients with metastatic melanoma who had failed anti-programmed cell death protein 1 therapy. RESULTS Among the 30 patients, we observed an overall response rate of 31.0% and a disease control rate of 63.3%. Responses were evident across patients with acral, mucosal, and cutaneous melanoma. The median duration of response was 8.8 months (range, 3.8-11.7 months). The median progression-free survival was 7.1 months (95% confidence interval, 3.6-10.6 months), and the median overall survival was 14.2 months (95% confidence interval, 9.3-19.1 months). Common adverse events were largely hematologic and manageable with dose interruptions and reductions. Exploratory biomarker analysis suggested that tumors with an immune-enriched microenvironment or alterations in the DDR pathway were more likely to respond to the study treatment. CONCLUSION We conclude that ceralasertib in combination with durvalumab has promising antitumor activity among patients with metastatic melanoma who have failed anti-programmed cell death protein 1 therapy, and constitute a population with unmet needs.
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Affiliation(s)
- R Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - M Kwon
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - M An
- Samsung Advanced Institute of Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S T Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S A Smith
- Oncology R&D, AstraZeneca, Cambridge, UK
| | - A B Loembé
- Oncology R&D, AstraZeneca, Cambridge, UK
| | | | - J Armenia
- Oncology R&D, AstraZeneca, Cambridge, UK
| | | | - N Shah
- Oncology R&D, AstraZeneca, Cambridge, UK
| | - E Dean
- Oncology R&D, AstraZeneca, Cambridge, UK
| | - W-Y Park
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea; Geninus Inc., Seoul, Korea
| | - J Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Korea.
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14
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Dean E, Söderlund A, Gosselink R, Jones AYM, Yu HPM, Skinner M. Immuno-modulation with lifestyle behaviour change to reduce SARS-CoV-2 susceptibility and COVID-19 severity: goals consistent with contemporary physiotherapy practice. Physiotherapy 2021; 114:63-67. [PMID: 34563382 PMCID: PMC8363425 DOI: 10.1016/j.physio.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/12/2021] [Accepted: 08/04/2021] [Indexed: 02/08/2023]
Abstract
Lifestyle-related non-communicable diseases (NCDs) and their risk factors are unequivocally associated with SARS-CoV-2 susceptibility and COVID-19 severity. NCD manifestations and their lifestyle risks are associated with chronic low-grade systemic inflammation (CLGSI). This review supports that immuno-modulation with positive lifestyle change aimed at reducing SARS-CoV-2 susceptibility and COVID-19 severity, is a goal consistent with contemporary physiotherapy practice. Physiotherapists have a long tradition of managing a , thus, managing CLGSI is a logical extension. Improving patients’ lifestyle practices also reduces their NCD risks and increases activity/exercise capacity, health and wellbeing – all principal goals of contemporary physiotherapy. The COVID-19 pandemic lends further support for prioritising health and lifestyle competencies including smoking cessation; whole food plant-based nutrition; healthy weight; healthy sleep practices; and stress management; in conjunction with reducing sedentariness and increasing physical activity/exercise, to augment immunity as well as function and overall health and wellbeing. To support patients’ lifestyle change efforts, physiotherapists may refer patients to other health professionals. The authors conclude that immuno-modulation with lifestyle behaviour change to reduce susceptibility to viruses including SARS-CoV-2, is consistent with contemporary physiotherapy practice. Immuno-modulation needs to be reflected in health competencies taught in physiotherapy professional education curricula and taught at standards comparable to other established interventions.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Rik Gosselink
- Department Rehabilitation Sciences, Faculty Movement and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium
| | - Alice Y M Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Homer Peng-Ming Yu
- Rehabilitation Medical Center, West China Hospital, Sichuan University, and Faculty of Physical Therapy, Rehabilitation Medicine College, Sichuan University, Chengdu, China
| | - Margot Skinner
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Subbiah Ponniah H, Ahmed M, Edwards T, Cobb J, Dean E, Clark C, Logishetty K. 905 How to prioritise patients and safely resume elective surgery during the Covid-19 pandemic. Br J Surg 2021. [PMCID: PMC8135653 DOI: 10.1093/bjs/znab134.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
There are now over 2.5 million NHS patients awaiting elective surgery, with the most in orthopaedics. We present an algorithm and results for safely and equitably restarting surgery at COVID-light sites.
Method
An MDT applied the COVID-19 Algorithm for Resuming Elective Surgery (CARES) on 1169 patients awaiting elective orthopaedic surgery. It assessed safety, procedural efficacy, and biopsychosocial factors, to prioritise patients. They were assigned to five categories and underwent surgery at one of three COVID-light sites (1. access to HDU/ITU/Paediatrics/specialist equipment, 2. an NHS elective surgical unit and 3. a private elective surgical unit).
Results
21 ‘Urgent’ patients received expedited care; 118 were Level 1/2; 222 were Level 3; 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p < 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery.
Conclusions
We validated a widely generalisable model to facilitate resumption of elective surgery in COVID-light sites. It enabled surgery for patients in most suffering, undergoing the most efficacious procedures and/or at highest risk of deterioration, without compromising patient-safety.
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Affiliation(s)
| | - M Ahmed
- Frimley Health NHS Foundation Trust, Slough, United Kingdom
| | | | - J Cobb
- MSk Lab, London, United Kingdom
| | - E Dean
- Frimley Health NHS Foundation Trust, Slough, United Kingdom
| | - C Clark
- Frimley Health NHS Foundation Trust, Slough, United Kingdom
| | - K Logishetty
- MSk Lab, London, United Kingdom
- Frimley Health NHS Foundation Trust, Slough, United Kingdom
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Dean E, Skinner M, Yu HPM, Jones AYM, Gosselink R, Söderlund A. Why COVID-19 strengthens the case to scale up assault on non-communicable diseases: role of health professionals including physical therapists in mitigating pandemic waves. AIMS Public Health 2021; 8:369-375. [PMID: 34017898 PMCID: PMC8116194 DOI: 10.3934/publichealth.2021028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/14/2021] [Indexed: 02/05/2023] Open
Abstract
As SARS-CoV-2, the virus responsible for COVID-19, spread globally, the most severely affected sub-populations were the elderly and those with multi-morbidity largely related to non-communicable diseases (NCDs), e.g., heart disease, hypertension, type 2 diabetes, obesity. NCDs are largely preventable with healthy nutrition, regular activity, and not smoking. This perspective outlines the rationale for health professionals' including physical therapists' role in reducing COVID-19 susceptibility. Evidence is synthesized supporting the pro-inflammatory effects of the western diet, increasingly consumed globally, inactivity, and smoking; and the immune-boosting, anti-inflammatory effects of a whole food plant-based diet, regular physical activity, and not smoking. An increased background of chronic low-grade systemic inflammation associated with unhealthy lifestyle practices appears implicated in an individual's susceptibility to SARS-CoV-2. It is timely to re-double efforts across healthcare sectors to reduce the global prevalence of NCDs on two fronts: one, to reduce SARS-CoV-2 susceptibility; and two, to reduce the impact of subsequent waves given high blood pressure and blood sugar, common in people with multi-morbidity, can be improved within days/weeks with anti-inflammatory healthy lifestyle practices, and weight loss and atherosclerosis reduction/reversal, within months/years. With re-doubled efforts to control NCD risk factors, subsequent waves could be less severe. Health professionals including physical therapists have a primary role in actively leading this initiative.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Margot Skinner
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Homer Peng-Ming Yu
- Rehabilitation Medical Center, West China Hospital, Sichuan University, and Faculty of Physical Therapy, Rehabilitation Medicine College, Sichuan University, Chengdu, China
| | - Alice YM Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rik Gosselink
- Department Rehabilitation Sciences, Faculty Movement and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Ahmed M, Ponniah HS, Edwards T, Liddle A, Cobb J, Dean E, Clark C, Logishetty K. V7 Project Restart’; Safe resumption of elective orthopaedic surgery following the Covid-19 pandemic. BJS Open 2021. [PMCID: PMC8030145 DOI: 10.1093/bjsopen/zrab034.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction The Covid-19 pandemic resulted in nearly 2 million patients being put on waiting lists for elective procedures in the UK. We aim to describe how the COVID-19 Algorithm for Resuming Elective Surgery (CARES) was used to allocate patients to elective theatre lists while factoring in patient safety, risk to healthcare workers and, protection of resources. Methodology A multidisciplinary team was employed with the task of using CARES to allocate theatre slots to 1169 patients on the waiting list. CARES was used in conjunction with an evidence-based scale for procedural urgency (Levels 1-4) to stratify patients and list them for surgery at one of three ‘COVID-light’ sites i.e. 1. With HDU/ITU access, specialist staff, and equipment, 2. An NHS short-stay surgical unit, 3. A private surgical unit. Incidence of post-operative Covid-19 infection was assessed by looking at positive Covid-19 RT-PCR or CT Chest with characteristic findings performed within 2 weeks of the surgery. Results 118 cases were deemed to be Priority 1/2, 222 were Level 3, and 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p < 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery. Conclusion CARES’ holistic approach enabled equitable and safe resumption of arthroplasty during the pandemic, by stratification and creation of COVID-light sites. It could be applied internationally and across sub-specialties. Introduction The Covid-19 pandemic resulted in nearly 2 million patients being put on waiting lists for elective procedures in the UK. We aim to describe how the COVID-19 Algorithm for Resuming Elective Surgery (CARES) was used to allocate patients to elective theatre lists while factoring in patient safety, risk to healthcare workers and, protection of resources. Methodology A multidisciplinary team was employed with the task of using CARES to allocate theatre slots to 1169 patients on the waiting list. CARES was used in conjunction with an evidence-based scale for procedural urgency (Levels 1-4) to stratify patients and list them for surgery at one of three ‘COVID-light’ sites i.e. 1. With HDU/ITU access, specialist staff, and equipment, 2. An NHS short-stay surgical unit, 3. A private surgical unit. Incidence of post-operative Covid-19 infection was assessed by looking at positive Covid-19 RT-PCR or CT Chest with characteristic findings performed within 2 weeks of the surgery. Results 118 cases were deemed to be Priority 1/2, 222 were Level 3, and 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p < 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery. Conclusion CARES’ holistic approach enabled equitable and safe resumption of arthroplasty during the pandemic, by stratification and creation of COVID-light sites. It could be applied internationally and across sub-specialties.
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Affiliation(s)
| | | | | | | | - Justin Cobb
- Wexham Park Hospital, Frimley Health NHS Trust
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18
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Fagevik Olsén M, Becovic S, Dean E. Short-term effects of mobilization on oxygenation in patients after open surgery for pancreatic cancer: a randomized controlled trial. BMC Surg 2021; 21:185. [PMID: 33827537 PMCID: PMC8028068 DOI: 10.1186/s12893-021-01187-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/05/2021] [Accepted: 03/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background Despite the unequivocal role of progressive mobilization in post-surgical patient management, its specific effects and timing, particularly after abdominal surgery, remain debated. This study’s aim was to examine the short-term effects of mobilization on oxygenation in hemodynamically stable patients after open surgery for pancreatic cancer. Methods A randomized controlled clinical trial was conducted in which patients (n = 83) after open pancreatic surgery were randomized to either the same-day mobilization group (mobilized when hemodynamically stable within four hours after surgery) or the next-day mobilization group (mobilized first time in the morning of the first post-operative day). Mobilization was prescribed and modified based on hemodynamic and subjective responses with the goal of achieving maximal benefit with minimal risk. Blood gas samples were taken three times the evening after surgery; and before and after mobilization on the first post-operative day. Spirometry was conducted pre-operatively and on the first post-operative day. Adverse events and length of stay in postoperative intensive care were also recorded. Results With three dropouts, 80 patients participated (40 per group). All patients in the same-day mobilization group, minimally sat over the edge of the bed on the day of surgery and all patients (both groups) minimally sat over the edge of the bed the day after surgery. Compared with patients in the next-day mobilization group, patients in the same-day mobilization group required lower FiO2 and had higher SaO2/FiO2 at 1800 h on the day of surgery (p < .05). On the day after surgery, FiO2, SaO2/FiO2, PaO2/FiO2, and alveolar-arterial oxygen gradient, before and after mobilization, were superior in the same-day mobilization group (p < 0.05). No differences were observed between groups in PCO2, pH, spirometry or length stay in postoperative intensive care. Conclusions Compared with patients after open pancreatic surgery in the next-day mobilization group, those in the same-day mobilization group, once hemodynamically stable, improved oxygenation to a greater extent after mobilization. Our findings support prescribed progressive mobilization in patients after pancreatic surgery (when hemodynamically stable and titrated to their individual responses and safety considerations), on the same day of surgery to augment oxygenation, potentially helping to reduce complications and hasten functional recovery. Trial registration: This prospective RCT was carried out at the Sahlgrenska University Hospital, Sweden. The study was approved by the Regional Ethical Review Board in Gothenburg (Registration number: 437-17). Trial registration: “FoU in Sweden” (Research and Development in Sweden, URL: https://www.researchweb.org/is/vgr) id: 238701 Registered 13 December 2017 and Clinical Trials (URL:clinicaltrials.gov) NCT03466593. Registered 15 March 2018.
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Affiliation(s)
- Monika Fagevik Olsén
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Physical Therapy, Sahlgrenska University Hospital, SE 431 45, Gothenburg, Sweden.
| | - Suada Becovic
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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19
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Elvén M, Dean E, Söderlund A. Augmented behavioral medicine competencies in physical therapy students' clinical reasoning with a targeted curriculum: a final-semester cohort-comparison study. Physiother Theory Pract 2021; 38:2007-2018. [PMID: 33663336 DOI: 10.1080/09593985.2021.1895387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Knowledge regarding the impact of curricula with behavioral medicine content and competencies (BMCC) on physical therapy (PT) students' clinical reasoning skills is lacking. Objectives: The primary objective was to compare the clinical reasoning skills, focusing on clients' behavioral change, of entry-level PT students with or without BMCC in their curricula. The secondary objective was to compare students' attitudes and beliefs in a biomedical and biopsychosocial practice orientation.Methods: Swedish final-semester PT students (n = 151) completed the Reasoning 4 Change (R4C) instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists. A blueprint was used for curricular categorization. The independent t-test was used.Results: Students attending programs with BMCC curricula (n = 61) had superior scores compared with students without BMCC curricula (n = 90) in the following R4C variables, all of which were related to clinical reasoning focused on behavioral change: Knowledge, Cognition, Self-efficacy, Input from the client, Functional behavioral analysis, and Strategies for behavioral change. Students who did not receive BMCC curricula scored higher in the R4C contextual factors and reported a greater biomedical practice orientation than students receiving BMCC curricula. There was no difference in the biopsychosocial practice orientation between groups.Conclusions: Our findings support the benefit of structured entry-level PT curricula with BMCC on final-semester students' clinical reasoning skills focused on behavioral change and their level of biomedical practice orientation. Further, our findings elucidated educational opportunities to augment students' self-efficacy and strengthen their behavioral competencies in clinical reasoning. For the generalizability of the results further research in other contexts is needed.
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Affiliation(s)
- Maria Elvén
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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20
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Fagevik Olsén M, Wiklund M, Sandberg E, Lundqvist S, Dean E. Long-term effects of physical activity prescription after bariatric surgery: A randomized controlled trial. Physiother Theory Pract 2021; 38:1591-1601. [PMID: 33576284 DOI: 10.1080/09593985.2021.1885087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study examined the effects of physical activity prescription (PAP) in patients after gastric bypass surgery. Patients' physical activity (PA) levels and outcomes were followed over their first postoperative year. METHODS Patients slated for bariatric surgery were randomized to a control group (n = 64) (basic information about postoperative PA) or an intervention group (n = 57) (also received physical therapist-prescribed PAP). Outcome measures were self-reported PA/exercise and sedentary time; and weight, waist circumference, blood pressure, and blood lipids; recorded pre-operatively and at 2, 6, and 12 months postoperatively. Follow-ups were conducted by nurses/dieticians. Trial registration: "Research and Development in Sweden" number 107371. RESULTS There were no differences between the groups except for higher level of PA (579 vs. 182 minutes/week) six months after surgery (p = .046) and a larger decrease in cholesterol (-24 vs. -8%) after a year (p = .017) in the intervention group. Patients in both groups lost considerable weight, had reduced waist circumference, and increased PA (p < .001). CONCLUSION Although marked differences between groups were not observed over one year, the intervention group increased its PA 6-months postoperatively, but not at other time points. Whether long-term outcomes of PAP use are more robust with physical therapist participation across follow-ups warrants study.
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Affiliation(s)
- Monika Fagevik Olsén
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Wiklund
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erica Sandberg
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Lundqvist
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centrum För Fysisk Aktivitet Göteborg, Gothenburg, Sweden
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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21
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Saturno G, Lopes F, Niculescu-Duvaz I, Niculescu-Duvaz D, Zambon A, Davies L, Johnson L, Preece N, Lee R, Viros A, Holovanchuk D, Pedersen M, McLeary R, Lorigan P, Dhomen N, Fisher C, Banerji U, Dean E, Krebs MG, Gore M, Larkin J, Marais R, Springer C. The paradox-breaking panRAF plus SRC family kinase inhibitor, CCT3833, is effective in mutant KRAS-driven cancers. Ann Oncol 2021; 32:269-278. [PMID: 33130216 PMCID: PMC7839839 DOI: 10.1016/j.annonc.2020.10.483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND KRAS is mutated in ∼90% of pancreatic ductal adenocarcinomas, ∼35% of colorectal cancers and ∼20% of non-small-cell lung cancers. There has been recent progress in targeting G12CKRAS specifically, but therapeutic options for other mutant forms of KRAS are limited, largely because the complexity of downstream signaling and feedback mechanisms mean that targeting individual pathway components is ineffective. DESIGN The protein kinases RAF and SRC are validated therapeutic targets in KRAS-mutant pancreatic ductal adenocarcinomas, colorectal cancers and non-small-cell lung cancers and we show that both must be inhibited to block growth of these cancers. We describe CCT3833, a new drug that inhibits both RAF and SRC, which may be effective in KRAS-mutant cancers. RESULTS We show that CCT3833 inhibits RAF and SRC in KRAS-mutant tumors in vitro and in vivo, and that it inhibits tumor growth at well-tolerated doses in mice. CCT3833 has been evaluated in a phase I clinical trial (NCT02437227) and we report here that it significantly prolongs progression-free survival of a patient with a G12VKRAS spindle cell sarcoma who did not respond to a multikinase inhibitor and therefore had limited treatment options. CONCLUSIONS New drug CCT3833 elicits significant preclinical therapeutic efficacy in KRAS-mutant colorectal, lung and pancreatic tumor xenografts, demonstrating a treatment option for several areas of unmet clinical need. Based on these preclinical data and the phase I clinical unconfirmed response in a patient with KRAS-mutant spindle cell sarcoma, CCT3833 requires further evaluation in patients with other KRAS-mutant cancers.
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Affiliation(s)
- G Saturno
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - F Lopes
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - I Niculescu-Duvaz
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - D Niculescu-Duvaz
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - A Zambon
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - L Davies
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - L Johnson
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - N Preece
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - R Lee
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - A Viros
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - D Holovanchuk
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - M Pedersen
- Targeted Therapy Team, the Institute of Cancer Research, London, UK
| | - R McLeary
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - P Lorigan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - N Dhomen
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - C Fisher
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U Banerji
- The Royal Marsden NHS Foundation Trust, London, UK
| | - E Dean
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M G Krebs
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M Gore
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J Larkin
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK.
| | - C Springer
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK.
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Beale A, O'Donnell J, Nakai M, Nanayakkara S, Vizi D, Carter K, Dean E, Ribiero R, Yiallourou S, Carrington M, Marques F, Kaye D. The Gut Microbiome of Heart Failure With Preserved Ejection Fraction. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Dean E, Kheslat H, Crozier I, Shaw D. P50 Autogenic Cardiac Injury as a Cause of Valvular Dysfunction. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.253] [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: 12/01/2022]
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Al-Sayegh N, Al-Enezi K, Nadar M, Dean E. Health Status, Behaviors, and Beliefs of Health Sciences Students and Staff at Kuwait University: Toward Maximizing the Health of Future Health Professionals and Their Patients. Int J Environ Res Public Health 2020; 17:ijerph17238776. [PMID: 33255967 PMCID: PMC7730932 DOI: 10.3390/ijerph17238776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/25/2022]
Abstract
Health professionals who engage in healthy lifestyle behaviors are more likely to promote their patients’ health. We evaluated health status, behaviors, and beliefs of students (future health professionals) and staff in four health sciences faculties, Kuwait University. In total, 600 students and 231 staff participated in this descriptive cross-sectional study. Questionnaire surveys were used to evaluate lifestyle-related practices and participants’ beliefs about these practices, in addition to health-related objective measures, e.g., heart rate, blood pressure, and body mass index. Overweight/obesity was prevalent among the participants (staff, 68.7%, students, 48.1%; p < 0.001); 57% of staff had suboptimal resting blood pressures. About half of the participants reported being moderately physically active (staff, 44.8%, students, 52.6%; p < 0.05), and most reported moderate/high stress (staff, 88.8%, students, 90.9%; p > 0.05). Only 25.1% of staff and 27.9% of students reported at least 8 h sleep nightly (p > 0.05). Staff reported healthier dietary practices than students (p-value range < 0.001–0.02). Overall, the participants had sub-optimal health indices. A marked gap existed between participants’ beliefs about healthy lifestyle practices and their actual health status. Healthy lifestyle programs are needed on campus with respect to diet, exercise, and stress management. As emerging health professionals, students in health sciences faculties, Kuwait University, need exposure to a health-promoting environment including healthy staff as role models.
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Affiliation(s)
- Nowall Al-Sayegh
- Department of Physical Therapy, Faculty of Allied Health Sciences, Kuwait University, Safat 12037, Kuwait
- Correspondence: ; Tel.: +965-2463-3510
| | - Khazna Al-Enezi
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat 12037, Kuwait;
| | - Mohammed Nadar
- Department of Occupational Therapy, Faculty of Allied Health Sciences, Kuwait University, Safat 12037, Kuwait;
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada;
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25
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Bai Y, Wu X, Tsang RCC, Yun R, Lu Y, Dean E, Jones AYM. A Randomised Controlled Trial to Evaluate the Administration of the Health Improvement Card as a Health Promotion Tool: A Physiotherapist-Led Community-Based Initiative. Int J Environ Res Public Health 2020; 17:ijerph17218065. [PMID: 33147721 PMCID: PMC7663545 DOI: 10.3390/ijerph17218065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/17/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022]
Abstract
A randomised controlled trial was conducted to evaluate the administration of the Health Improvement Card (HIC) on lifestyle practices and biometric variables in community-dwelling Chinese participants. Adults living in Shanghai were randomly assigned to either the HIC-intervention or control group. Measurements/assessments were conducted at baseline and three-month follow-up. Supervised physiotherapy students administered the HIC and four standardised questionnaires related to health and wellbeing. Both groups received a health promotion education pamphlet. Based on participants’ HIC biometric and lifestyle scores, students prescribed lifestyle, and exercise advice to the HIC-intervention group. 171 individuals (39 men, 132 women) (mean age 68.4 ± 9.7 y) participated. At follow-up, body mass index (BMI) and waist circumference decreased significantly in the HIC-intervention group. Furthermore, the number of participants in the HIC-intervention group categorised as low risk regarding their physical activity and dietary practices, increased by 32.2% and 20%, respectively. Changes in standardised questionnaire scores did not meet minimum clinically importance differences in either group. This is the first study to demonstrate that HIC-informed health promotion education can improve people’s lifestyle practices, thereby, objective biometric variables. Evaluation of the effect of HIC-informed lifestyle education on some biometric parameters (blood pressure and BMI) may warrant a longer timeframe.
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Affiliation(s)
- Yiwen Bai
- Department of Physical Therapy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.B.); (X.W.); (R.Y.)
- Department of Rehabilitation Medicine, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China;
| | - Xubo Wu
- Department of Physical Therapy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.B.); (X.W.); (R.Y.)
- Department of Rehabilitation Medicine, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China;
| | - Raymond CC Tsang
- Department of Physiotherapy, MacLehose Rehabilitation Centre, Hong Kong, China;
| | - Ruisheng Yun
- Department of Physical Therapy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.B.); (X.W.); (R.Y.)
| | - Yan Lu
- Department of Rehabilitation Medicine, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China;
| | - Elizabeth Dean
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Alice YM Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia
- Correspondence: ; Tel.: +61-407-997-828
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26
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Ámundadóttir ÓR, Jónasdóttir RJ, Sigvaldason K, Jónsdóttir H, Möller AD, Dean E, Sveinsson T, Sigurðsson GH. Predictive variables for poor long-term physical recovery after intensive care unit stay: An exploratory study. Acta Anaesthesiol Scand 2020; 64:1477-1490. [PMID: 32813915 DOI: 10.1111/aas.13690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/22/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Elucidating factors that influence physical recovery of survivors after an intensive care unit (ICU) stay is paramount in maximizing long-term functional outcomes. We examined potential predictors for poor long-term physical recovery in ICU survivors. METHODS Based on secondary analysis of a trial of 50 ICU patients who underwent mobilization in the ICU and were followed for one year, linear regression analysis examined the associations of exposure variables (baseline characteristics, severity of illness variables, ICU-related variables, and lengths of ICU and hospital stay), with physical recovery variables (muscle strength, exercise capacity, and self-reported physical function), measured one year after ICU discharge. RESULTS When the data were adjusted for age, female gender was associated with reduced muscle strength (P = .003), exercise capacity (P < .0001), and self-reported physical function (P = .01). Older age, when adjusted for gender, was associated with reduced exercise capacity (P < .001). After adjusting for gender and age, an association was observed between a lower score on one or two physical recovery variables and exposure variables, specifically, high body mass index, low functional independence, comorbidity and low self-reported physical function at baseline, muscle weakness at ICU discharge, and longer hospital stay. No adjustment was made for cumulative type I error rate due to small number of participants. CONCLUSION Elucidating risk factors for poor long-term physical recovery after ICU stay, including gender, may be critical if mobilization and exercise are to be prescribed expediently during and after ICU stay, to ensure maximal long-term recovery.
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Affiliation(s)
- Ólöf R. Ámundadóttir
- Department of Physiotherapy Landspitali – The National University Hospital of Iceland Reykjavik Iceland
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
| | - Rannveig J. Jónasdóttir
- Faculty of Nursing School of Health Sciences University of Iceland Reykjavik Iceland
- Department of Anaesthesiology and Intensive Care Medicine Landspitali – The National University Hospital of Iceland Reykjavik Iceland
| | - Kristinn Sigvaldason
- Department of Anaesthesiology and Intensive Care Medicine Landspitali – The National University Hospital of Iceland Reykjavik Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing School of Health Sciences University of Iceland Reykjavik Iceland
| | | | - Elizabeth Dean
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
- Department of Physical Therapy Faculty of Medicine The University of British Columbia Vancouver Canada
| | - Thorarinn Sveinsson
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
| | - Gísli H. Sigurðsson
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
- Department of Anaesthesiology and Intensive Care Medicine Landspitali – The National University Hospital of Iceland Reykjavik Iceland
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27
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Zhao LHM, Yu HPM, Skinner M, Gosselink R, Dean E, Jones AYM. Establishing essential cardiopulmonary physiotherapy services in acute care settings in China. J Rehabil Med 2020; 52:jrm00082. [PMID: 32720696 DOI: 10.2340/16501977-2715] [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] Open
Abstract
Missing (Letter).
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Affiliation(s)
- Lucy Hong-Mei Zhao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
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Kheslat HH, Dean E, Singh H. Successful Identification and Resection of a Peripherally Located Left Lower Lobe Inhaled Foreign Body Using Indocyanine Green. Heart Lung Circ 2020; 29:e276-e278. [PMID: 32622908 DOI: 10.1016/j.hlc.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - Harsh Singh
- Christchurch Hospital, Christchurch, New Zealand
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Dean E, Jones A, Yu HPM, Gosselink R, Skinner M. Translating COVID-19 Evidence to Maximize Physical Therapists' Impact and Public Health Response. Phys Ther 2020; 100:1458-1464. [PMID: 32589718 PMCID: PMC7337734 DOI: 10.1093/ptj/pzaa115] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2020] [Indexed: 02/05/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has sounded alarm bells throughout global health systems. As of late May, 2020, over 100,000 COVID-19-related deaths were reported in the United States, which is the highest number of any country. This article describes COVID-19 as the next historical turning point in the physical therapy profession's growth and development. The profession has had over a 100-year tradition of responding to epidemics, including poliomyelitis; 2 world wars and geographical regions experiencing conflicts and natural disasters; and, the epidemic of noncommunicable diseases (NCDs). The evidence-based role of noninvasive interventions (nonpharmacological/nonsurgical) that hallmark physical therapist practice has emerged as being highly relevant today in addressing COVID-19 in 2 primary ways. First, despite some unique features, COVID-19 presents as acute respiratory distress syndrome in its severe acute stage. Acute respiratory distress syndrome is very familiar to physical therapists in intensive care units. Body positioning and mobilization, prescribed based on comprehensive assessments/examinations, counter the negative sequelae of recumbency and bedrest; augment gas exchange and reduce airway closure, deconditioning, and critical illness complications; and maximize long-term functional outcomes. Physical therapists have an indisputable role across the contiuum of COVID-19 care. Second, over 90% of individuals who die from COVID-19 have comorbidities, most notably cardiovascular disease, hypertension, chronic lung disease, type 2 diabetes mellitus, and obesity. Physical therapists need to redouble their efforts to address NCDs by assessing patients for risk factors and manifestations and institute evidence-based health education (smoking cessation, whole-food plant-based nutrition, weight control, physical activity/exercise), and/or support patients' efforts when these are managed by other professionals. Effective health education is a core competency for addressing risk of death by COVID-19 as well as NCDs. COVID-19 is a wake-up call to the profession, an opportunity to assert its role throughout the COVID-19 care continuum, and augment public health initiatives by reducing the impact of the current pandemic.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 Friedman Bldg, 2177 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada,Address all correspondence to Dr. Dean at:
| | - Alice Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Homer Peng-Ming Yu
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Sichuan, China; and Faculty of Physical Therapy, Rehabilitation Medicine College, Sichuan University
| | - Rik Gosselink
- Department Rehabilitation Sciences, Faculty Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Margot Skinner
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Yu HPM, Jones AY, Dean E, Liisa Laakso E. Ultra-shortwave diathermy - a new purported treatment for management of patients with COVID-19. Physiother Theory Pract 2020; 36:559-563. [PMID: 32406778 DOI: 10.1080/09593985.2020.1757264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The pandemic spread of coronavirus disease 2019 (COVID-19) has driven efforts to address the global threat to public health and there is increasing pressure to exploit interventions to manage the pneumonic inflammation manifested in this disease. Ultra-shortwave diathermy (USWD) is proposed by some rehabilitation professions in China, purportedly to minimise pneumonic inflammation. However, treatment of any symptomatic pneumonia should be evidence-based. There is no valid evidence, published in English, which establishes any benefit of USWD in pulmonary conditions, let alone COVID-19. The need for rigorous research and evidence-based practice is discussed in this article. Novel interventions require a solid physiological basis and must undergo rigorous testing prior to clinical adoption even during a pandemic. We are of the view that deployment of USWD in patients with COVID-19 must be prudent and supported by a logical scientific basis.
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Affiliation(s)
- Homer Peng-Ming Yu
- Department of Rehabilitation, West China Hospital, Sichuan University , Sichuan, China
| | - Alice Ym Jones
- School of Health and Rehabilitation Sciences, University of Queensland , Brisbane, Australia.,Sydney School of Health Sciences, University of Sydney , Sydney, Australia
| | - E Dean
- Department of Physical Therapy, University of British Columbia , Vancouver, Canada
| | - E- Liisa Laakso
- Mater Research , Brisbane, Australia.,Menzies Health Institute Queensland, Griffith University , Gold Coast, Australia
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Dillon M, Guevara J, Mohammed K, Smith S, Dean E, McLellan L, Boylan Z, Spicer J, Forster M, Harrington K. A phase I study of ATR inhibitor, AZD6738, as monotherapy in advanced solid tumours (PATRIOT part A, B). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz244.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wu X, Jones AY, Bai Y, Han J, Dean E. Use of the Health Improvement Card by Chinese physical therapy students: A pilot study. PLoS One 2019; 14:e0221630. [PMID: 31487297 PMCID: PMC6728073 DOI: 10.1371/journal.pone.0221630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/12/2019] [Indexed: 11/18/2022] Open
Abstract
This study investigated the perceptions of Chinese physical therapy students on use of the Health Improvement Card (HIC) as a clinical tool to assess lifestyle and prescribe health education to others. The biometrics and health indices/attributes/lifestyles of these students were also evaluated with self-administration of the HIC. After a tutorial on the HIC and its clinical application, physical therapy students (n = 82) from two Chinese universities, completed the Chinese translation of the HIC followed by a questionnaire on students’ perceptions of it. Second, they invited a friend/relative to complete the HIC. Then, they provided feedback on the HIC’s strengths and challenges related to its administration. The data were analyzed with descriptive statistics and content thematic analysis. Response rate of self-completed HICs was 100% (n = 82) and that of questionnaires was 99% (n = 81). Participants’ age range was 20–34 years; mean body mass index (BMI) was 23.9±5.4 for men and 20.5±2.6 kg/m2 for women. Generally, participants had low-risk BMIs (82%) and blood pressures (BPs) (91%), moderate-risk dietary habits (90%), but fewer had low-risk exercise habits (41%). Of 81 friends/relatives who participated, 25% had high-risk exercise habits. Student participants concurred the HIC is useful in developing lifestyle education programs. Challenges included uncertainty about obtaining laboratory data, serving-size quantities and confidence to effect lifestyle change in others. Although students appeared receptive to assessing health and lifestyle behaviors using the HIC, they reported being unconfident to prescribe long-term effective lifestyle advice. We recommend introducing the HIC in physical therapy curricula as an effective way of sensitizing emerging physical therapists to their responsibility to assess health/attributes/lifestyle non-communicable diseases (NCDs) risk factors. Prescribing lifestyle education/counselling warrants greater curricular focus. Further research will establish how HIC data and information can be effectively used as a clinical assessment and education tool to target health and lifestyle, and track behavior change over time.
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Affiliation(s)
- Xubo Wu
- Shanghai University of Traditional Chinese Medicine, Department of Physical Therapy, Shanghai, China
- Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Department of Rehabilitation Medicine, Shanghai, China
| | - Alice Ym Jones
- The University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Yiwen Bai
- Shanghai University of Traditional Chinese Medicine, Department of Physical Therapy, Shanghai, China
- Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Department of Rehabilitation Medicine, Shanghai, China
| | - Jia Han
- Shanghai University of Sports, Physiotherapy and Sports Rehabilitation Department, Shanghai, China
- University of Canberra, Research Institute for Sport and Exercise, Canberra, ACT, Australia
- Swinburne University of Technology, Faculty of Health, Arts and Design, Melbourne, VIC, Australia
| | - Elizabeth Dean
- University of British Columbia, Department of Physical Therapy, Vancouver, Canada
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Dean E, Skinner M, Myezwa H, Mkumbuzi V, Mostert K, Parra DC, Shirley D, Söderlund A, de Andrade AD, Abaraogu UO, Bruno S, Clark D, Gylfadóttir S, Jones A, Veluswamy SK, Lomi C, Moffat M, Morris D, Stensdotter AK, Wong WP. Health Competency Standards in Physical Therapist Practice. Phys Ther 2019; 99:1242-1254. [PMID: 31189180 DOI: 10.1093/ptj/pzz087] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 07/11/2018] [Accepted: 02/23/2019] [Indexed: 02/09/2023]
Abstract
Although the physical therapist profession is the leading established, largely nonpharmacological health profession in the world and is committed to health promotion and noncommunicable disease (NCD) prevention, these have yet to be designated as core physical therapist competencies. Based on findings of 3 Physical Therapy Summits on Global Health, addressing NCDs (heart disease, cancer, hypertension, stroke, diabetes, obesity, and chronic lung disease) has been declared an urgent professional priority. The Third Summit established the status of health competencies in physical therapist practice across the 5 World Confederation for Physical Therapy (WCPT) regions with a view to establish health competency standards, this article's focus. Three general principles related to health-focused practice emerged, along with 3 recommendations for its inclusion. Participants acknowledged that specific competencies are needed to ensure that health promotion and NCD prevention are practiced consistently by physical therapists within and across WCPT regions (ie, effective counseling for smoking cessation, basic nutrition, weight control, and reduced sitting and increased activity/exercise in patients and clients, irrespective of their presenting complaints/diagnoses). Minimum accreditable health competency standards within the profession, including use of the WCPT-supported Health Improvement Card, were recommended for inclusion into practice, entry-to-practice education, and research. Such standards are highly consistent with the mission of the WCPT and the World Health Organization. The physical therapist profession needs to assume a leadership role vis-à-vis eliminating the gap between what we know unequivocally about the causes of and contributors to NCDs and the long-term benefits of effective, sustained, nonpharmacological lifestyle behavior change, which no drug nor many surgical procedures have been reported to match.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada, North America/Caribbean
| | - Margot Skinner
- School of Physiotherapy, University of Otago, Dunedin, New Zealand, Asia Western Pacific
| | - Hellen Myezwa
- Department of Physiotherapy, University of Witwatersrand, Johannesburg, South Africa
| | - Vyvienne Mkumbuzi
- Physiotherapy Program, College of Medicine, University of Malawi, Blantyre, Malawi, Africa
| | - Karien Mostert
- Department of Physiotherapy, University of Pretoria, Hatfield, South Africa
| | - Diana C Parra
- Department of Physical Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri; and Rosario University, Bogota, Colombia, North America/Caribbean, South America
| | - Debra Shirley
- Discipline of Physiotherapy, Faculty of Health Sciences, Sydney, The University of Sydney, Lidcombe, Australia, Asia Western Pacific
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden, Europe
| | | | - Ukachukwu Okoroafor Abaraogu
- Department of Medical Rehabilitation, University of Nigeria Enugu Campus, Enugu, Nigeria, Africa; and School of Life Sciences, Glasgow Caledonia University, Glasgow, United Kingdom, Europe
| | - Selma Bruno
- Departmento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil, South America
| | - Diane Clark
- Department of Physical Therapy, University of Alabama, Birmingham, Alabama, North America/Caribbean
| | - Sif Gylfadóttir
- Physical Therapy, Reykjalundur Rehabilitation Center, Mosfellsbaer, Iceland, Europe
| | - Alice Jones
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney; and Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Asia Western Pacific
| | - Sundar Kumar Veluswamy
- Department of Physiotherapy, Ramaiah Medical College and Hospitals, Bangalore, India, Asia Western Pacific
| | - Constantina Lomi
- Department of Occupational and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden, Europe
| | - Marilyn Moffat
- Department of Physical Therapy, New York University, New York, New York, North America/Caribbean
| | - David Morris
- Department of Physical Therapy, University of Alabama (NA)
| | - Ann-Katrin Stensdotter
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway, Europe
| | - Wai Pong Wong
- Academic Programmes Division, Singapore Institute of Technology, Singapore, Asia Western Pacific
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Elvén M, Hochwälder J, Dean E, Söderlund A. Predictors of Clinical Reasoning Using the Reasoning 4 Change Instrument With Physical Therapist Students. Phys Ther 2019; 99:964-976. [PMID: 30869789 PMCID: PMC6665874 DOI: 10.1093/ptj/pzz044] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 02/03/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although physical therapist students must be well prepared to integrate biopsychosocial and behavioral perspectives into their clinical reasoning, there is a lack of knowledge regarding factors that influence such competence. OBJECTIVE This study explored the associations among the independent variables-knowledge, cognition, metacognition, psychological factors, contextual factors, and curriculum orientation vis-à-vis behavioral medicine competencies-and the dependent variables-outcomes of input from client (IC), functional behavioral analysis (FBA), and strategies for behavior change (SBC) as levels in physical therapist students' clinical reasoning processes. DESIGN This study used an exploratory cross-sectional design. METHODS The Reasoning 4 Change instrument was completed by 151 final-semester physical therapist students. Hierarchical multiple regression analyses for IC, FBA, and SBC were conducted. In the first step, curriculum orientation was inserted into the model; in the second step, self-rated knowledge, cognition, and metacognition; and in the third step, psychological factors. RESULTS All independent variables except contextual factors explained 37% of the variance in the outcome of IC. Curriculum orientation explained 3%, cognitive and metacognitive factors an additional 22%, and attitudes another 15%. Variance in the outcomes of FBA and SBC were explained by curriculum orientation only (FBA change in R2 = 0.04; SBC change in R2 = 0.05). Higher scores of the dependent variables were associated with a curriculum having behavioral medicine competencies. LIMITATIONS The limitations of this study are that it was cross-sectional. CONCLUSIONS Cognitive and metacognitive capabilities and skills and positive attitudes are important predictors of physical therapist students' clinical reasoning focused on behavior change at the IC level. Curricula with behavioral medicine competencies are associated with positive outcomes at all clinical reasoning levels.
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Affiliation(s)
- Maria Elvén
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden,Address all correspondence to Ms Elvén at:
| | - Jacek Hochwälder
- Division of Psychology, School of Health, Care and Social Welfare, Mälardalen University
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University
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Amundadottir OR, Jónasdóttir RJ, Sigvaldason K, Gunnsteinsdottir E, Haraldsdottir B, Sveinsson T, Sigurdsson GH, Dean E. Effects of intensive upright mobilisation on outcomes of mechanically ventilated patients in the intensive care unit: a randomised controlled trial with 12-months follow-up. European Journal of Physiotherapy 2019. [DOI: 10.1080/21679169.2019.1645880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Olof R. Amundadottir
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Physiotherapy, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Rannveig J. Jónasdóttir
- Department of Anaesthesiology and Intensive Care Medicine, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Kristinn Sigvaldason
- Department of Anaesthesiology and Intensive Care Medicine, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ester Gunnsteinsdottir
- Department of Physiotherapy, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Brynja Haraldsdottir
- Department of Physiotherapy, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Gisli H. Sigurdsson
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Anaesthesiology and Intensive Care Medicine, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Elizabeth Dean
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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Dean E. Health Competencies: The C.R.A.N.E. JOURNAL/carpt/04.03/01823246-201907000-00002/inline-graphic1/v/2021-01-21T100215Z/r/image-tiff. Cardiopulm Phys Ther J 2019. [DOI: 10.1097/cpt.0000000000000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang P, Li Z, Jones A, Bodner ME, Dean E. Discordance between lifestyle-related health behaviors and beliefs of urban mainland Chinese: A questionnaire study with implications for targeting health education. AIMS Public Health 2019; 6:49-66. [PMID: 30931342 PMCID: PMC6433611 DOI: 10.3934/publichealth.2019.1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/22/2019] [Indexed: 11/22/2022] Open
Abstract
Background Morbidity and mortality in China are increasingly associated with lifestyle behaviors, e.g., smoking, poor nutritional choices, and physical inactivity. Lifestyle-related non-communicable diseases (e.g., hypertension, stroke, heart disease, lung disease) are at critical levels globally, in turn their socioeconomic burdens. Knowledge of lifestyle-related health behaviors and beliefs of mainland Chinese would help inform the design and targeting of cost-effective health education for individuals and campaigns in the interests of promoting and protecting health, and preventing disease. This study's objective was to describe the lifestyle behaviors and beliefs of a sample of urban mainland Chinese, and their congruence with evidence-based guidelines for maximal health. Methods A cross-sectional interview questionnaire study was conducted in which 835 mainland Chinese (55% men, 45% women) from four urban areas participated. Results About half (52%) reported smoking to some degree with 21% being habitual smokers; 33% being above average weight; 62.1% met physical activity guidelines for health benefits; 92% being sedentary for 5.8 ± 3.40 h/d; 66% experiencing moderate/high stress; and sleeping 7.1 ± 1.31 h nightly with 35% reporting sleeping poorly. When standard serving sizes were considered, daily consumption of grains, fruits, and vegetables was reported to be consistent with dietary recommendations for good health, however, added salt (3.7 ± 7.42 tsp) and sugar (3.9 ± 12.99 tsp) exceeded recommendations. Life stress was rated moderate by 59.6% of respondents, with personal and family health stresses ranking highest (43% and 55%, respectively). Regarding beliefs about importance of lifestyle behaviors to health, respondents' understanding was not consistent with evidence-based recommendations. Only 64% of participants believed smoking abstinence is highly important to health; 56% regular exercise; and 37% consumption of whole grains, 62% fruit and vegetables; and 54% maintaining a healthy body weight. Conclusion To be congruent with established guidelines for healthy living, health promotion and disease prevention education for individuals and public campaigns warrants targeting health knowledge and beliefs of urban Chinese as well as lifestyle-related health behaviors. The roles of gender, education and living rurally, on lifestyle behaviors and beliefs of the Chinese, warrant elucidation.
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Affiliation(s)
- Peng Wang
- School of Foreign Studies, Central University of Finance and Economics, Beijing, China, and formerly visiting scholar, School of Communication and Culture, Royal Roads University, Victoria, British Columbia, Canada
| | - Zhenyi Li
- School of Communication and Culture, Royal Roads University, Victoria, British Columbia, Canada
| | - Alice Jones
- Alice Jones, Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Michael E Bodner
- School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Krebs M, Lopez J, El-Khoueiry A, Bang YJ, Postel-Vinay S, Abidah W, Im SA, Khoja L, Standifer N, Jones G, Marco-Casanova P, Frewer P, Berges A, Cheung A, Stephens C, Felicetti B, Dean E, Pierce A, Hollingsworth S. Phase I clinical and translational evaluation of AZD6738 in combination with durvalumab in patients (pts) with lung or head and neck carcinoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy279.401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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39
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Plummer R, Cook N, Arkenau T, Melear J, Redfern C, Spira A, Chung K, Haddad T, Ramalingam S, Wesolowski R, Dean E, Goddemeier T, Falk M, Shapiro G. Phase I dose expansion data for M6620 (formerly VX-970), a first-in-class ATR inhibitor, combined with gemcitabine (Gem) in patients (pts) with advanced non-small cell lung cancer (NSCLC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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40
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Byrne-Davis LMT, Marchant D, Bull ER, Gyles D, Dean E, Hart JK. How do members of a fire and rescue service perceive expanding their roles to deliver more health care services? J Public Health (Oxf) 2018; 41:593-599. [DOI: 10.1093/pubmed/fdy148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 07/04/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Increasingly, public sector workers are being required to expand their roles into public health. Fire and rescue services, as part of the Emergency Medical Response trial, are at the forefront of role expansion, with increasing capacity due to reducing numbers of fires in recent years. Firefighter roles, successfully implemented, include responding to cardiac arrests and conducting checks on health and wellbeing in people’s own homes. In this study, we explored fire service members’ perceptions about this role expansion, to increase understanding of how role expansion can be introduced and supported.
Methods
We interviewed 21 firefighters and team members about their perceptions of new roles. Interviews were conducted, transcribed and thematically analysed until reaching thematic saturation.
Results
Perspectives differed for responding to cardiac arrests and wellbeing checks. Cardiac arrests were seen as aligned with core roles and thus more acceptable. For both types of new role participants wanted more training and opportunities to provide feedback on implementation.
Conclusions
How team members viewed role expansion depended on new role alignment with core role, training and being able to give feedback to management to shape future services.
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Affiliation(s)
- L M T Byrne-Davis
- Division of Medical Education, University of Manchester, Manchester, UK
| | - D Marchant
- Division of Medical Education, University of Manchester, Manchester, UK
| | - E R Bull
- Division of Medical Education, University of Manchester, Manchester, UK
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - D Gyles
- Division of Medical Education, University of Manchester, Manchester, UK
| | - E Dean
- Greater Manchester Fire and Rescue Service, GMFRS Headquarters, Swinton, Salford, UK
| | - J K Hart
- Division of Medical Education, University of Manchester, Manchester, UK
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Elvén M, Hochwälder J, Dean E, Hällman O, Söderlund A. Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'. AIMS Public Health 2018; 5:235-259. [PMID: 30280115 PMCID: PMC6141557 DOI: 10.3934/publichealth.2018.3.235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/29/2018] [Indexed: 01/22/2023] Open
Abstract
Background and aim: 'Reasoning 4 Change' (R4C) is a newly developed instrument, including four domains (D1-D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1-D4); inter-rater reliability (D2-D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (α range: 0.67-0.91), satisfactory test-retest reliability (ICC range: 0.46-0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94-1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06-0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.
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Affiliation(s)
- Maria Elvén
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Jacek Hochwälder
- Division of Psychology, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Elizabeth Dean
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Olle Hällman
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Bodner ME, Rhodes RE, Miller WC, Dean E. Predictors of physical therapists' intentions to counsel for smoking cessation: Implications for practice and professional education. Physiother Theory Pract 2018; 36:628-637. [PMID: 29944038 DOI: 10.1080/09593985.2018.1490365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study explored factors predicting intention (predominant construct in social cognitive behavioral models) for smoking cessation (SC) counseling that may provide salient information for designing/targeting SC counseling training for physical therapists (PTs). Design: Cross-sectional questionnaire survey of PTs licensed to practice in Canada. Methods: Self-efficacy items and PT views were assessed for internal consistency (Cronbach's α) and data reduced using principal axis factor analysis. Hierarchical linear regression modeling assessed predictors of intention to counsel for SC. Results: Internal consistency: self-efficacy and PT views: r = 0.937, r = 0.821, respectively. Factor structures from self-efficacy: "skills and knowledge" and "clinic incidentals" (57% total variance); from PT views': "professional role" and "role modeling" (63.8% total variance). Significant predictors of intent to counsel for SC were "professional role" (β = 0.54, p ≤ 0.001), and "skills and knowledge" (β = 0.23, p ≤ 0.001). Conclusions: Physical therapists' intent to engage in SC counseling increases when they consider it their "professional role." Encouraging PTs to view SC counseling as a professional role as well as increasing SC counseling self-efficacy focusing on skills and knowledge to do so needs to be incorporated into entry-level academic physical therapy programs and continuing professional PT education.
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Affiliation(s)
- Michael E Bodner
- School of Human Kinetics, Trinity Western University , Langley, Canada
| | - Ryan E Rhodes
- Behavioural Medicine Laboratory, Faculty of Education, University of Victoria , Victoria, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia , Vancouver, Canada
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia , Vancouver, Canada
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Sandborgh M, Dean E, Denison E, Elvén M, Fritz J, Wågert PVH, Moberg J, Overmeer T, Snöljung Å, Johansson AC, Söderlund A. Integration of behavioral medicine competencies into physiotherapy curriculum in an exemplary Swedish program: rationale, process, and review. Physiother Theory Pract 2018; 36:365-377. [DOI: 10.1080/09593985.2018.1488192] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Maria Sandborgh
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Elizabeth Dean
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eva Denison
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
- Division of health sciences, Norwegian Institute of Public Health, Nydalen, Oslo, Norway
| | - Maria Elvén
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Johanna Fritz
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Petra von Heideken Wågert
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Johan Moberg
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Thomas Overmeer
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
- Centre for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Åsa Snöljung
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Ann-Christin Johansson
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden
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Lacey R, Dean E, Onyeigo S, Sims G, Shah U. Polysubstance abuse: the overlooked factor of benzodiazepines in opioid overdose in harris county. Res Social Adm Pharm 2018. [DOI: 10.1016/j.sapharm.2018.04.029] [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: 10/14/2022]
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Telli ML, Lord S, Dean E, Abramson V, Arkenau HT, Murias C, Becerra C, Tang R, Penney MS, Pollard J, Conboy G, Fields SZ, Shapiro G, Tolaney SM. Abstract OT2-07-07: ATR inhibitor M6620 (formerly VX-970) with cisplatin in metastatic triple-negative breast cancer: Preliminary results from a phase 1 dose expansion cohort (NCT02157792). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-07-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: ATR is a critical regulator of the cellular response to replication stress; it signals DNA damage repair, mediated through homologous recombination. Many cancers depend on ATR to survive DNA damage. M6620 is a potent, selective inhibitor of ATR that augments the anticancer activity of cisplatin in preclinical triple-negative breast cancer (TNBC) models. Given the high prevalence of TP53 mutations in TNBC and limited platinum responsiveness in patients lacking a BRCA1/2 mutation, this study was designed to evaluate the safety and efficacy of M6620 in combination with cisplatin in an expansion cohort of patients with BRCA1/2 wild-type advanced/metastatic TNBC.
Methods: Eligible patients had advanced/metastatic ER-, PR-, and HER2- breast cancer with 0-2 prior non–platinum-based therapies and measurable disease per RECIST 1.1. First line patients were eligible if relapse occurred ≥3 months after prior (neo)adjuvant chemotherapy. Of a maximum 50 patients planned for enrollment, ≥30 were required to have BRCA1/2 germline wild-type status and basaloid molecular subtype tumors on central testing. Patients received intravenous cisplatin 75 mg/m2 on day 1 with intravenous M6620 140 mg/m2 on days 2 and 9 of each 21-day cycle. In patients intolerant of cisplatin or at investigator's discretion, cisplatin could be switched to carboplatin AUC 5 with M6620 90 mg/m2.
Results: At the time of abstract submission, 35 female patients were enrolled in this study; 18 patients with confirmed BRCA1/2 wild-type and basaloid metastatic TNBC who received ≥1 cycle of study drug and had ≥1 baseline scan and ≥1 on-treatment scan at the time of the data cut were included in the primary efficacy analysis. Median progression-free survival (PFS) was 4.1 months (90% CI, 1.6-6.9 months). PFS was ≥ 6 months in 2 patients and ≥ 3 months in 8 patients. Preliminary unconfirmed objective response [complete response or partial response (PR)] was observed in 38.9% (90% CI, 19.9%-60.8%) of patients. All 7 patients with preliminary objective response had PR as best overall response; the longest duration of response was 183 days. Response was ongoing in 4 patients with PR at the time of data cutoff. Grade ≥3 related treatment-emergent adverse events occurred in 16 of 35 patients: neutropenia (n=8), anemia (n=5), vomiting (n=4), nausea (n=3), and, in 1 patient each, thrombocytopenia, neutrophil count decreased, platelet count decreased, hypokalemia, generalized weakness, rigors, and acute kidney injury.
Conclusions: Combination of M6620 and cisplatin shows encouraging antitumor activity and tolerability in patients with advanced/metastatic TNBC. The study is ongoing; updated safety and efficacy results will be presented.
Citation Format: Telli ML, Lord S, Dean E, Abramson V, Arkenau H-T, Murias C, Becerra C, Tang R, Penney MS, Pollard J, Conboy G, Fields SZ, Shapiro G, Tolaney SM. ATR inhibitor M6620 (formerly VX-970) with cisplatin in metastatic triple-negative breast cancer: Preliminary results from a phase 1 dose expansion cohort (NCT02157792) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-07-07.
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Affiliation(s)
- ML Telli
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - S Lord
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - E Dean
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - V Abramson
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - H-T Arkenau
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - C Murias
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - C Becerra
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - R Tang
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - MS Penney
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - J Pollard
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - G Conboy
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - SZ Fields
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - G Shapiro
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - SM Tolaney
- Stanford University School of Medicine, Stanford, CA; Churchill Hospital, Oxford, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Vanderbilt University Medical Center, Nashville, TN; Sarah Cannon Research Institute, London, United Kingdom; Texas Oncology, P.A., Dallas, TX; Vertex Pharmaceuticals Incorporated, Boston, MA; Vertex Pharmaceuticals Limited, Milton Park, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
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Elvén M, Hochwälder J, Dean E, Söderlund A. Development and initial evaluation of an instrument to assess physiotherapists’ clinical reasoning focused on clients’ behavior change. Physiother Theory Pract 2018; 34:367-383. [DOI: 10.1080/09593985.2017.1419521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maria Elvén
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Jacek Hochwälder
- Division of Psychology, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Vergote I, Dean E, Lassen U, de Bono J, Drew Y, Machiels JP, Nielsen D, Arkenau HT, Forster M, Jones R, Slomovitz B, Spicer J, Johnson M, Cornez N, Gennigens C, Fulton B, Lisby S, Basse L, Coleman R, Hong D. A phase IIa study of tisotumab vedotin (HuMax®-TF-ADC) in patients with relapsed, recurrent and/or metastatic cervical cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx372.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Telli M, Lord S, Dean E, Abramson V, Arkenau HT, Becerra C, Tolaney S, Tang R, Penney M, Pollard J, Conboy G, Fields S, Shapiro G. Initial results of a phase 1 dose expansion cohort of M6620 (formerly VX-970), an ATR inhibitor, in combination with cisplatin in patients with advanced triple-negative breast cancer NCT02157792). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cook N, Carter L, Aruketty S, O'Brien C, Thistlethwaite F, Dean E, Krebs M, Warren M, Berman R. Enhanced supportive care in early phase clinical trials. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx388.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gupta A, Ayub M, Miller C, Rothwell D, Wallace A, Jordan A, Cook N, Thistlethwaite F, Carter L, O’Brien C, Aruketty S, Dean E, Hudson A, Frese K, Dransfield J, Hughes A, Marais R, Dive C, Brady G, Krebs M. Development of the Manchester Cancer Research Centre Molecular Tumour Board for matching patients to clinical trials based on tumour and ctDNA genetic profiling. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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