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Mo A, Wood E, Shortt J, Charlton A, Evers D, Hoeks M, Pritchard E, Daly J, Hodgson C, Opat S, Bowen D, Reynolds J, Thi Phung Thao L, Stanworth SJ, McQuilten Z. Rethinking the transfusion pathway in myelodysplastic syndromes: Study protocol for a novel randomized feasibility n-of-1 trial of weekly-interval red cell transfusion in myelodysplastic syndromes. Transfusion 2024; 64:236-247. [PMID: 38214417 DOI: 10.1111/trf.17706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Anemia in myelodysplastic syndromes (MDS) is associated with poorer health-related quality of life (HRQoL) and physical function, and is frequently treated with transfusions. The current common practice of transfusing multiple red blood cells (RBC) units every 2-4 weeks may result in peaks/troughs in hemoglobin (Hb) level, yet maintaining a stable Hb may better improve HRQoL. We describe a study protocol aiming to investigate the feasibility of weekly low-dose RBC transfusion in MDS patients, including assessing HRQoL and physical function outcomes. STUDY DESIGN AND METHODS In this n-of-1 pilot study, patients receive two treatment arms, with randomly allocated treatment sequence: arm A (patient's usual transfusion schedule) and arm B (weekly transfusion, individualized per patient). To facilitate timely delivery of weekly transfusion, extended-matched RBCs are provided, with transfusion based upon the previous week's Hb/pre-transfusion testing results to eliminate delays of awaiting contemporaneous cross-matching. Primary outcome is the feasibility of delivering weekly transfusion. Secondary outcomes include HRQoL, functional activity measurements, RBC usage, and alloimmunization rates. A qualitative substudy explores patient and staff experiences. RESULTS The trial is open in Australia, Netherlands, and UK. The first patient was recruited in 2020. Inter-country differences in providing RBCs are observed, including patient genotyping versus serological phenotyping to select compatible units. DISCUSSION This pilot trial evaluates a novel personalized transfusion approach of weekly matched RBC transfusion and challenges the dogma of current routine pre-transfusion matching practice. Findings on study feasibility, HRQoL, and physical functional outcomes and the qualitative substudy will inform the design of a larger definitive trial powered for clinical outcomes.
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Affiliation(s)
- Allison Mo
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
- Department of Haematology, Monash Health, Clayton, Australia
- Austin Pathology & Department of Haematology, Austin Health, Heidelberg, Australia
| | - Erica Wood
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
- Department of Haematology, Monash Health, Clayton, Australia
| | - Jake Shortt
- Department of Haematology, Monash Health, Clayton, Australia
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Andrew Charlton
- Department of Haematology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Dorothea Evers
- Department of Haematology, Radboudumc, Nijmegen, The Netherlands
| | - Marlijn Hoeks
- Department of Haematology, Radboudumc, Nijmegen, The Netherlands
| | - Elizabeth Pritchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - James Daly
- Australian Red Cross Lifeblood, Melbourne, Australia
| | - Carol Hodgson
- The Australian and New Zealand Intensive Care-Research Centre, Monash University, Melbourne, Australia
- The Alfred, Melbourne, Australia
- The George Institute for Global Health, Sydney, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
| | - Stephen Opat
- Department of Haematology, Monash Health, Clayton, Australia
| | - David Bowen
- Department of Health Sciences, University of York, York, UK
| | - John Reynolds
- Department of Clinical Haematology, The Alfred, Melbourne, Australia
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - Le Thi Phung Thao
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
| | - Simon J Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Zoe McQuilten
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
- Department of Haematology, Monash Health, Clayton, Australia
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McQuilten Z, Heritier S, Fox L, Fox V, Young L, Blombery P, Cunningham I, Curnow J, Higgins A, Hiwase DK, Filshie R, Firkin F, Lacaze P, Mason K, Mills AK, Pepperell D, Patil S, Stevenson W, Szer J, Waters N, Wilson K, Ting S, Wood E. Efficacy and safety of avatrombopag in combination with immunosuppressive therapy in treatment-naïve and relapsed/refractory severe aplastic anaemia: protocol for the DIAAMOND-Ava-FIRST and DIAAMOND-Ava-NEXT Bayesian Optimal Phase II trials. BMJ Open 2024; 14:e076246. [PMID: 38238183 PMCID: PMC10806710 DOI: 10.1136/bmjopen-2023-076246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Immunosuppressive therapy (IST) with antithymocyte globulin (ATG) and ciclosporin is standard of care for patients with severe aplastic anaemia (sAA) not eligible or suitable for allogeneic stem cell transplant. While patients respond to IST, few achieve complete responses and a significant proportion are refractory or relapse. The addition of eltrombopag, a thrombopoietin-receptor agonist (TPO-A), to IST has been shown to improve haematological responses in sAA. Avatrombopag is a second-generation TPO-A with potential advantages over eltrombopag. However, to date avatrombopag has not been studied in sAA. METHODS AND ANALYSIS Investigator-initiated, single-arm registry-based Bayesian Optimal Phase II trial of avatrombopag conducted in two cohorts, patients with untreated sAA (FIRST cohort) and in patients with sAA that has relapsed or is refractory to IST (NEXT cohort). In the FIRST cohort, participants receive IST (equine ATG and ciclosporin) plus avatrombopag from day 1 until day 180 at 60 mg oral daily, with dose adjusted according to platelet count. Participants in the NEXT cohort receive avatrombopag at 60 mg oral daily from day 1 until day 180, with or without additional IST at the discretion of the treating clinician.For each cohort, two primary endpoints (haematological response and acquired clonal evolution) are jointly monitored and the trial reviewed at each interim analysis where a 'go/no-go' decision is made by evaluating the posterior probability of the events of interests. ETHICS AND DISSEMINATION The trial has received ethics approval (Monash Health RES-18-0000707A). The trial conduct will comply with ICH-GCP and all applicable regulatory requirements. The results of the trial will be submitted to a peer-review journal for publication. TRIAL REGISTRATION NUMBER ACTRN12619001042134, ACTRN12619001043123.
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Affiliation(s)
- Zoe McQuilten
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephane Heritier
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lucy Fox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Vanessa Fox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lauren Young
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Piers Blombery
- Department of Clinical Haematology, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Ilona Cunningham
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Curnow
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Alisa Higgins
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Devendra K Hiwase
- Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
| | - Robin Filshie
- Haematology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Frank Firkin
- Haematology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kylie Mason
- Department of Clinical Haematology, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Anthony K Mills
- University of Queensland, Brisbane, Queensland, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Dominic Pepperell
- Department of Haematology, Fiona Stanley Hospital, Murdoch, Perth, Australia
| | - Sushrut Patil
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - William Stevenson
- Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Jeff Szer
- Department of Clinical Haematology, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Neil Waters
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kate Wilson
- University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Ting
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Haematology, Eastern Health, Melbourne, Victoria, Australia
| | - Erica Wood
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Plattner P, Wood E, Al Ayoubi L, Beliuskina O, Bissell ML, Blaum K, Campbell P, Cheal B, de Groote RP, Devlin CS, Eronen T, Filippin L, Garcia Ruiz RF, Ge Z, Geldhof S, Gins W, Godefroid M, Heylen H, Hukkanen M, Imgram P, Jaries A, Jokinen A, Kanellakopoulos A, Kankainen A, Kaufmann S, König K, Koszorús Á, Kujanpää S, Lechner S, Malbrunot-Ettenauer S, Müller P, Mathieson R, Moore I, Nörtershäuser W, Nesterenko D, Neugart R, Neyens G, Ortiz-Cortes A, Penttilä H, Pohjalainen I, Raggio A, Reponen M, Rinta-Antila S, Rodríguez LV, Romero J, Sánchez R, Sommer F, Stryjczyk M, Virtanen V, Xie L, Xu ZY, Yang XF, Yordanov DT. Nuclear Charge Radius of ^{26m}Al and Its Implication for V_{ud} in the Quark Mixing Matrix. Phys Rev Lett 2023; 131:222502. [PMID: 38101341 DOI: 10.1103/physrevlett.131.222502] [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] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023]
Abstract
Collinear laser spectroscopy was performed on the isomer of the aluminium isotope ^{26m}Al. The measured isotope shift to ^{27}Al in the 3s^{2}3p ^{2}P_{3/2}^{○}→3s^{2}4s ^{2}S_{1/2} atomic transition enabled the first experimental determination of the nuclear charge radius of ^{26m}Al, resulting in R_{c}=3.130(15) fm. This differs by 4.5 standard deviations from the extrapolated value used to calculate the isospin-symmetry breaking corrections in the superallowed β decay of ^{26m}Al. Its corrected Ft value, important for the estimation of V_{ud} in the Cabibbo-Kobayashi-Maskawa matrix, is thus shifted by 1 standard deviation to 3071.4(1.0) s.
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Affiliation(s)
- P Plattner
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Universität Innsbruck, Innrain 52, 6020 Innsbruck, Austria
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - E Wood
- Department of Physics, University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | - L Al Ayoubi
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - O Beliuskina
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - M L Bissell
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Department of Physics and Astronomy, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - K Blaum
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - P Campbell
- Department of Physics and Astronomy, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - B Cheal
- Department of Physics, University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | - R P de Groote
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - C S Devlin
- Department of Physics, University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | - T Eronen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - L Filippin
- Spectroscopy, Quantum Chemistry and Atmospheric Remote Sensing (SQUARES), Université libre de Bruxelles, 1050 Brussels, Belgium
| | - R F Garcia Ruiz
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, Massachusetts 02139, USA
| | - Z Ge
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - S Geldhof
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
| | - W Gins
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - M Godefroid
- Spectroscopy, Quantum Chemistry and Atmospheric Remote Sensing (SQUARES), Université libre de Bruxelles, 1050 Brussels, Belgium
| | - H Heylen
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - M Hukkanen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - P Imgram
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - A Jaries
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - A Jokinen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - A Kanellakopoulos
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
| | - A Kankainen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - S Kaufmann
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - K König
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - Á Koszorús
- Department of Physics, University of Liverpool, Liverpool L69 7ZE, United Kingdom
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
| | - S Kujanpää
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - S Lechner
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
| | - S Malbrunot-Ettenauer
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - P Müller
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - R Mathieson
- Department of Physics, University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | - I Moore
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - W Nörtershäuser
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - D Nesterenko
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - R Neugart
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- Institut für Kernchemie, Universität Mainz, Fritz-Straßmann-Weg 2, 55128 Mainz, Germany
| | - G Neyens
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
| | - A Ortiz-Cortes
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - H Penttilä
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - I Pohjalainen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - A Raggio
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - M Reponen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - S Rinta-Antila
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - L V Rodríguez
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- IJCLab, CNRS/IN2P3, Université Paris-Saclay, 91400 Orsay, France
| | - J Romero
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - R Sánchez
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
| | - F Sommer
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - M Stryjczyk
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - V Virtanen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - L Xie
- Department of Physics and Astronomy, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Z Y Xu
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
| | - X F Yang
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
- School of Physics and State Key Laboratory of Nuclear Physics and Technology, Peking University, 209 Chengfu Road, 100871 Beijing, China
| | - D T Yordanov
- IJCLab, CNRS/IN2P3, Université Paris-Saclay, 91400 Orsay, France
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Mulhern RE, Kondash AJ, Norman E, Johnson J, Levine K, McWilliams A, Napier M, Weber F, Stella L, Wood E, Lee Pow Jackson C, Colley S, Cajka J, MacDonald Gibson J, Hoponick Redmon J. Improved Decision Making for Water Lead Testing in U.S. Child Care Facilities Using Machine-Learned Bayesian Networks. Environ Sci Technol 2023; 57:17959-17970. [PMID: 36932953 PMCID: PMC10666530 DOI: 10.1021/acs.est.2c07477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Tap water lead testing programs in the U.S. need improved methods for identifying high-risk facilities to optimize limited resources. In this study, machine-learned Bayesian network (BN) models were used to predict building-wide water lead risk in over 4,000 child care facilities in North Carolina according to maximum and 90th percentile lead levels from water lead concentrations at 22,943 taps. The performance of the BN models was compared to common alternative risk factors, or heuristics, used to inform water lead testing programs among child care facilities including building age, water source, and Head Start program status. The BN models identified a range of variables associated with building-wide water lead, with facilities that serve low-income families, rely on groundwater, and have more taps exhibiting greater risk. Models predicting the probability of a single tap exceeding each target concentration performed better than models predicting facilities with clustered high-risk taps. The BN models' Fβ-scores outperformed each of the alternative heuristics by 118-213%. This represents up to a 60% increase in the number of high-risk facilities that could be identified and up to a 49% decrease in the number of samples that would need to be collected by using BN model-informed sampling compared to using simple heuristics. Overall, this study demonstrates the value of machine-learning approaches for identifying high water lead risk that could improve lead testing programs nationwide.
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Affiliation(s)
- Riley E. Mulhern
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - AJ Kondash
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Ed Norman
- Environmental
Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina 27609, United States
| | - Joseph Johnson
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Keith Levine
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Andrea McWilliams
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Melanie Napier
- Environmental
Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina 27609, United States
| | - Frank Weber
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Laurie Stella
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Erica Wood
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | | | - Sarah Colley
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Jamie Cajka
- RTI
International, Research
Triangle Park, North Carolina 27709, United States
| | - Jacqueline MacDonald Gibson
- Department
of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
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Mo A, Wood E, Shortt J, Hu E, McQuilten Z. Platelet transfusions and predictors of bleeding in patients with myelodysplastic syndromes. Eur J Haematol 2023; 111:592-600. [PMID: 37452616 PMCID: PMC10952506 DOI: 10.1111/ejh.14049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES This study aimed to describe the burden of thrombocytopenia, supportive care practices, bleeding complications and predictors of bleeding in MDS patients within a large Australian hospital network, to better understand the use and effectiveness of platelet transfusions in MDS. METHODS A retrospective cohort study of patients aged ≥18 years with MDS, chronic myelomonocytic leukaemia or MDS/myeloproliferative overlap neoplasm admitted from 2016 to 2018 was conducted. Data were obtained from hospital medical records. RESULTS One hundred seventy-nine patients (median age 78 years, 61.5% male) were identified. The median platelet count at first admission was 90 × 109 /L. Twenty-eight (15.6%) patients had severe thrombocytopenia (platelet count <20 × 109 /L), of whom nine (32.1%) received prophylactic platelet transfusions, five (17.9%) received tranexamic acid (TXA), seven (25%) received both platelet transfusions and TXA, and seven (25%) received no treatment. Bleeding events requiring hospitalisation occurred in 20 (11.2%) patients. Bleeding was not predicted by presenting platelet count, TXA use, platelet transfusion or anticoagulant/antiplatelet therapies. Three patients died of bleeding, at varying platelet counts (18, 38 and 153 × 109 /L). CONCLUSION Thrombocytopenia is common in MDS. Although guidelines recommend otherwise, prophylactic platelet transfusions were commonly used for severe thrombocytopenia. Despite the majority of patients receiving platelet transfusions and/or TXA, 11% developed major bleeding occurring at a wide range of platelet counts.
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Affiliation(s)
- Allison Mo
- Transfusion Research Unit, School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Monash HaematologyMonash HealthMelbourneVictoriaAustralia
- Austin Pathology and Department of HaematologyAustin HealthMelbourneVictoriaAustralia
| | - Erica Wood
- Transfusion Research Unit, School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Monash HaematologyMonash HealthMelbourneVictoriaAustralia
| | - Jake Shortt
- Monash HaematologyMonash HealthMelbourneVictoriaAustralia
- School of Clinical Sciences, Faculty of Medicine, Nursing & Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Erin Hu
- Pharmacy DepartmentMonash HealthMelbourneVictoriaAustralia
| | - Zoe McQuilten
- Transfusion Research Unit, School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Monash HaematologyMonash HealthMelbourneVictoriaAustralia
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Mo A, Poynton M, Wood E, Shortt J, Brunskill SJ, Doree C, Sandercock J, Saadah N, Luk E, Stanworth SJ, McQuilten Z. Do anemia treatments improve quality of life and physical function in patients with myelodysplastic syndromes (MDS)? A systematic review. Blood Rev 2023; 61:101114. [PMID: 37479599 DOI: 10.1016/j.blre.2023.101114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
Anemia is common in Myelodysplastic Syndromes (MDS). Different anemia treatments have been tested in clinical studies, but the full impact on patients' health-related quality of life (HRQoL) and physical function is unknown. The main aim of this review was to assess whether improvements in anemia are associated with changes in HRQoL/physical function. Twenty-six full-text publications were identified, enrolling 2211 patients: nine randomized trials (RCTs), fourteen non-randomized studies of interventions and three cross-sectional studies. Interventions included: growth factors/erythropoiesis-stimulating agents (n = 14), red cell transfusion (n = 9), erythroid maturation agents (n = 1), or a combination (n = 2). Five RCTs reported no changes in HRQoL despite erythroid response to the intervention, raising the question of whether anemia treatment alone can effectively improve HRQoL. Many studies were considered at high risk of bias for assessing HRQoL. There is a pressing need for future clinical trials to better define the nature of the relationship between anemia and HRQoL/functional outcomes.
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Affiliation(s)
- Allison Mo
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia; Department of Haematology, Monash Health, Clayton, Australia; Austin Pathology & Department of Haematology, Heidelberg, Australia
| | - Matthew Poynton
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Erica Wood
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia; Department of Haematology, Monash Health, Clayton, Australia
| | - Jake Shortt
- Department of Haematology, Monash Health, Clayton, Australia; School of Clinical Sciences, Monash University, Australia
| | - Susan J Brunskill
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, United Kingdom
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, United Kingdom
| | - Josie Sandercock
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, United Kingdom
| | - Nicholas Saadah
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
| | - Edwin Luk
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, Australia
| | - Simon J Stanworth
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; NHS Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom; Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Zoe McQuilten
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia; Department of Haematology, Monash Health, Clayton, Australia.
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Dinesh K, White N, Baker L, Sowden JE, Behrens-Spraggins S, Wood E, Charles J, Herrmann DN, Sharma G, Eichinger K. Disease-specific wearable sensor algorithms for profiling activity, gait, and balance in individuals with Charcot-Marie-Tooth disease type 1A. J Peripher Nerv Syst 2023; 28:368-381. [PMID: 37209301 DOI: 10.1111/jns.12562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND/AIMS Charcot-Marie-Tooth Disease type 1A (CMT1A), the most common inherited peripheral neuropathy, is characterized by progressive sensory loss and weakness, which results in impaired mobility. Increased understanding of the genetics and pathophysiology of CMT1A has led to development of potential therapeutic agents, necessitating clinical trial readiness. Wearable sensors may provide useful outcome measures for future trials. METHODS Individuals with CMT1A and unaffected controls were recruited for this 12-month study. Participants wore sensors for in-clinic assessments and at-home, from which activity, gait, and balance metrics were derived. Mann-Whitney U tests were used to analyze group differences for activity, gait, and balance parameters. Test-retest reliability of gait and balance parameters and correlations of these parameters with clinical outcome assessments (COAs) were examined. RESULTS Thirty individuals, 15 CMT1A, and 15 controls, participated. Gait and balance metrics demonstrated moderate to excellent reliability. CMT1A participants had longer step durations (p < .001), shorter step lengths (p = .03), slower gait speeds (p < .001), and greater postural sway (p < .001) than healthy controls. Moderate correlations were found between CMT-Functional Outcome Measure and step length (r = -0.59; p = .02), and gait speed (r = 0.64; p = .01); 11 out of 15 CMT1A participants demonstrated significant increases in stride duration between the first and last quarter of the 6-min walk test, suggesting fatigue. INTERPRETATION In this initial study, gait and balance metrics derived from wearable sensors were reliable and associated with COAs in individuals with CMT1A. Larger longitudinal studies are needed to confirm our findings and evaluate sensitivity and utility of these disease-specific algorithms for clinical trial use.
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Affiliation(s)
- K Dinesh
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA
| | - N White
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - L Baker
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - J E Sowden
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - S Behrens-Spraggins
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - E Wood
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - J Charles
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - D N Herrmann
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - G Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA
| | - K Eichinger
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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Casas-Orozco D, Laky D, Wang V, Abdi M, Feng X, Wood E, Reklaitis GV, Nagy ZK. Techno-economic analysis of dynamic, end-to-end optimal pharmaceutical campaign manufacturing using PharmaPy. AIChE J 2023; 69:e18142. [PMID: 38179085 PMCID: PMC10765457 DOI: 10.1002/aic.18142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 04/16/2023] [Indexed: 01/06/2024]
Abstract
Increased interest in the pharmaceutical industry to transition from batch to continuouos manufacturing motivates the use of digital frameworks that allow systematic comparison of candidate process configurations. This paper evaluates the technical and economic feasibility of different end-to-end optimal process configurations, viz. batch, hybrid and continuous, for small-scale manufacturing of an active pharmaceutical ingredient. Production campaigns were analyzed for those configurations containing continuous equipment, where significant start-up effects are expected given the relatively short campaign times considered. Hybrid operating mode was found to be the most attractive process configuration at intermediate and large annual production targets, which stems from combining continuous reactors and semi-batch vaporization equipment. Continuous operation was found to be more costly, due to long stabilization times of continuous crystallization, and thermodynamic limitations of flash vaporization. Our work reveals the benefits of systematic digital evaluation of process configurations that operate under feasible conditions and compliant product quality attributes.
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Affiliation(s)
- Daniel Casas-Orozco
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Daniel Laky
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Vivian Wang
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - Mesfin Abdi
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - X Feng
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - E Wood
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - Gintaras V Reklaitis
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Zoltan K Nagy
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
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9
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Jolley S, Lord J, Plant D, Wood E, Bracegirdle K, Browning S, Carter B, James K. A cluster randomised, 16-week, parallel-group multicentre trial to compare the effectiveness of a digital school-based cognitive behavioural resilience/wellbeing-building intervention targeting emotional and behavioural problems in vulnerable Year 4 primary school children in whole classes, to the usual school curriculum: a study protocol to the "CUES for Schools" trial. Trials 2023; 24:253. [PMID: 37013581 PMCID: PMC10071738 DOI: 10.1186/s13063-023-07267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Around 10% of school-aged children experience mental health difficulties. Many more are 'vulnerable': experiencing emotional and/or behavioural problems reaching clinical levels, and thus at greatest risk of future mental illness. The trial aim is to evaluate the effectiveness of the CUES for schools programme in reducing emotional and behavioural problems in vulnerable children. METHODS The "CUES for Schools" study is a multicentre cluster randomised controlled trial in primary schools in south east England. Schools will be randomised to receive the usual school curriculum, or the CUES programme (1:1). We aim to enrol 74 schools (5550 children including 2220 vulnerable children). CUES is a whole-class teacher-facilitated interactive digital cognitive-behavioural intervention, delivered as 24 short (20-min) modules over 12 weeks, targeting emotional/behavioural regulation skills. Children self-report emotional/behavioural problems at baseline, 8, and 16 weeks, and wellbeing and cognitive vulnerability at 0 and 16 weeks. Adverse events are assessed at 8 and 16 weeks. Teachers rate classroom behaviour at baseline and 16 weeks. School senior leadership teams and individual teachers consent to involvement in the study; parents can opt their child out of CUES sessions, assessments, or research. Children can similarly opt out and assent to research participation. The primary objective of this trial is to evaluate the effectiveness of CUES for schools compared to the usual school curriculum in improving emotional/behavioural problems for vulnerable Year 4 (8-9 years old) children at 16 weeks post-randomisation, as measured using a standardised questionnaire designed for primary schools. The secondary objective is to investigate the impact of the CUES for schools programme on both vulnerable and non-vulnerable children on wellbeing and teacher-rated classroom behaviour. DISCUSSION The study will show whether CUES for schools is more effective than the usual curriculum in reducing emotional and behavioural problems in vulnerable Year 4 children, and thus reducing the risk of mental health difficulties in later adolescent and adult life. As a digital, teacher-facilitated intervention, CUES for schools can be readily implemented, at minimal cost. If effective, CUES for schools therefore has the potential to reduce the impact of emotional/behavioural difficulties on children's learning, behaviour, and relationships and the burden of future mental health morbidity. TRIAL REGISTRATION Trial Registration ISRCTN11445338. Registered on September 12, 2022.
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Affiliation(s)
- S Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - J Lord
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - D Plant
- South London and Maudsley NHS Foundation Trust, Snowfields Adolescent Unit, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - E Wood
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - K Bracegirdle
- South London and Maudsley NHS Foundation Trust, Snowfields Adolescent Unit, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - S Browning
- South London and Maudsley NHS Foundation Trust, Snowfields Adolescent Unit, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - K James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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Pandolfo S, Wu Z, Giuseppe S, Ferro M, Sundaram C, Yong C, Derweesh I, Dhanji S, Margulis V, Taylor J, Tozzi M, Davis M, Wood E, Mehrazin R, Gonzalgo M, Eilender B, Mendiola D, Wang L, Tuderti G, Checcucci E, Verze P, Djaladat H, Porpiglia F, Abdollah F, Autorino R. Predictive factors of complications in patients undergoing minimally invasive radical nephroureterectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00955-7] [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: 02/12/2023]
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11
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Klimas J, Gorfinkel LR, Hamilton M, Lail M, Krupchanka D, Cullen W, Wood E, Fairbairn N. Early Career Training in Addiction Medicine: A Qualitative Study with Health Professions Trainees Following a Specialized Training Program in a Canadian Setting. Subst Use Misuse 2022; 57:2134-2141. [PMID: 36315582 PMCID: PMC9970042 DOI: 10.1080/10826084.2022.2137815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: There has been a notable deficiency in the implementation of addiction science in clinical practice and many healthcare providers feel unprepared to treat patients with substance use disorders (SUD) following training. However, the perceptions of addiction medicine training by learners in health professions have not been fully investigated. This qualitative study explored perceptions of prior training in SUD care among early-career trainees enrolled in Addiction Medicine fellowships and electives in Vancouver, Canada. Methods: From April 2015 - August 2018, we interviewed 45 early-career physicians, social workers, nurses, and 17 medical students participating in training in addiction medicine. We coded transcripts inductively using qualitative data analysis software (NVivo 11.4.3). Results: Findings revealed six key themes related to early-career training in addiction medicine: (1) Insufficient time spent on addiction education, (2) A need for more structured addictions training, (3) Insufficient hands-on clinical training and skill development, (4) Lack of patient-centeredness and empathy in the training environment, (5) Insufficient implementation of evidence-based medicine, and (6) Prevailing stigmas toward addiction medicine. Conclusion: Early clinical training in addiction medicine appears insufficient and largely focused on symptoms, rather than etiology or evidence. Early career learners in health professions perceived benefit to expanding access to quality education and reported positive learning outcomes after completing structured training programs.
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Affiliation(s)
- J. Klimas
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Addictology, First Faculty of Medicine, Charles University, Czech Republic
| | - Lauren R. Gorfinkel
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - M.A. Hamilton
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - M. Lail
- School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Ireland
| | - D. Krupchanka
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic; Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - W. Cullen
- School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Ireland
| | - E. Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - N. Fairbairn
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
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12
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Redmon JH, Kondash AJ, Norman E, Johnson J, Levine K, McWilliams A, Napier M, Weber F, Stella L, Wood E, Jackson CLP, Mulhern R. Lead Levels in Tap Water at Licensed North Carolina Child Care Facilities, 2020-2021. Am J Public Health 2022; 112:S695-S705. [PMID: 36179303 PMCID: PMC9528649 DOI: 10.2105/ajph.2022.307003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 09/03/2023]
Abstract
Objectives. To evaluate lead levels in tap water at licensed North Carolina child care facilities. Methods. Between July 2020 and October 2021, we enrolled 4005 facilities in a grant-funded, participatory science testing program. We identified risk factors associated with elevated first-draw lead levels using multiple logistic regression analysis. Results. By sample (n = 22 943), 3% of tap water sources exceeded the 10 parts per billion (ppb) North Carolina hazard level, whereas 25% of tap water sources exceeded 1 ppb, the American Academy of Pediatrics' reference level. By facility, at least 1 tap water source exceeded 1 ppb and 10 ppb at 56% and 12% of facilities, respectively. Well water reliance was the largest risk factor, followed by participation in Head Start programs and building age. We observed large variability between tap water sources within the same facility. Conclusions. Tap water in child care facilities is a potential lead exposure source for children. Given variability among tap water sources, it is imperative to test every source used for drinking and cooking so appropriate action can be taken to protect children's health. (Am J Public Health. 2022;112(S7):S695-S705. https://doi.org/10.2105/AJPH.2022.307003).
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Affiliation(s)
- Jennifer Hoponick Redmon
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - A J Kondash
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Ed Norman
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Joseph Johnson
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Keith Levine
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Andrea McWilliams
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Melanie Napier
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Frank Weber
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Laurie Stella
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Erica Wood
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Crystal Lee Pow Jackson
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Riley Mulhern
- Jennifer Hoponick Redmon, A. J. Kondash, Joseph Johnson, Keith Levine, Andrea McWilliams, Frank Weber, Laurie Stella, Erica Wood, Crystal Lee Pow Jackson, and Riley Mulhern are with RTI International, Research Triangle Park, NC. Ed Norman and Melanie Napier are with the Environmental Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
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McQuilten Z, Wellard C, Moore E, Augustson B, Bergin K, Blacklock H, Harrison S, Ho PJ, King T, Quach H, Mollee P, Rosengarten B, Walker P, Wood E, Spencer A. Predictors of early mortality in multiple myeloma: Results from the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR). Br J Haematol 2022; 198:830-837. [PMID: 35818641 PMCID: PMC9541953 DOI: 10.1111/bjh.18324] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/31/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Abstract
The frequency and causes of early mortality in patients with newly diagnosed multiple myeloma (NDMM) have not been well described in the era of novel agents. We investigated early mortality in a prospective cohort study of all patients with NDMM registered on the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR) at 36 institutions between July 2011 and March 2020. Early mortality was defined as death from any cause within the first 12 months after diagnosis. A total of 2377 patients with NDMM were included in the analysis, with a median (interquartile range) age of 67.4 (58.9–74.60 years, and 60% were male. Overall, 216 (9.1%) patients died within 12 months, with 119 (4.5%) having died within 6 months. Variables that were independent predictors of early mortality after adjustment in multivariable regression included age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.05–1.08; p < 0.001), Eastern Cooperative Oncology Group performance status (OR 1.50, 95% CI 1.26–1.79; p < 0.001), serum albumin (OR 0.95, 95% CI 0.93–0.98; p < 0.001), cardiac disease (OR 1.96, 95% CI 1.35–2.86; p < 0.001) and International Staging System (OR 1.40, 95% CI 1.07–1.82; p = 0.01). For those with a primary cause of death available, it was reported as disease‐related in 151 (78%), infection 13 (7%), other 29 (15%). Infection was listed as a contributing factor for death in 38% of patients.
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Affiliation(s)
- Zoe McQuilten
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cameron Wellard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elizabeth Moore
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Simon Harrison
- Peter MacCallum Cancer Centre/Royal Melbourne Hospital, Melbourne, Australia
| | - P Joy Ho
- Royal Prince Alfred Hospital, Sydney, Australia
| | - Tracy King
- Royal Prince Alfred Hospital, Sydney, Australia
| | - Hang Quach
- St.Vincent's Hospital, Melbourne, Australia
| | - Peter Mollee
- Princess Alexandra Hospital and University of Queensland, Brisbane, Australia
| | | | | | - Erica Wood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Unni DR, Moxon SAT, Bada M, Brush M, Bruskiewich R, Caufield JH, Clemons PA, Dancik V, Dumontier M, Fecho K, Glusman G, Hadlock JJ, Harris NL, Joshi A, Putman T, Qin G, Ramsey SA, Shefchek KA, Solbrig H, Soman K, Thessen AE, Haendel MA, Bizon C, Mungall CJ, Acevedo L, Ahalt SC, Alden J, Alkanaq A, Amin N, Avila R, Balhoff J, Baranzini SE, Baumgartner A, Baumgartner W, Belhu B, Brandes M, Brandon N, Burtt N, Byrd W, Callaghan J, Cano MA, Carrell S, Celebi R, Champion J, Chen Z, Chen M, Chung L, Cohen K, Conlin T, Corkill D, Costanzo M, Cox S, Crouse A, Crowder C, Crumbley ME, Dai C, Dančík V, De Miranda Azevedo R, Deutsch E, Dougherty J, Duby MP, Duvvuri V, Edwards S, Emonet V, Fehrmann N, Flannick J, Foksinska AM, Gardner V, Gatica E, Glen A, Goel P, Gormley J, Greyber A, Haaland P, Hanspers K, He K, He K, Henrickson J, Hinderer EW, Hoatlin M, Hoffman A, Huang S, Huang C, Hubal R, Huellas‐Bruskiewicz K, Huls FB, Hunter L, Hyde G, Issabekova T, Jarrell M, Jenkins L, Johs A, Kang J, Kanwar R, Kebede Y, Kim KJ, Kluge A, Knowles M, Koesterer R, Korn D, Koslicki D, Krishnamurthy A, Kvarfordt L, Lee J, Leigh M, Lin J, Liu Z, Liu S, Ma C, Magis A, Mamidi T, Mandal M, Mantilla M, Massung J, Mauldin D, McClelland J, McMurry J, Mease P, Mendoza L, Mersmann M, Mesbah A, Might M, Morton K, Muller S, Muluka AT, Osborne J, Owen P, Patton M, Peden DB, Peene RC, Persaud B, Pfaff E, Pico A, Pollard E, Price G, Raj S, Reilly J, Riutta A, Roach J, Roper RT, Rosenblatt G, Rubin I, Rucka S, Rudavsky‐Brody N, Sakaguchi R, Santos E, Schaper K, Schmitt CP, Schurman S, Scott E, Seitanakis S, Sharma P, Shmulevich I, Shrestha M, Shrivastava S, Sinha M, Smith B, Southall N, Southern N, Stillwell L, Strasser M"M, Su AI, Ta C, Thessen AE, Tinglin J, Tonstad L, Tran‐Nguyen T, Tropsha A, Vaidya G, Veenhuis L, Viola A, Grotthuss M, Wang M, Wang P, Watkins PB, Weber R, Wei Q, Weng C, Whitlock J, Williams MD, Williams A, Womack F, Wood E, Wu C, Xin JK, Xu H, Xu C, Yakaboski C, Yao Y, Yi H, Yilmaz A, Zheng M, Zhou X, Zhou E, Zhu Q, Zisk T. Biolink Model: A universal schema for knowledge graphs in clinical, biomedical, and translational science. Clin Transl Sci 2022; 15:1848-1855. [PMID: 36125173 PMCID: PMC9372416 DOI: 10.1111/cts.13302] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 12/12/2022] Open
Abstract
Within clinical, biomedical, and translational science, an increasing number of projects are adopting graphs for knowledge representation. Graph‐based data models elucidate the interconnectedness among core biomedical concepts, enable data structures to be easily updated, and support intuitive queries, visualizations, and inference algorithms. However, knowledge discovery across these “knowledge graphs” (KGs) has remained difficult. Data set heterogeneity and complexity; the proliferation of ad hoc data formats; poor compliance with guidelines on findability, accessibility, interoperability, and reusability; and, in particular, the lack of a universally accepted, open‐access model for standardization across biomedical KGs has left the task of reconciling data sources to downstream consumers. Biolink Model is an open‐source data model that can be used to formalize the relationships between data structures in translational science. It incorporates object‐oriented classification and graph‐oriented features. The core of the model is a set of hierarchical, interconnected classes (or categories) and relationships between them (or predicates) representing biomedical entities such as gene, disease, chemical, anatomic structure, and phenotype. The model provides class and edge attributes and associations that guide how entities should relate to one another. Here, we highlight the need for a standardized data model for KGs, describe Biolink Model, and compare it with other models. We demonstrate the utility of Biolink Model in various initiatives, including the Biomedical Data Translator Consortium and the Monarch Initiative, and show how it has supported easier integration and interoperability of biomedical KGs, bringing together knowledge from multiple sources and helping to realize the goals of translational science.
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Affiliation(s)
- Deepak R. Unni
- Genome Biology Unit, European Molecular Biology Laboratory Heidelberg Germany
- Division of Environmental Genomics and Systems Biology Lawrence Berkeley National Laboratory Berkeley California USA
| | - Sierra A. T. Moxon
- Division of Environmental Genomics and Systems Biology Lawrence Berkeley National Laboratory Berkeley California USA
| | - Michael Bada
- Center for Health AI University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Matthew Brush
- Center for Health AI University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | | | - J. Harry Caufield
- Division of Environmental Genomics and Systems Biology Lawrence Berkeley National Laboratory Berkeley California USA
| | - Paul A. Clemons
- Chemical Biology and Therapeutics Science Program Broad Institute Cambridge Massachusetts USA
| | - Vlado Dancik
- Chemical Biology and Therapeutics Science Program Broad Institute Cambridge Massachusetts USA
| | - Michel Dumontier
- Institute of Data Science Maastricht University Maastricht The Netherlands
| | - Karamarie Fecho
- Renaissance Computing Institute University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | | | | | - Nomi L. Harris
- Division of Environmental Genomics and Systems Biology Lawrence Berkeley National Laboratory Berkeley California USA
| | - Arpita Joshi
- Institute for Systems Biology Seattle Washington USA
| | - Tim Putman
- Center for Health AI University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Guangrong Qin
- Institute for Systems Biology Seattle Washington USA
| | - Stephen A. Ramsey
- Department of Biomedical Sciences Oregon State University Corvallis Oregon USA
| | - Kent A. Shefchek
- Center for Health AI University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | | | - Karthik Soman
- Department of Neurology University of California San Francisco San Francisco California USA
| | - Anne E. Thessen
- Center for Health AI University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Melissa A. Haendel
- Center for Health AI University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Chris Bizon
- Renaissance Computing Institute University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Christopher J. Mungall
- Division of Environmental Genomics and Systems Biology Lawrence Berkeley National Laboratory Berkeley California USA
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MacDonald Gibson J, III FS, Wood E, Lockhart S, Bruine de Bruin W. Private Well Testing in Peri-Urban African-American Communities Lacking Access to Regulated Municipal Drinking Water: A Mental Models Approach to Risk Communication. Risk Anal 2022; 42:799-817. [PMID: 34342023 PMCID: PMC9292044 DOI: 10.1111/risa.13799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Majority African-American neighborhoods on the edges of North Carolina municipalities are less likely than white peri-urban neighborhoods to be served by a community system regulated under the Safe Drinking Water Act. These households rely on unregulated private wells, which are at much higher risk of contamination than neighboring community water supplies. Yet, risk awareness of consuming well water is low, and no prior research has tested risk communication interventions for these communities. We present a randomized-controlled trial of an oversized postcard to promote water testing among this audience. The postcard design followed the mental models approach to risk communication. To our knowledge, this is the first U.S. randomized-controlled trial of a mailed communication to promote water testing in any audience and one of few trials of the mental models approach. We evaluated the postcard's effects on self-reported water testing with and without a free water test offer (vs. no-intervention control) via a survey mailed one month after the interventions. The combined communication and free test doubled the odds of self-reported water testing, compared to the control group (p = 0.046). It increased the odds of testing by 65%, compared to the free test alone. Recall of receiving a postcard about water testing increased the odds of self-reported testing twelve-fold (p < 0.001). Although these results suggest that targeted risk information delivered by mail can promote water testing when paired with a free test, the mechanism remains unclear. Additional research on beliefs influencing perceptions about well water may yield interventions that are even more effective.
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Affiliation(s)
- Jacqueline MacDonald Gibson
- Department of Environmental and Occupational HealthSchool of Public Health, Indiana UniversityBloomingtonINUSA
| | | | | | | | - Wändi Bruine de Bruin
- Sol Price School of Public Policy and Department of PsychologyUniversity of Southern CaliforniaLos AngelesCAUSA
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Nosyk B, Min JE, Pearce LA, Zhou H, Homayra F, Wang L, Piske M, McCarty D, Gardner G, O'Briain W, Wood E, Daly P, Walsh T, Henry B. Development and validation of health system performance measures for opioid use disorder in British Columbia, Canada. Drug Alcohol Depend 2022; 233:109375. [PMID: 35231716 DOI: 10.1016/j.drugalcdep.2022.109375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/11/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Performance measurement provides an evidence-based means to inform development of interventions to improve the quality of care for people who use opioids. We aimed to develop and assess the predictive validity of health system performance measures for opioid use disorder (OUD) in British Columbia (BC), Canada. METHODS Performance measures were generated using retrospective population-level administrative datasets (both provincial and regional) and publicly-reported retrospective data according to four domains (care engagement, clinical guideline compliance, integration, and healthcare utilization). The adjusted odds ratio was estimated via generalized linear mixed models to determine predictive validity for all-cause hospitalization or mortality within 6 months of measurement. FINDINGS A total of 102 performance measures were constructed. We identified 55,470 diagnosed PWOUD, and 39,456 ever engaged in opioid agonist treatment (OAT). We found divergent rates of treatment for concurrent conditions (7.4% for alcohol use disorder to 80.1% for HIV/AIDS), low levels of linkage to OAT and other outpatient care following acute care, and increasing levels of service provision, including increases in OAT prescribers and pharmacies, naloxone kit distribution and overdose prevention site visitation. Our analyses on the predictive validity measures largely supported a priori hypotheses on the direction of effect on the outcome. CONCLUSIONS We identified a range of priorities to improve the quality of care for PWOUD, with critical gaps in linkage to care through acute care settings and long-term engagement in OAT. The proposed measures can be derived for geographic and clinical subgroups and updated over time, providing a basis to monitor and evaluate efforts to address the public health burden of OUD.
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Affiliation(s)
- B Nosyk
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Rm 11300 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
| | - J E Min
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - L A Pearce
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - H Zhou
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - F Homayra
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - L Wang
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - M Piske
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - D McCarty
- Oregon Health & Science University, 1810 SW 5th Ave, Flrs 2 5 and 6, Portland, OR 97201, USA
| | - G Gardner
- British Columbia Ministry of Mental Health and Addictions, PO Box 9672 Stn Prov Govt, Victoria, British Columbia V8W 9P6, Canada
| | - W O'Briain
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia V6Z 2A9, Canada
| | - E Wood
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317 -2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - P Daly
- Vancouver Coastal Health Authority, 601 West Broadway, Vancouver, British Columbia V5Z 4C2, Canada
| | - T Walsh
- British Columbia Ministry of Mental Health and Addictions, PO Box 9672 Stn Prov Govt, Victoria, British Columbia V8W 9P6, Canada
| | - B Henry
- Office of the Provincial Health Officer, PO Box 9648, Stn Prov Govt, Victoria, British Columbia V8W 9P4, Canada
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Lucas R, Dennington P, Wood E, Murray KJ, Cheng A, Burgner D, Singh-Grewal D. Epidemiology of Kawasaki disease in Australia using two nationally complete datasets. J Paediatr Child Health 2022; 58:674-682. [PMID: 34716731 DOI: 10.1111/jpc.15816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/17/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
AIM The incidence of Kawasaki disease (KD) is reported to be increasing in some populations. We sought to describe long-term trends in the incidence and epidemiology of KD in Australia over 25 years. METHODS Two nationally complete administrative datasets relevant to KD in Australia were analysed and compared. The Australian Red Cross Lifeblood Supply Tracking Analysis Reporting System (STARS) recorded all doses of immunoglobulin (IVIG) approved in Australia between January 2007 and June 2016. The Australian Institute of Health and Welfare National Hospital Morbidity Database (NHMD) records all episodes of care in hospitals across Australia. Data relevant to KD were extracted an analysed, with comparisons made for the period of data overlap. RESULTS During the period of data overlap (2007-2015) the IVIG treatment rate in the 0- to 4-year age group (calculated from STARS) was 14.31 per 100 000 person-years (95% confidence interval 13.67-14.97). The hospitalisation rate in the same age group (calculated from the NHMD) was 14.99 per 100 000 person-years (95% confidence interval 14.33-15.66). Hospitalisation rates rose at an average rate of 3.54% annually over the 25 years to 2017 in the 0- to 4-year age group, almost exclusively in the 1- to 4-year age group. CONCLUSIONS There is evidence of increasing KD diagnosis in Australia. Similar trends have also been reported in Asia but not in North America or Europe. Increasing diagnosis may reflect a true increase in disease incidence, increasing recognition or overdiagnosis. Further research is needed to determine the cause for these trends.
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Affiliation(s)
- Ryan Lucas
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of General Medicine, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Peta Dennington
- Transfusion Medicine Services Team, Australian Red Cross Lifeblood New South Wales and Australian Capital Territory, Sydney, New South Wales, Australia
| | - Erica Wood
- Transfusion Research Unit, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.,Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Kevin J Murray
- Department of Rheumatology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Allen Cheng
- Department of Infectious Diseases, Alfred Health, Infection Prevention and Healthcare Epidemiology Unit, Melbourne, Victoria, Australia.,Infectious Disease Epidemiology Unit, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - David Burgner
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Melbourne Medical School, Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Davinder Singh-Grewal
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of General Medicine, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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Green L, Stanworth S, McQuilten Z, Lin V, Tucker H, Jackson B, Badawi M, Hindawi S, Chaurasia R, Patidar G, Pandey HC, Fasola F, Miyata S, Matsumoto M, Matsushita T, Rahimi-Levene N, Peer V, Pavenski K, Callum J, Thompson T, Murphy M, Staves J, Maegele M, Abeyakoon C, Rushford K, Wood E, Nuñez MA, Mellado S, Saa E, Triyono T, Pratomo B, Apelseth TO, Dunbar N. International Forum on the Management of Major Haemorrhage: Summary. Vox Sang 2022; 117:746-753. [PMID: 35050497 DOI: 10.1111/vox.13244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 12/24/2022]
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19
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Green L, Stanworth S, McQuilten Z, Lin V, Tucker H, Jackson B, Badawi M, Hindawi S, Chaurasia R, Patidar G, Pandey HC, Fasola F, Miyata S, Matsumoto M, Matsushita T, Rahimi-Levene N, Peer V, Pavenski K, Callum J, Thompson T, Murphy M, Staves J, Maegele M, Abeyakoon C, Rushford K, Wood E, Nuñez MA, Mellado S, Saa E, Triyono T, Pratomo B, Apelseth TO, Dunbar N. International Forum on the Management of Major Haemorrhage: Responses. Vox Sang 2022; 117:E58-E74. [PMID: 35050501 DOI: 10.1111/vox.13243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
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Kim R, Chaoul J, Wood E, Ascher-Walsh C. Patient and Surgical Characteristics Associated with Delay or Cancellation of Elective Gynecologic Surgeries Due to the COVID-19 Pandemic. J Minim Invasive Gynecol 2021. [PMCID: PMC8518383 DOI: 10.1016/j.jmig.2021.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Study Objective This study aims to identify patient characteristics associated with length of delay or not returning for elective benign gynecologic surgical procedures that were canceled due to the COVID-19 pandemic. Design Retrospective review of electronic medical records. Setting Academic, urban, tertiary hospital system. Patients or Participants Between March 15, 2020, and May 15, 2020, all elective surgical procedures were canceled due to resource limitations. Electronic medical records were reviewed through November 15, 2020, to assess whether patients rescheduled or did not come back for surgery within the following six-month period. Interventions N/A. Measurements and Main Results 219 benign gynecologic surgeries were canceled between March 15 and May 15, 2020. 158 (72%) patients returned within the following six months for their procedure, and 61 patients (28%) did not return. Among patients who rescheduled, the length of delay was not correlated with age, race/ethnicity, or route of surgery. There was, however, sufficient data to conclude that length of delay differed by primary indication of surgery (p=.0173). There was an association between not returning for surgery and primary indication of pelvic organ prolapse/ incontinence repair (p=.0203). Conclusion The majority of patients rescheduled their procedure within six months following the peak of the COVID-19 crisis. The primary indication of pelvic organ prolapse and incontinence was associated with a decreased likelihood of returning for surgery within six months.
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Shaw B, Wood E, McQuilten Z, Callum J, Romon I, Sanroma P, Garcia D, Crispin P, Castilho L, Kutner JM, Yokoyama APH, Bravo A, Sanchez EF, Silva KM, Arora S, Radhakrishnan N, Dua S, Ziman A, Wikman A, Lubenow N, Zingmark LB, Louw V, Loebenberg P, Sidhu D, Redfern T, Nahirniak S, Dunbar N. International Forum on Home-Based Blood Transfusion: Responses. Vox Sang 2021; 117:E44-E57. [PMID: 34697811 DOI: 10.1111/vox.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
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Shaw B, Wood E, McQuilten Z, Callum J, Romon I, Sanroma P, Garcia D, Crispin PJ, Castilho L, Kutner JM, Yokoyama APH, Bravo A, Sanchez EF, Maldonado Silva K, Arora S, Radhakrishnan N, Dua S, Ziman A, Wikman A, Lubenow N, Bodecker Zingmark L, Louw VJ, Loebenberg P, Sidhu D, Redfern T, Nahirniak S, Dunbar N. International Forum on Home-Based Blood Transfusion: Summary. Vox Sang 2021; 117:616-623. [PMID: 34697808 DOI: 10.1111/vox.13200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
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Casas-Orozco D, Laky D, Wang V, Abdi M, Feng X, Wood E, Laird C, Reklaitis GV, Nagy ZK. PharmaPy: An object-oriented tool for the development of hybrid pharmaceutical flowsheets. Comput Chem Eng 2021; 153:107408. [PMID: 38235368 PMCID: PMC10793241 DOI: 10.1016/j.compchemeng.2021.107408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Process design and optimization continue to provide computational challenges as the chemical engineering and process optimization communities seek to address more complex and larger scale applications. Software tools for digital design and flowsheet simulation are readily available for traditional chemical processing applications such as in commodity chemicals and hydrocarbon processing; however, tools for pharmaceutical manufacturing are much less well developed. This paper introduces, PharmaPy, a Python-based modelling platform for pharmaceutical manufacturing systems design and optimization. The versatility of the platform is demonstrated in simulation and optimization of both continuous and batch processes. The structure and features of a Python-based modeling platform, PharmaPy are presented. Illustrative examples are shown to highlight key features of the platform and framework.
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Affiliation(s)
- Daniel Casas-Orozco
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Daniel Laky
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Vivian Wang
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - Mesfin Abdi
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - X. Feng
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - E. Wood
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - Carl Laird
- Sandia National Laboratories, Albuquerque, NM 87123, USA
| | - Gintaras V. Reklaitis
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Zoltan K. Nagy
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
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Bergin K, Wellard C, Augustson B, Cooke R, Blacklock H, Harrison SJ, Ho J, King T, Quach H, Mollee P, Walker P, Moore E, McQuilten Z, Wood E, Spencer A. Real-world utilisation of ASCT in multiple myeloma (MM): a report from the Australian and New Zealand myeloma and related diseases registry (MRDR). Bone Marrow Transplant 2021; 56:2533-2543. [PMID: 34011965 DOI: 10.1038/s41409-021-01308-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 12/22/2022]
Abstract
Supported by clinical trial proven survival benefit, clinical guidelines recommend upfront autologous stem cell transplantation (ASCT) for eligible MM patients. However, reported real-world utilisation is lower than expected (40-60%). We reviewed ASCT utilisation, demographics and outcomes for MM patients (≤70 years, ≥12-month follow-up) enroled onto the Australian/New Zealand MRDR from June 2012 to May 2020. In 982 patients (<65 years: 684, 65-70 years: 298), ASCT utilisation was 76% overall (<65 years: 83%, 65-70 years: 61%, front-line therapy: 67%). Non-ASCT recipients were older (median age: 65 years vs 60 years, p < 0.001), had more comorbidities (cardiac disease: 16.9% vs 5.4%, p < 0.001; diabetes: 19.1% vs 7.0%, p < 0.001; renal dysfunction: median eGFR(ml/min): 68 vs 80, p < 0.001), inferior performance status (ECOG ≥ 2: 26% vs 13%, p < 0.001) and higher-risk MM (ISS-3: 37% vs 26%, p = 0.009, R-ISS-3 18.6% vs 11.8%, p = 0.051) than ASCT recipients. ASCT survival benefit (median progression-free survival (PFS): 45.3 months vs 35.2 months, p < 0.001; overall survival (OS): NR vs 64.0 months, p < 0.001) was maintained irrespective of age (<65 years: median PFS: 45.3 months vs 37.7 months, p = 0.04, OS: NR vs 68.2 months, p = 0.002; 65-70 years: median PFS: 46.7 months vs 29.2 months, p < 0.001, OS: 76.9 months vs 55.6 months, p = 0.005). This large, real-world cohort reaffirms ASCT survival benefit, including in 'older' patients necessitating well-designed studies evaluating ASCT in 'older' MM to inform evidence-based patient selection.
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Affiliation(s)
- Krystal Bergin
- Alfred Health-Monash University, Melbourne, VIC, Australia
| | - Cameron Wellard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | | | | | - Simon J Harrison
- Peter MacCallum Cancer Centre/Royal Melbourne Hospital, Melbourne, VIC, Australia.,Sir Peter MacCallum Dept of Oncology, Melbourne University, Melbourne, VIC, Australia
| | - Joy Ho
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Tracy King
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Hang Quach
- St.Vincent's Hospital, Melbourne, VIC, Australia
| | - Peter Mollee
- Princess Alexandra Hospital and University of Queensland, Brisbane, QLD, Australia
| | | | - Elizabeth Moore
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Zoe McQuilten
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Erica Wood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew Spencer
- Alfred Health-Monash University, Melbourne, VIC, Australia.
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25
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Lucas R, Dennington P, Wood E, Dionne A, de Ferranti SD, Newburger JW, Dahdah N, Cheng A, Burgner D, Singh-Grewal D. Variation in the management of Kawasaki disease in Australia and New Zealand: A survey of paediatricians. J Paediatr Child Health 2021; 57:646-652. [PMID: 33296115 DOI: 10.1111/jpc.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to describe the current management practices for Kawasaki disease (KD) in Australia and New Zealand. METHODS We performed a secondary analysis on the Australian and New Zealand responses to a large international survey of clinicians' perspectives on KD diagnosis and management. RESULTS There was general consensus among Australian and New Zealand clinicians regarding the indications for intravenous immunoglobulin and aspirin in the management of acute KD. There was less consensus on the dose of these agents, the definition and management of treatment-resistant KD and the approach to long-term thromboprophylaxis. CONCLUSION Most clinicians use intravenous immunoglobulin for primary treatment of KD. There is variation regarding other aspects of KD diagnosis and important management issues. Future studies should confirm whether this reported variation occurs in real-world practice and assess potential impacts on patient outcome.
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Affiliation(s)
- Ryan Lucas
- Department of General Medicine, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia.,Children's Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Peta Dennington
- Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Erica Wood
- Transfusion Research Unit, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Nagib Dahdah
- Department of Pediatric Cardiology, University of Montreal, Montreal, Quebec, Canada
| | - Allen Cheng
- Infectious Disease Epidemiology Unit, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - David Burgner
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Davinder Singh-Grewal
- Department of General Medicine, The Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia.,Children's Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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26
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Goel R, Bloch EM, Pirenne F, Al-Riyami AZ, Crowe E, Dau L, Land K, Townsend M, Jecko T, Rahimi-Levene N, Patidar G, Josephson CD, Arora S, Vermeulen M, Vrielink H, Montemayor C, Oreh A, Hindawi S, van den Berg K, Serrano K, So-Osman C, Wood E, Devine DV, Spitalnik SL. ABO blood group and COVID-19: a review on behalf of the ISBT COVID-19 working group. Vox Sang 2021; 116:849-861. [PMID: 33578447 PMCID: PMC8014128 DOI: 10.1111/vox.13076] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [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: 11/11/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 12/30/2022]
Abstract
Growing evidence suggests that ABO blood group may play a role in the immunopathogenesis of SARS-CoV-2 infection, with group O individuals less likely to test positive and group A conferring a higher susceptibility to infection and propensity to severe disease. The level of evidence supporting an association between ABO type and SARS-CoV-2/COVID-19 ranges from small observational studies, to genome-wide-association-analyses and country-level meta-regression analyses. ABO blood group antigens are oligosaccharides expressed on red cells and other tissues (notably endothelium). There are several hypotheses to explain the differences in SARS-CoV-2 infection by ABO type. For example, anti-A and/or anti-B antibodies (e.g. present in group O individuals) could bind to corresponding antigens on the viral envelope and contribute to viral neutralization, thereby preventing target cell infection. The SARS-CoV-2 virus and SARS-CoV spike (S) proteins may be bound by anti-A isoagglutinins (e.g. present in group O and group B individuals), which may block interactions between virus and angiotensin-converting-enzyme-2-receptor, thereby preventing entry into lung epithelial cells. ABO type-associated variations in angiotensin-converting enzyme-1 activity and levels of von Willebrand factor (VWF) and factor VIII could also influence adverse outcomes, notably in group A individuals who express high VWF levels. In conclusion, group O may be associated with a lower risk of SARS-CoV-2 infection and group A may be associated with a higher risk of SARS-CoV-2 infection along with severe disease. However, prospective and mechanistic studies are needed to verify several of the proposed associations. Based on the strength of available studies, there are insufficient data for guiding policy in this regard.
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Affiliation(s)
- Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine and Mississippi Valley Regional Blood Center, Springfield, IL, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - France Pirenne
- Etablissement Français du Sang Ile de France, Hôpital Henri Mondor, Créteil, France
| | - Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Elizabeth Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laetitia Dau
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Land
- Vitalant, Scottsdale, AZ, USA.,Department of Pathology, UT, San Antonio, TX, USA
| | | | | | | | - Gopal Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Satyam Arora
- Super Speciality Pediatric Hospital and Post Graduate Teaching Institute, Noida, India
| | - Marion Vermeulen
- The South African National Blood Service, Port Elizabeth, South Africa
| | - Hans Vrielink
- Dept Unit Transfusion Medicine, Sanquin Bloodbank, Amsterdam, the Netherlands
| | | | - Adaeze Oreh
- National Blood Transfusion Service, Department of Hospital Services, Federal Ministry of Health, Abuja, Nigeria
| | | | - Karin van den Berg
- Translational Research Department, Medical Division, South African National Blood Service, Port Elizabeth, South Africa.,Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Katherine Serrano
- Canadian Blood Services, Vancouver, BC, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia So-Osman
- Dept Unit Transfusion Medicine, Sanquin Bloodbank, Amsterdam, the Netherlands.,Dept. of Haematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Erica Wood
- Monash University, Melbourne, VIC, Australia
| | - Dana V Devine
- Canadian Blood Services, Vancouver, BC, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Steven L Spitalnik
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
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27
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Bergin K, Wellard C, Moore E, McQuilten Z, Blacklock H, Harrison SJ, Ho PJ, King T, Quach H, Mollee P, Walker P, Wood E, Spencer A. The Myeloma Landscape in Australia and New Zealand: The First 8 Years of the Myeloma and Related Diseases Registry (MRDR). Clin Lymphoma Myeloma Leuk 2021; 21:e510-e520. [PMID: 33785297 DOI: 10.1016/j.clml.2021.01.016] [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] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Real-world multiple myeloma (MM) data are scarce, with most data originating from clinical trials. The Myeloma and Related Diseases Registry (MRDR) is a prospective clinical-quality registry of newly diagnosed cases of plasma cell disorders established in 2012 and operating at 44 sites in Australia and New Zealand as of April 2020. METHODS We reviewed all patients enrolled onto the MRDR between June 2012 and April 2020. Baseline characteristics, treatment, and outcome data were reviewed for MM patients with comparisons made by chi-square tests (categorical variables) and rank sum tests (continuous variables). Kaplan-Meier analysis was used to estimate progression-free survival and overall survival (OS). RESULTS As of April 2020, a total of 2405 MM patients were enrolled (median age, 67 years, with 40% aged > 70 years). High-risk features were present in 13% to 31% of patients: fluorescence in-situ hybridization (FISH) ≥ 1 of t(4;14), t(14;16), or del(17p) 18%, International Staging System (ISS)-3 31%, and Revised ISS (R-ISS)-3 13%. Cytogenetic/FISH analyses were performed in 50% and 68% of patients, respectively, with an abnormal karyotype result in 34%. Bortezomib-containing therapy was the most common first-line therapy (79.3%, n = 1706). Patients not receiving bortezomib were older (median age, 76 vs 65 years, P < .001) with inferior performance status (Eastern Cooperative Oncology Group performance status ≥ 2, 41% vs 18%, P < .001). Median progression-free survival and OS were 30.8 and 65.8 months, respectively. Younger patients had superior OS (76.3 vs 46.7 months, P < .001, < 70 and ≥ 70 years, respectively). R-ISS score was available in 50.7% (n = 1220) of patients, and higher R-ISS was associated with inferior OS (R-ISS-1 vs R-ISS-2 vs R-ISS-3: not reached vs 68.1 months vs 33.2 months, respectively, P < .001). CONCLUSION Clinical registries provide a more complete picture of MM diagnosis and treatment, and highlight the challenges of adhering to best practices in a real-world context.
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Affiliation(s)
- Krystal Bergin
- Department of Haematology, Alfred Health-Monash University, Melbourne, Victoria, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zoe McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hilary Blacklock
- Clinical Haematology, Middlemore Hospital, Middlemore, Auckland, New Zealand
| | - Simon J Harrison
- Clinical Haematology, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Melbourne, Victoria, Australia; Clinical Haematology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - P Joy Ho
- Royal Prince Alfred Hospital, Camperdown, and University of Sydney, Sydney, New South Wales, Australia
| | - Tracy King
- Royal Prince Alfred Hospital, Camperdown, and University of Sydney, Sydney, New South Wales, Australia
| | - Hang Quach
- Clinical Haematology, University of Melbourne and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter Mollee
- Clinical Haematology, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Patricia Walker
- Clinical Haematology, Peninsula Health, Frankston, Victoria, Australia
| | - Erica Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Spencer
- Department of Haematology, Alfred Health-Monash University, Melbourne, Victoria, Australia.
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28
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Catlin CC, Connors HL, Teaster PB, Wood E, Sager ZS, Moye J. Unrepresented Adults Face Adverse Healthcare Consequences: The Role of Guardians, Public Guardianship Reform, and Alternative Policy Solutions. J Aging Soc Policy 2021; 34:418-437. [PMID: 33461436 PMCID: PMC8286275 DOI: 10.1080/08959420.2020.1851433] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Persons without family or friends to serve as healthcare agents may become "unrepresented" in healthcare, with no one to serve as healthcare agents when decisional support is needed. Surveys of clinicians (N = 81) and attorneys/guardians (N = 23) in Massachusetts reveal that unrepresented adults experience prolonged hospital stays (66%), delays in receiving palliative care (52%), delays in treatment (49%), and other negative consequences. Clinicians say guardianship is most helpful in resolving issues related to care transitions, medical treatment, quality of life, housing, finances, and safety. However, experiences with guardianship are varied, with delays often/always in court appointments (43%) and actions after appointments (24%). Policy solutions include legal reform, education, and alternate models.
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Affiliation(s)
- Casey C Catlin
- Boston VA Research Institute and VA Boston Healthcare System, Boston, MA, USA
| | | | - Pamela B Teaster
- Virginia Tech University, Department of Human Development and Faculty Science, Blacksburg, VA, USA
| | - Erica Wood
- American Bar Association Commission on Law and Aging, Washington DC, USA
| | - Zachary S Sager
- New England GRECC and Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Jennifer Moye
- New England GRECC and Harvard Medical School, Department of Psychiatry, Boston, MA, USA
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29
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Angus DC, Derde L, Al-Beidh F, Annane D, Arabi Y, Beane A, van Bentum-Puijk W, Berry L, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Buzgau A, Cheng AC, de Jong M, Detry M, Estcourt L, Fitzgerald M, Goossens H, Green C, Haniffa R, Higgins AM, Horvat C, Hullegie SJ, Kruger P, Lamontagne F, Lawler PR, Linstrum K, Litton E, Lorenzi E, Marshall J, McAuley D, McGlothin A, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Parker J, Rowan K, Sanil A, Santos M, Saunders C, Seymour C, Turner A, van de Veerdonk F, Venkatesh B, Zarychanski R, Berry S, Lewis RJ, McArthur C, Webb SA, Gordon AC, Al-Beidh F, Angus D, Annane D, Arabi Y, van Bentum-Puijk W, Berry S, Beane A, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Cheng A, De Jong M, Derde L, Estcourt L, Goossens H, Gordon A, Green C, Haniffa R, Lamontagne F, Lawler P, Litton E, Marshall J, McArthur C, McAuley D, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Rowan K, Seymour C, Turner A, van de Veerdonk F, Webb S, Zarychanski R, Campbell L, Forbes A, Gattas D, Heritier S, Higgins L, Kruger P, Peake S, Presneill J, Seppelt I, Trapani T, Young P, Bagshaw S, Daneman N, Ferguson N, Misak C, Santos M, Hullegie S, Pletz M, Rohde G, Rowan K, Alexander B, Basile K, Girard T, Horvat C, Huang D, Linstrum K, Vates J, Beasley R, Fowler R, McGloughlin S, Morpeth S, Paterson D, Venkatesh B, Uyeki T, Baillie K, Duffy E, Fowler R, Hills T, Orr K, Patanwala A, Tong S, Netea M, Bihari S, Carrier M, Fergusson D, Goligher E, Haidar G, Hunt B, Kumar A, Laffan M, Lawless P, Lother S, McCallum P, Middeldopr S, McQuilten Z, Neal M, Pasi J, Schutgens R, Stanworth S, Turgeon A, Weissman A, Adhikari N, Anstey M, Brant E, de Man A, Lamonagne F, Masse MH, Udy A, Arnold D, Begin P, Charlewood R, Chasse M, Coyne M, Cooper J, Daly J, Gosbell I, Harvala-Simmonds H, Hills T, MacLennan S, Menon D, McDyer J, Pridee N, Roberts D, Shankar-Hari M, Thomas H, Tinmouth A, Triulzi D, Walsh T, Wood E, Calfee C, O’Kane C, Shyamsundar M, Sinha P, Thompson T, Young I, Bihari S, Hodgson C, Laffey J, McAuley D, Orford N, Neto A, Detry M, Fitzgerald M, Lewis R, McGlothlin A, Sanil A, Saunders C, Berry L, Lorenzi E, Miller E, Singh V, Zammit C, van Bentum Puijk W, Bouwman W, Mangindaan Y, Parker L, Peters S, Rietveld I, Raymakers K, Ganpat R, Brillinger N, Markgraf R, Ainscough K, Brickell K, Anjum A, Lane JB, Richards-Belle A, Saull M, Wiley D, Bion J, Connor J, Gates S, Manax V, van der Poll T, Reynolds J, van Beurden M, Effelaar E, Schotsman J, Boyd C, Harland C, Shearer A, Wren J, Clermont G, Garrard W, Kalchthaler K, King A, Ricketts D, Malakoutis S, Marroquin O, Music E, Quinn K, Cate H, Pearson K, Collins J, Hanson J, Williams P, Jackson S, Asghar A, Dyas S, Sutu M, Murphy S, Williamson D, Mguni N, Potter A, Porter D, Goodwin J, Rook C, Harrison S, Williams H, Campbell H, Lomme K, Williamson J, Sheffield J, van’t Hoff W, McCracken P, Young M, Board J, Mart E, Knott C, Smith J, Boschert C, Affleck J, Ramanan M, D’Souza R, Pateman K, Shakih A, Cheung W, Kol M, Wong H, Shah A, Wagh A, Simpson J, Duke G, Chan P, Cartner B, Hunter S, Laver R, Shrestha T, Regli A, Pellicano A, McCullough J, Tallott M, Kumar N, Panwar R, Brinkerhoff G, Koppen C, Cazzola F, Brain M, Mineall S, Fischer R, Biradar V, Soar N, White H, Estensen K, Morrison L, Smith J, Cooper M, Health M, Shehabi Y, Al-Bassam W, Hulley A, Whitehead C, Lowrey J, Gresha R, Walsham J, Meyer J, Harward M, Venz E, Williams P, Kurenda C, Smith K, Smith M, Garcia R, Barge D, Byrne D, Byrne K, Driscoll A, Fortune L, Janin P, Yarad E, Hammond N, Bass F, Ashelford A, Waterson S, Wedd S, McNamara R, Buhr H, Coles J, Schweikert S, Wibrow B, Rauniyar R, Myers E, Fysh E, Dawda A, Mevavala B, Litton E, Ferrier J, Nair P, Buscher H, Reynolds C, Santamaria J, Barbazza L, Homes J, Smith R, Murray L, Brailsford J, Forbes L, Maguire T, Mariappa V, Smith J, Simpson S, Maiden M, Bone A, Horton M, Salerno T, Sterba M, Geng W, Depuydt P, De Waele J, De Bus L, Fierens J, Bracke S, Reeve B, Dechert W, Chassé M, Carrier FM, Boumahni D, Benettaib F, Ghamraoui A, Bellemare D, Cloutier È, Francoeur C, Lamontagne F, D’Aragon F, Carbonneau E, Leblond J, Vazquez-Grande G, Marten N, Wilson M, Albert M, Serri K, Cavayas A, Duplaix M, Williams V, Rochwerg B, Karachi T, Oczkowski S, Centofanti J, Millen T, Duan E, Tsang J, Patterson L, English S, Watpool I, Porteous R, Miezitis S, McIntyre L, Brochard L, Burns K, Sandhu G, Khalid I, Binnie A, Powell E, McMillan A, Luk T, Aref N, Andric Z, Cviljevic S, Đimoti R, Zapalac M, Mirković G, Baršić B, Kutleša M, Kotarski V, Vujaklija Brajković A, Babel J, Sever H, Dragija L, Kušan I, Vaara S, Pettilä L, Heinonen J, Kuitunen A, Karlsson S, Vahtera A, Kiiski H, Ristimäki S, Azaiz A, Charron C, Godement M, Geri G, Vieillard-Baron A, Pourcine F, Monchi M, Luis D, Mercier R, Sagnier A, Verrier N, Caplin C, Siami S, Aparicio C, Vautier S, Jeblaoui A, Fartoukh M, Courtin L, Labbe V, Leparco C, Muller G, Nay MA, Kamel T, Benzekri D, Jacquier S, Mercier E, Chartier D, Salmon C, Dequin P, Schneider F, Morel G, L’Hotellier S, Badie J, Berdaguer FD, Malfroy S, Mezher C, Bourgoin C, Megarbane B, Voicu S, Deye N, Malissin I, Sutterlin L, Guitton C, Darreau C, Landais M, Chudeau N, Robert A, Moine P, Heming N, Maxime V, Bossard I, Nicholier TB, Colin G, Zinzoni V, Maquigneau N, Finn A, Kreß G, Hoff U, Friedrich Hinrichs C, Nee J, Pletz M, Hagel S, Ankert J, Kolanos S, Bloos F, Petros S, Pasieka B, Kunz K, Appelt P, Schütze B, Kluge S, Nierhaus A, Jarczak D, Roedl K, Weismann D, Frey A, Klinikum Neukölln V, Reill L, Distler M, Maselli A, Bélteczki J, Magyar I, Fazekas Á, Kovács S, Szőke V, Szigligeti G, Leszkoven J, Collins D, Breen P, Frohlich S, Whelan R, McNicholas B, Scully M, Casey S, Kernan M, Doran P, O’Dywer M, Smyth M, Hayes L, Hoiting O, Peters M, Rengers E, Evers M, Prinssen A, Bosch Ziekenhuis J, Simons K, Rozendaal W, Polderman F, de Jager P, Moviat M, Paling A, Salet A, Rademaker E, Peters AL, de Jonge E, Wigbers J, Guilder E, Butler M, Cowdrey KA, Newby L, Chen Y, Simmonds C, McConnochie R, Ritzema Carter J, Henderson S, Van Der Heyden K, Mehrtens J, Williams T, Kazemi A, Song R, Lai V, Girijadevi D, Everitt R, Russell R, Hacking D, Buehner U, Williams E, Browne T, Grimwade K, Goodson J, Keet O, Callender O, Martynoga R, Trask K, Butler A, Schischka L, Young C, Lesona E, Olatunji S, Robertson Y, José N, Amaro dos Santos Catorze T, de Lima Pereira TNA, Neves Pessoa LM, Castro Ferreira RM, Pereira Sousa Bastos JM, Aysel Florescu S, Stanciu D, Zaharia MF, Kosa AG, Codreanu D, Marabi Y, Al Qasim E, Moneer Hagazy M, Al Swaidan L, Arishi H, Muñoz-Bermúdez R, Marin-Corral J, Salazar Degracia A, Parrilla Gómez F, Mateo López MI, Rodriguez Fernandez J, Cárcel Fernández S, Carmona Flores R, León López R, de la Fuente Martos C, Allan A, Polgarova P, Farahi N, McWilliam S, Hawcutt D, Rad L, O’Malley L, Whitbread J, Kelsall O, Wild L, Thrush J, Wood H, Austin K, Donnelly A, Kelly M, O’Kane S, McClintock D, Warnock M, Johnston P, Gallagher LJ, Mc Goldrick C, Mc Master M, Strzelecka A, Jha R, Kalogirou M, Ellis C, Krishnamurthy V, Deelchand V, Silversides J, McGuigan P, Ward K, O’Neill A, Finn S, Phillips B, Mullan D, Oritz-Ruiz de Gordoa L, Thomas M, Sweet K, Grimmer L, Johnson R, Pinnell J, Robinson M, Gledhill L, Wood T, Morgan M, Cole J, Hill H, Davies M, Antcliffe D, Templeton M, Rojo R, Coghlan P, Smee J, Mackay E, Cort J, Whileman A, Spencer T, Spittle N, Kasipandian V, Patel A, Allibone S, Genetu RM, Ramali M, Ghosh A, Bamford P, London E, Cawley K, Faulkner M, Jeffrey H, Smith T, Brewer C, Gregory J, Limb J, Cowton A, O’Brien J, Nikitas N, Wells C, Lankester L, Pulletz M, Williams P, Birch J, Wiseman S, Horton S, Alegria A, Turki S, Elsefi T, Crisp N, Allen L, McCullagh I, Robinson P, Hays C, Babio-Galan M, Stevenson H, Khare D, Pinder M, Selvamoni S, Gopinath A, Pugh R, Menzies D, Mackay C, Allan E, Davies G, Puxty K, McCue C, Cathcart S, Hickey N, Ireland J, Yusuff H, Isgro G, Brightling C, Bourne M, Craner M, Watters M, Prout R, Davies L, Pegler S, Kyeremeh L, Arbane G, Wilson K, Gomm L, Francia F, Brett S, Sousa Arias S, Elin Hall R, Budd J, Small C, Birch J, Collins E, Henning J, Bonner S, Hugill K, Cirstea E, Wilkinson D, Karlikowski M, Sutherland H, Wilhelmsen E, Woods J, North J, Sundaran D, Hollos L, Coburn S, Walsh J, Turns M, Hopkins P, Smith J, Noble H, Depante MT, Clarey E, Laha S, Verlander M, Williams A, Huckle A, Hall A, Cooke J, Gardiner-Hill C, Maloney C, Qureshi H, Flint N, Nicholson S, Southin S, Nicholson A, Borgatta B, Turner-Bone I, Reddy A, Wilding L, Chamara Warnapura L, Agno Sathianathan R, Golden D, Hart C, Jones J, Bannard-Smith J, Henry J, Birchall K, Pomeroy F, Quayle R, Makowski A, Misztal B, Ahmed I, KyereDiabour T, Naiker K, Stewart R, Mwaura E, Mew L, Wren L, Willams F, Innes R, Doble P, Hutter J, Shovelton C, Plumb B, Szakmany T, Hamlyn V, Hawkins N, Lewis S, Dell A, Gopal S, Ganguly S, Smallwood A, Harris N, Metherell S, Lazaro JM, Newman T, Fletcher S, Nortje J, Fottrell-Gould D, Randell G, Zaman M, Elmahi E, Jones A, Hall K, Mills G, Ryalls K, Bowler H, Sall J, Bourne R, Borrill Z, Duncan T, Lamb T, Shaw J, Fox C, Moreno Cuesta J, Xavier K, Purohit D, Elhassan M, Bakthavatsalam D, Rowland M, Hutton P, Bashyal A, Davidson N, Hird C, Chhablani M, Phalod G, Kirkby A, Archer S, Netherton K, Reschreiter H, Camsooksai J, Patch S, Jenkins S, Pogson D, Rose S, Daly Z, Brimfield L, Claridge H, Parekh D, Bergin C, Bates M, Dasgin J, McGhee C, Sim M, Hay SK, Henderson S, Phull MK, Zaidi A, Pogreban T, Rosaroso LP, Harvey D, Lowe B, Meredith M, Ryan L, Hormis A, Walker R, Collier D, Kimpton S, Oakley S, Rooney K, Rodden N, Hughes E, Thomson N, McGlynn D, Walden A, Jacques N, Coles H, Tilney E, Vowell E, Schuster-Bruce M, Pitts S, Miln R, Purandare L, Vamplew L, Spivey M, Bean S, Burt K, Moore L, Day C, Gibson C, Gordon E, Zitter L, Keenan S, Baker E, Cherian S, Cutler S, Roynon-Reed A, Harrington K, Raithatha A, Bauchmuller K, Ahmad N, Grecu I, Trodd D, Martin J, Wrey Brown C, Arias AM, Craven T, Hope D, Singleton J, Clark S, Rae N, Welters I, Hamilton DO, Williams K, Waugh V, Shaw D, Puthucheary Z, Martin T, Santos F, Uddin R, Somerville A, Tatham KC, Jhanji S, Black E, Dela Rosa A, Howle R, Tully R, Drummond A, Dearden J, Philbin J, Munt S, Vuylsteke A, Chan C, Victor S, Matsa R, Gellamucho M, Creagh-Brown B, Tooley J, Montague L, De Beaux F, Bullman L, Kersiake I, Demetriou C, Mitchard S, Ramos L, White K, Donnison P, Johns M, Casey R, Mattocks L, Salisbury S, Dark P, Claxton A, McLachlan D, Slevin K, Lee S, Hulme J, Joseph S, Kinney F, Senya HJ, Oborska A, Kayani A, Hadebe B, Orath Prabakaran R, Nichols L, Thomas M, Worner R, Faulkner B, Gendall E, Hayes K, Hamilton-Davies C, Chan C, Mfuko C, Abbass H, Mandadapu V, Leaver S, Forton D, Patel K, Paramasivam E, Powell M, Gould R, Wilby E, Howcroft C, Banach D, Fernández de Pinedo Artaraz Z, Cabreros L, White I, Croft M, Holland N, Pereira R, Zaki A, Johnson D, Jackson M, Garrard H, Juhaz V, Roy A, Rostron A, Woods L, Cornell S, Pillai S, Harford R, Rees T, Ivatt H, Sundara Raman A, Davey M, Lee K, Barber R, Chablani M, Brohi F, Jagannathan V, Clark M, Purvis S, Wetherill B, Dushianthan A, Cusack R, de Courcy-Golder K, Smith S, Jackson S, Attwood B, Parsons P, Page V, Zhao XB, Oza D, Rhodes J, Anderson T, Morris S, Xia Le Tai C, Thomas A, Keen A, Digby S, Cowley N, Wild L, Southern D, Reddy H, Campbell A, Watkins C, Smuts S, Touma O, Barnes N, Alexander P, Felton T, Ferguson S, Sellers K, Bradley-Potts J, Yates D, Birkinshaw I, Kell K, Marshall N, Carr-Knott L, Summers C. Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA 2020. [PMID: 32876697 DOI: 10.1001/jama.2020.1702221] [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] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. OBJECTIVE To determine whether hydrocortisone improves outcome for patients with severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. INTERVENTIONS The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). MAIN OUTCOMES AND MEASURES The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). RESULTS After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. CONCLUSIONS AND RELEVANCE Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02735707.
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Affiliation(s)
- Derek C Angus
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Farah Al-Beidh
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Djillali Annane
- Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), Paris, France
- Simone Veil School of Medicine, University of Versailles, Versailles, France
- University Paris Saclay, Garches, France
| | - Yaseen Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abigail Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Wilma van Bentum-Puijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Zahra Bhimani
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Charlotte Bradbury
- Bristol Royal Informatory, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | - Frank Brunkhorst
- Center for Clinical Studies and Center for Sepsis Control and Care (CSCC), Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Meredith Buxton
- Global Coalition for Adaptive Research, San Francisco, California
| | - Adrian Buzgau
- Helix, Monash University, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Menno de Jong
- Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | | | - Lise Estcourt
- NHS Blood and Transplant, Bristol, United Kingdom
- Transfusion Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | | | - Herman Goossens
- Department of Microbiology, Antwerp University Hospital, Antwerp, Belgium
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Horvat
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Sebastiaan J Hullegie
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Patrick R Lawler
- Cardiac Intensive Care Unit, Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Linstrum
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Edward Litton
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | | | - John Marshall
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Daniel McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | | | - Shay McGuinness
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Bryan McVerry
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie Montgomery
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Paul Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Srinivas Murthy
- University of British Columbia School of Medicine, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jane Parker
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kathryn Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | | | - Marlene Santos
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Christopher Seymour
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Anne Turner
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Frank van de Veerdonk
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Balasubramanian Venkatesh
- Southside Clinical Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Ryan Zarychanski
- Department of Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Roger J Lewis
- Berry Consultants LLC, Austin, Texas
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Department of Emergency Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Colin McArthur
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Steven A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- St John of God Hospital, Subiaco, Western Australia, Australia
| | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
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Angus DC, Derde L, Al-Beidh F, Annane D, Arabi Y, Beane A, van Bentum-Puijk W, Berry L, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Buzgau A, Cheng AC, de Jong M, Detry M, Estcourt L, Fitzgerald M, Goossens H, Green C, Haniffa R, Higgins AM, Horvat C, Hullegie SJ, Kruger P, Lamontagne F, Lawler PR, Linstrum K, Litton E, Lorenzi E, Marshall J, McAuley D, McGlothin A, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Parker J, Rowan K, Sanil A, Santos M, Saunders C, Seymour C, Turner A, van de Veerdonk F, Venkatesh B, Zarychanski R, Berry S, Lewis RJ, McArthur C, Webb SA, Gordon AC, Al-Beidh F, Angus D, Annane D, Arabi Y, van Bentum-Puijk W, Berry S, Beane A, Bhimani Z, Bonten M, Bradbury C, Brunkhorst F, Buxton M, Cheng A, De Jong M, Derde L, Estcourt L, Goossens H, Gordon A, Green C, Haniffa R, Lamontagne F, Lawler P, Litton E, Marshall J, McArthur C, McAuley D, McGuinness S, McVerry B, Montgomery S, Mouncey P, Murthy S, Nichol A, Parke R, Rowan K, Seymour C, Turner A, van de Veerdonk F, Webb S, Zarychanski R, Campbell L, Forbes A, Gattas D, Heritier S, Higgins L, Kruger P, Peake S, Presneill J, Seppelt I, Trapani T, Young P, Bagshaw S, Daneman N, Ferguson N, Misak C, Santos M, Hullegie S, Pletz M, Rohde G, Rowan K, Alexander B, Basile K, Girard T, Horvat C, Huang D, Linstrum K, Vates J, Beasley R, Fowler R, McGloughlin S, Morpeth S, Paterson D, Venkatesh B, Uyeki T, Baillie K, Duffy E, Fowler R, Hills T, Orr K, Patanwala A, Tong S, Netea M, Bihari S, Carrier M, Fergusson D, Goligher E, Haidar G, Hunt B, Kumar A, Laffan M, Lawless P, Lother S, McCallum P, Middeldopr S, McQuilten Z, Neal M, Pasi J, Schutgens R, Stanworth S, Turgeon A, Weissman A, Adhikari N, Anstey M, Brant E, de Man A, Lamonagne F, Masse MH, Udy A, Arnold D, Begin P, Charlewood R, Chasse M, Coyne M, Cooper J, Daly J, Gosbell I, Harvala-Simmonds H, Hills T, MacLennan S, Menon D, McDyer J, Pridee N, Roberts D, Shankar-Hari M, Thomas H, Tinmouth A, Triulzi D, Walsh T, Wood E, Calfee C, O’Kane C, Shyamsundar M, Sinha P, Thompson T, Young I, Bihari S, Hodgson C, Laffey J, McAuley D, Orford N, Neto A, Detry M, Fitzgerald M, Lewis R, McGlothlin A, Sanil A, Saunders C, Berry L, Lorenzi E, Miller E, Singh V, Zammit C, van Bentum Puijk W, Bouwman W, Mangindaan Y, Parker L, Peters S, Rietveld I, Raymakers K, Ganpat R, Brillinger N, Markgraf R, Ainscough K, Brickell K, Anjum A, Lane JB, Richards-Belle A, Saull M, Wiley D, Bion J, Connor J, Gates S, Manax V, van der Poll T, Reynolds J, van Beurden M, Effelaar E, Schotsman J, Boyd C, Harland C, Shearer A, Wren J, Clermont G, Garrard W, Kalchthaler K, King A, Ricketts D, Malakoutis S, Marroquin O, Music E, Quinn K, Cate H, Pearson K, Collins J, Hanson J, Williams P, Jackson S, Asghar A, Dyas S, Sutu M, Murphy S, Williamson D, Mguni N, Potter A, Porter D, Goodwin J, Rook C, Harrison S, Williams H, Campbell H, Lomme K, Williamson J, Sheffield J, van’t Hoff W, McCracken P, Young M, Board J, Mart E, Knott C, Smith J, Boschert C, Affleck J, Ramanan M, D’Souza R, Pateman K, Shakih A, Cheung W, Kol M, Wong H, Shah A, Wagh A, Simpson J, Duke G, Chan P, Cartner B, Hunter S, Laver R, Shrestha T, Regli A, Pellicano A, McCullough J, Tallott M, Kumar N, Panwar R, Brinkerhoff G, Koppen C, Cazzola F, Brain M, Mineall S, Fischer R, Biradar V, Soar N, White H, Estensen K, Morrison L, Smith J, Cooper M, Health M, Shehabi Y, Al-Bassam W, Hulley A, Whitehead C, Lowrey J, Gresha R, Walsham J, Meyer J, Harward M, Venz E, Williams P, Kurenda C, Smith K, Smith M, Garcia R, Barge D, Byrne D, Byrne K, Driscoll A, Fortune L, Janin P, Yarad E, Hammond N, Bass F, Ashelford A, Waterson S, Wedd S, McNamara R, Buhr H, Coles J, Schweikert S, Wibrow B, Rauniyar R, Myers E, Fysh E, Dawda A, Mevavala B, Litton E, Ferrier J, Nair P, Buscher H, Reynolds C, Santamaria J, Barbazza L, Homes J, Smith R, Murray L, Brailsford J, Forbes L, Maguire T, Mariappa V, Smith J, Simpson S, Maiden M, Bone A, Horton M, Salerno T, Sterba M, Geng W, Depuydt P, De Waele J, De Bus L, Fierens J, Bracke S, Reeve B, Dechert W, Chassé M, Carrier FM, Boumahni D, Benettaib F, Ghamraoui A, Bellemare D, Cloutier È, Francoeur C, Lamontagne F, D’Aragon F, Carbonneau E, Leblond J, Vazquez-Grande G, Marten N, Wilson M, Albert M, Serri K, Cavayas A, Duplaix M, Williams V, Rochwerg B, Karachi T, Oczkowski S, Centofanti J, Millen T, Duan E, Tsang J, Patterson L, English S, Watpool I, Porteous R, Miezitis S, McIntyre L, Brochard L, Burns K, Sandhu G, Khalid I, Binnie A, Powell E, McMillan A, Luk T, Aref N, Andric Z, Cviljevic S, Đimoti R, Zapalac M, Mirković G, Baršić B, Kutleša M, Kotarski V, Vujaklija Brajković A, Babel J, Sever H, Dragija L, Kušan I, Vaara S, Pettilä L, Heinonen J, Kuitunen A, Karlsson S, Vahtera A, Kiiski H, Ristimäki S, Azaiz A, Charron C, Godement M, Geri G, Vieillard-Baron A, Pourcine F, Monchi M, Luis D, Mercier R, Sagnier A, Verrier N, Caplin C, Siami S, Aparicio C, Vautier S, Jeblaoui A, Fartoukh M, Courtin L, Labbe V, Leparco C, Muller G, Nay MA, Kamel T, Benzekri D, Jacquier S, Mercier E, Chartier D, Salmon C, Dequin P, Schneider F, Morel G, L’Hotellier S, Badie J, Berdaguer FD, Malfroy S, Mezher C, Bourgoin C, Megarbane B, Voicu S, Deye N, Malissin I, Sutterlin L, Guitton C, Darreau C, Landais M, Chudeau N, Robert A, Moine P, Heming N, Maxime V, Bossard I, Nicholier TB, Colin G, Zinzoni V, Maquigneau N, Finn A, Kreß G, Hoff U, Friedrich Hinrichs C, Nee J, Pletz M, Hagel S, Ankert J, Kolanos S, Bloos F, Petros S, Pasieka B, Kunz K, Appelt P, Schütze B, Kluge S, Nierhaus A, Jarczak D, Roedl K, Weismann D, Frey A, Klinikum Neukölln V, Reill L, Distler M, Maselli A, Bélteczki J, Magyar I, Fazekas Á, Kovács S, Szőke V, Szigligeti G, Leszkoven J, Collins D, Breen P, Frohlich S, Whelan R, McNicholas B, Scully M, Casey S, Kernan M, Doran P, O’Dywer M, Smyth M, Hayes L, Hoiting O, Peters M, Rengers E, Evers M, Prinssen A, Bosch Ziekenhuis J, Simons K, Rozendaal W, Polderman F, de Jager P, Moviat M, Paling A, Salet A, Rademaker E, Peters AL, de Jonge E, Wigbers J, Guilder E, Butler M, Cowdrey KA, Newby L, Chen Y, Simmonds C, McConnochie R, Ritzema Carter J, Henderson S, Van Der Heyden K, Mehrtens J, Williams T, Kazemi A, Song R, Lai V, Girijadevi D, Everitt R, Russell R, Hacking D, Buehner U, Williams E, Browne T, Grimwade K, Goodson J, Keet O, Callender O, Martynoga R, Trask K, Butler A, Schischka L, Young C, Lesona E, Olatunji S, Robertson Y, José N, Amaro dos Santos Catorze T, de Lima Pereira TNA, Neves Pessoa LM, Castro Ferreira RM, Pereira Sousa Bastos JM, Aysel Florescu S, Stanciu D, Zaharia MF, Kosa AG, Codreanu D, Marabi Y, Al Qasim E, Moneer Hagazy M, Al Swaidan L, Arishi H, Muñoz-Bermúdez R, Marin-Corral J, Salazar Degracia A, Parrilla Gómez F, Mateo López MI, Rodriguez Fernandez J, Cárcel Fernández S, Carmona Flores R, León López R, de la Fuente Martos C, Allan A, Polgarova P, Farahi N, McWilliam S, Hawcutt D, Rad L, O’Malley L, Whitbread J, Kelsall O, Wild L, Thrush J, Wood H, Austin K, Donnelly A, Kelly M, O’Kane S, McClintock D, Warnock M, Johnston P, Gallagher LJ, Mc Goldrick C, Mc Master M, Strzelecka A, Jha R, Kalogirou M, Ellis C, Krishnamurthy V, Deelchand V, Silversides J, McGuigan P, Ward K, O’Neill A, Finn S, Phillips B, Mullan D, Oritz-Ruiz de Gordoa L, Thomas M, Sweet K, Grimmer L, Johnson R, Pinnell J, Robinson M, Gledhill L, Wood T, Morgan M, Cole J, Hill H, Davies M, Antcliffe D, Templeton M, Rojo R, Coghlan P, Smee J, Mackay E, Cort J, Whileman A, Spencer T, Spittle N, Kasipandian V, Patel A, Allibone S, Genetu RM, Ramali M, Ghosh A, Bamford P, London E, Cawley K, Faulkner M, Jeffrey H, Smith T, Brewer C, Gregory J, Limb J, Cowton A, O’Brien J, Nikitas N, Wells C, Lankester L, Pulletz M, Williams P, Birch J, Wiseman S, Horton S, Alegria A, Turki S, Elsefi T, Crisp N, Allen L, McCullagh I, Robinson P, Hays C, Babio-Galan M, Stevenson H, Khare D, Pinder M, Selvamoni S, Gopinath A, Pugh R, Menzies D, Mackay C, Allan E, Davies G, Puxty K, McCue C, Cathcart S, Hickey N, Ireland J, Yusuff H, Isgro G, Brightling C, Bourne M, Craner M, Watters M, Prout R, Davies L, Pegler S, Kyeremeh L, Arbane G, Wilson K, Gomm L, Francia F, Brett S, Sousa Arias S, Elin Hall R, Budd J, Small C, Birch J, Collins E, Henning J, Bonner S, Hugill K, Cirstea E, Wilkinson D, Karlikowski M, Sutherland H, Wilhelmsen E, Woods J, North J, Sundaran D, Hollos L, Coburn S, Walsh J, Turns M, Hopkins P, Smith J, Noble H, Depante MT, Clarey E, Laha S, Verlander M, Williams A, Huckle A, Hall A, Cooke J, Gardiner-Hill C, Maloney C, Qureshi H, Flint N, Nicholson S, Southin S, Nicholson A, Borgatta B, Turner-Bone I, Reddy A, Wilding L, Chamara Warnapura L, Agno Sathianathan R, Golden D, Hart C, Jones J, Bannard-Smith J, Henry J, Birchall K, Pomeroy F, Quayle R, Makowski A, Misztal B, Ahmed I, KyereDiabour T, Naiker K, Stewart R, Mwaura E, Mew L, Wren L, Willams F, Innes R, Doble P, Hutter J, Shovelton C, Plumb B, Szakmany T, Hamlyn V, Hawkins N, Lewis S, Dell A, Gopal S, Ganguly S, Smallwood A, Harris N, Metherell S, Lazaro JM, Newman T, Fletcher S, Nortje J, Fottrell-Gould D, Randell G, Zaman M, Elmahi E, Jones A, Hall K, Mills G, Ryalls K, Bowler H, Sall J, Bourne R, Borrill Z, Duncan T, Lamb T, Shaw J, Fox C, Moreno Cuesta J, Xavier K, Purohit D, Elhassan M, Bakthavatsalam D, Rowland M, Hutton P, Bashyal A, Davidson N, Hird C, Chhablani M, Phalod G, Kirkby A, Archer S, Netherton K, Reschreiter H, Camsooksai J, Patch S, Jenkins S, Pogson D, Rose S, Daly Z, Brimfield L, Claridge H, Parekh D, Bergin C, Bates M, Dasgin J, McGhee C, Sim M, Hay SK, Henderson S, Phull MK, Zaidi A, Pogreban T, Rosaroso LP, Harvey D, Lowe B, Meredith M, Ryan L, Hormis A, Walker R, Collier D, Kimpton S, Oakley S, Rooney K, Rodden N, Hughes E, Thomson N, McGlynn D, Walden A, Jacques N, Coles H, Tilney E, Vowell E, Schuster-Bruce M, Pitts S, Miln R, Purandare L, Vamplew L, Spivey M, Bean S, Burt K, Moore L, Day C, Gibson C, Gordon E, Zitter L, Keenan S, Baker E, Cherian S, Cutler S, Roynon-Reed A, Harrington K, Raithatha A, Bauchmuller K, Ahmad N, Grecu I, Trodd D, Martin J, Wrey Brown C, Arias AM, Craven T, Hope D, Singleton J, Clark S, Rae N, Welters I, Hamilton DO, Williams K, Waugh V, Shaw D, Puthucheary Z, Martin T, Santos F, Uddin R, Somerville A, Tatham KC, Jhanji S, Black E, Dela Rosa A, Howle R, Tully R, Drummond A, Dearden J, Philbin J, Munt S, Vuylsteke A, Chan C, Victor S, Matsa R, Gellamucho M, Creagh-Brown B, Tooley J, Montague L, De Beaux F, Bullman L, Kersiake I, Demetriou C, Mitchard S, Ramos L, White K, Donnison P, Johns M, Casey R, Mattocks L, Salisbury S, Dark P, Claxton A, McLachlan D, Slevin K, Lee S, Hulme J, Joseph S, Kinney F, Senya HJ, Oborska A, Kayani A, Hadebe B, Orath Prabakaran R, Nichols L, Thomas M, Worner R, Faulkner B, Gendall E, Hayes K, Hamilton-Davies C, Chan C, Mfuko C, Abbass H, Mandadapu V, Leaver S, Forton D, Patel K, Paramasivam E, Powell M, Gould R, Wilby E, Howcroft C, Banach D, Fernández de Pinedo Artaraz Z, Cabreros L, White I, Croft M, Holland N, Pereira R, Zaki A, Johnson D, Jackson M, Garrard H, Juhaz V, Roy A, Rostron A, Woods L, Cornell S, Pillai S, Harford R, Rees T, Ivatt H, Sundara Raman A, Davey M, Lee K, Barber R, Chablani M, Brohi F, Jagannathan V, Clark M, Purvis S, Wetherill B, Dushianthan A, Cusack R, de Courcy-Golder K, Smith S, Jackson S, Attwood B, Parsons P, Page V, Zhao XB, Oza D, Rhodes J, Anderson T, Morris S, Xia Le Tai C, Thomas A, Keen A, Digby S, Cowley N, Wild L, Southern D, Reddy H, Campbell A, Watkins C, Smuts S, Touma O, Barnes N, Alexander P, Felton T, Ferguson S, Sellers K, Bradley-Potts J, Yates D, Birkinshaw I, Kell K, Marshall N, Carr-Knott L, Summers C. Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA 2020; 324:1317-1329. [PMID: 32876697 PMCID: PMC7489418 DOI: 10.1001/jama.2020.17022] [Citation(s) in RCA: 537] [Impact Index Per Article: 134.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. OBJECTIVE To determine whether hydrocortisone improves outcome for patients with severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. INTERVENTIONS The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). MAIN OUTCOMES AND MEASURES The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). RESULTS After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. CONCLUSIONS AND RELEVANCE Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02735707.
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Affiliation(s)
- Derek C Angus
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Farah Al-Beidh
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Djillali Annane
- Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), Paris, France
- Simone Veil School of Medicine, University of Versailles, Versailles, France
- University Paris Saclay, Garches, France
| | - Yaseen Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abigail Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Wilma van Bentum-Puijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Zahra Bhimani
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Charlotte Bradbury
- Bristol Royal Informatory, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | - Frank Brunkhorst
- Center for Clinical Studies and Center for Sepsis Control and Care (CSCC), Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Meredith Buxton
- Global Coalition for Adaptive Research, San Francisco, California
| | - Adrian Buzgau
- Helix, Monash University, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Menno de Jong
- Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | | | - Lise Estcourt
- NHS Blood and Transplant, Bristol, United Kingdom
- Transfusion Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | | | - Herman Goossens
- Department of Microbiology, Antwerp University Hospital, Antwerp, Belgium
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Horvat
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Sebastiaan J Hullegie
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Patrick R Lawler
- Cardiac Intensive Care Unit, Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Linstrum
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Edward Litton
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | | | - John Marshall
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Daniel McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | | | - Shay McGuinness
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Bryan McVerry
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie Montgomery
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Paul Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Srinivas Murthy
- University of British Columbia School of Medicine, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The Health Research Council of New Zealand, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jane Parker
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kathryn Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | | | - Marlene Santos
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Christopher Seymour
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Anne Turner
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Frank van de Veerdonk
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Balasubramanian Venkatesh
- Southside Clinical Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Ryan Zarychanski
- Department of Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Roger J Lewis
- Berry Consultants LLC, Austin, Texas
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Department of Emergency Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Colin McArthur
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Steven A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- St John of God Hospital, Subiaco, Western Australia, Australia
| | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
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Brar R, Grant C, DeBeck K, Milloy MJ, Fairbairn N, Wood E, Kerr T, Hayashi K. Changes in drug use behaviors coinciding with the emergence of illicit fentanyl among people who use drugs in Vancouver, Canada. Am J Drug Alcohol Abuse 2020; 46:625-631. [PMID: 32689810 DOI: 10.1080/00952990.2020.1771721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: With the emergence of illicitly-manufactured fentanyl, drug overdose deaths have risen in unprecedented numbers. In this context, there is an urgent need to characterize potential changes in drug use behaviors among people who use drugs (PWUD). Objective: To examine changes in drug use behaviors following the emergence of illicit fentanyl among people who use drugs (PWUD). Methods: Data for this cross-sectional analysis was derived from three prospective cohorts of PWUD between December 2016 and May 2017 in Vancouver, Canada. Multivariable logistic regression was used to determine factors associated with self-reported behavior changes (binary variable "yes" or "no") following the emergence of illicit fentanyl. Results: Among 999 participants [363 (36.3%) females], 388 (38.8%) reported some behavior change. The remaining 611 (61.2%) reported no change in behavior; 240 (39.3%) of these individuals had recently been exposed to fentanyl. In multivariable analyses, factors independently associated with behavior change included recent non-fatal overdose (Adjusted Odds Ratio [AOR] = 2.28), active injection drug use (AOR = 1.96), being on opioid agonist therapy (AOR = 1.80), and urine drug screen positive for fentanyl (AOR = 1.45), (all p < .05). Conclusion: The majority of PWUD in our sample did not change their drug use behavior despite a high prevalence of fentanyl exposure, indicating a need for targeted behavior change messaging and overdose prevention efforts such as naloxone and addiction treatment for this sub-population of PWUD. Further, the high fentanyl exposure observed in our sample suggests a need to address upstream structural factors shaping the overdose risk in addition to individual behavioral change.
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Affiliation(s)
- R Brar
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Department of Medicine, University of British Columbia , Vancouver, BC, CANADA
| | - C Grant
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA
| | - K DeBeck
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,School of Public Policy, Simon Fraser University , Vancouver, BC, CANADA
| | - M-J Milloy
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Department of Medicine, University of British Columbia , Vancouver, BC, CANADA
| | - N Fairbairn
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Department of Medicine, University of British Columbia , Vancouver, BC, CANADA
| | - E Wood
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Department of Medicine, University of British Columbia , Vancouver, BC, CANADA
| | - T Kerr
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Department of Medicine, University of British Columbia , Vancouver, BC, CANADA
| | - Kanna Hayashi
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Faculty of Health Sciences, Simon Fraser University , Burnaby, BC, Canada
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Abstract
Bordering the wealthy town of Apex, North Carolina, is a majority African-American neighborhood, Irongate Drive, without town water service, relying on private wells. Residents have long sought access to town water as their wells are running dry, but problems have not been systematically documented. Using a comprehensive survey and qualitative interviews, this study assesses the frequency of water shortages, uncovers the effects on daily lives, and reports on water source preferences. Surveys showed 80 percent of households experience water scarcity. Respondents reported not having enough water to flush toilets, shower, wash hands, or do laundry. Annual well maintenance costs averaged $1405; additional costs included dealing with water shortage and buying additional items to cope. More than 75 percent actively seek municipal water, and none oppose it. These results could inform assessments of impacts of water access disparities in similar peri-urban minority communities nationwide that remain excluded from nearby municipal services.
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Affiliation(s)
- Sydney Lockhart
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Erica Wood
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
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Affiliation(s)
- Linley Bielby
- Department of Health and Human Services Victoria and the Australian Red Cross Blood Service Melbourne VIC Australia
| | - Rachel Moss
- Department of Laboratory Medicine Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Allison Mo
- Transfusion Research Unit School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia
- Department of Haematology Monash Health Clayton VIC Australia
- Austin Pathology and Department of Clinical Haematology Austin Health Heidelburg VIC Australia
| | - Zoe McQuilten
- Transfusion Research Unit School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia
- Department of Haematology Monash Health Clayton VIC Australia
| | - Erica Wood
- Transfusion Research Unit School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia
- Department of Haematology Monash Health Clayton VIC Australia
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Baldwin N, Gray R, Goel A, Wood E, Buxton J, Rieb L. Corrigendum to "Fentanyl and heroin contained in seized illicit drugs and overdose-related deaths in British Columbia, Canada: An observational analysis" [Drug Alcohol Depend. 185 (2018) 322-327]. Drug Alcohol Depend 2019; 197:48. [PMID: 30772782 DOI: 10.1016/j.drugalcdep.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- N Baldwin
- Department of Family Practice, University of British Columbia, Canada
| | - R Gray
- Department of Family Practice, University of British Columbia, Canada
| | - A Goel
- Department of Family Practice, University of British Columbia, Canada
| | - E Wood
- Department of Medicine, University of British Columbia, Canada
| | - J Buxton
- School of Population and Public Health, University of British Columbia, Canada
| | - L Rieb
- Department of Family Practice, University of British Columbia, Canada.
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Lim MS, Indran T, Cummins A, Bennett A, Wood E, Brown S, McQuilten Z, Tran H, Epi MC, Chan NC, Chunilal S. Utility of a Nurse-Led Pathway for Patients with Acute Venous Thromboembolism Discharged on Rivaroxaban: A Prospective Cohort Study. Semin Thromb Hemost 2018; 45:187-195. [PMID: 30566971 DOI: 10.1055/s-0038-1676320] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The highest risk of adverse events for patients with acute venous thromboembolism (VTE) is during the early anticoagulation period. However, no established model exists for early clinical monitoring of patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). The authors' aim was to evaluate the utility of a nurse-led pathway to minimize adverse events in acute VTE patients starting on rivaroxaban. The rivaroxaban VTE treatment pathway is a prospective cohort study of consecutive patients with objectively confirmed VTE between July 2015 and May 2017. Primary outcome was the proportion of patients identified at major risk of adverse events (bleeding or recurrent VTE). Secondary outcomes were rates of interventions, major or clinically relevant nonmajor bleeding (CRNMB), recurrent VTE, and all-cause mortality at 90 days. Among 304 participants, 5% (n = 15) were identified to be at major and 9% (n = 28) at possible risk for adverse events. Appropriate interventions to prevent harm were required in 40 patients. Rates of major bleeding, CRNMB, recurrence, and all-cause mortality were 0.3% (95% confidence interval [CI]: 0.1-1.8), 7.2% (95% CI: 4.8-10.7), 1.0 (95% CI: 0.3-2.9), and 1.6% (95% CI: 0.7-3.8), respectively. In conclusion, following discharge of acute VTE patients, a nurse-led pathway identified one in seven (14%) patients at major or possible risk of adverse events. Preemptive interventions to reduce harm translated into the low rates of bleeding and recurrence. The authors' experience highlights the feasibility and importance of a structured clinical surveillance pathway for acute VTE patients initiating NOAC therapy.
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Affiliation(s)
- Ming Sheng Lim
- Department of Hematology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Tishya Indran
- Department of Hematology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Anita Cummins
- Department of Hematology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Ashwini Bennett
- Department of Hematology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Erica Wood
- Department of Hematology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia.,Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan Brown
- Department of Hematology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Zoe McQuilten
- Department of Hematology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia.,Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Master Clin Epi
- The Australian Centre for Blood Diseases, Monash University, Alfred Medical Research and Educational Precinct, Melbourne, Australia.,Department of Clinical Hematology, The Alfred Hospital, Melbourne, Australia
| | - Noel C Chan
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sanjeev Chunilal
- Department of Hematology, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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Wood E, Catlin C, Connors H, Teaster P. CLINICIAN, GUARDIAN, AND COUNSEL PERSPECTIVES ON GUARDIANSHIP FOR ADULTS WHO ARE INCAPACITATED AND ALONE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Wood
- VA Medical Center, Jamaica Plain, Massachusetts, United States
- American Bar Association, Washington DC USA
| | - C Catlin
- Boston VA Research Institute, Boston MA USA
| | - H Connors
- Guardianship Community Trust, Andover MA USA
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Akers C, Bielby L, Glazebrook B, Wood E, Wynne A, Flores C, Davis A, Daly J. RhD immunoglobulin: should I, will I, do I give it? Women Birth 2018. [DOI: 10.1016/j.wombi.2018.08.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Akers C, Savoia H, Kane S, Crispin P, Keegan A, Wood E, Glazebrook B, Bielby L, Davis AK. Misinterpretation of blood group and antibody screen leading to serious errors in RhD immunoglobulin administration: A report on first two years of data from Serious Transfusion Incident Reporting program. Aust N Z J Obstet Gynaecol 2018; 59:161-164. [PMID: 30187454 DOI: 10.1111/ajo.12889] [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: 02/13/2018] [Accepted: 07/29/2018] [Indexed: 11/26/2022]
Abstract
The Serious Transfusion Incident Reporting program (STIR) commenced haemovigilance in relation to RhD immunoglobulin (Ig) administration in 2015. During two years of reporting, 21 reports relating to RhD Ig administration were received. Thirty-three percent (7/21) were related to omission of RhD Ig, putting women at risk of RhD alloimmunisation and adverse consequences in future pregnancies. A recent case reported to STIR highlights poor communication and misinterpretation of pathology results leading to significant morbidity from haemolysis in the fetus. STIR makes recommendations related to education of staff and communication between clinical and laboratory staff to improve the safety of patient care.
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Affiliation(s)
- Christine Akers
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,Blood Matters Program, Melbourne, Victoria, Australia
| | - Helen Savoia
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Stefan Kane
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Philip Crispin
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Anastazia Keegan
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,Australian Red Cross Blood Service, Melbourne, Victoria, Australia
| | - Erica Wood
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bridget Glazebrook
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,Blood Matters Program, Melbourne, Victoria, Australia
| | - Linley Bielby
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,Blood Matters Program, Melbourne, Victoria, Australia
| | - Amanda K Davis
- Blood Matters, Department of Health and Human Services, Serious Transfusion Incident Reporting Program, Melbourne, Victoria, Australia.,Alfred Hospital, Melbourne, Victoria, Australia
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Levitz N, Wood E, Kantor L. The Influence of Technology Delivery Mode on Intervention Outcomes: Analysis of a Theory-Based Sexual Health Program. J Med Internet Res 2018; 20:e10398. [PMID: 30158100 PMCID: PMC6135965 DOI: 10.2196/10398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/05/2018] [Accepted: 06/28/2018] [Indexed: 01/19/2023] Open
Abstract
Background There are few studies on the role of technology delivery mode on health intervention outcomes. Furthermore, the opportunity to examine potential mode effects on a program that is theory-based and integrates principles of communication and decision-making science to influence sexual and reproductive health outcomes is a new contribution to the literature. Objective Planned Parenthood Federation of America’s national Chat/Text program can be accessed via short message service (SMS; more commonly referred to as text messaging), Web-based desktop chatting, and mobile phone chatting. The program has been in existence since 2010 and has conducted over 1,000,000 conversations. In this study, we examined whether the mode used to access the program (SMS text, desktop chat, or mobile phone chat) affected program users’ intention to act on the action plan established in their conversation. Methods Data were examined for a 6-month period from January 2016 to June 2016. The data were collected as a part of the monitoring and evaluation of an ongoing program. We limited our sample to the program’s priority audience of 15-24 years residing within the United States, which resulted in a sample of 64,939 conversations. Available data items for analysis included user demographics, delivery mode, topic discussed, helpfulness rating (on a 4-point scale), user confidence in following through on the intentions made during the conversation (on a 4-point scale), and educator confidence in whether the user would follow through on the stated intention. Linear and multinomial robust regression analyses were conducted to examine the relationships between conversation delivery mode and confidence. Results No significant relationships between users’ confidence to carry out their intentions and gender or race were found. None of the 3 modalities (SMS text, desktop chat, or mobile phone chat) were significantly associated with user confidence. All the 3 modalities had significant associations with educator confidence and showed similar effect sizes to those of user confidence. Educator confidence was significantly associated with all the topics discussed. Conclusions The Planned Parenthood Chat/Text program was designed as a tool to improve access to sexual and reproductive health care among young people. The mode of intervention delivery was not associated with users’ confidence in their ability to carry out their stated intention, suggesting that all modes are legitimate for delivering this intervention. Furthermore, each mode worked across gender and race or ethnicity, indicating that this is a modality that can work across groups.
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Affiliation(s)
- Nicole Levitz
- Planned Parenthood Federation of America, New York, NY, United States
| | - Erica Wood
- Planned Parenthood Federation of America, New York, NY, United States
| | - Leslie Kantor
- Planned Parenthood Federation of America, New York, NY, United States.,Rutgers School of Public Health, Rutgers University, Newark, NJ, United States
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Schiff ER, Frampton M, Ben-Yosef N, Avila BE, Semplici F, Pontikos N, Bloom SL, McCartney SA, Vega R, Lovat LB, Wood E, Hart A, Israeli E, Crespi D, Furman MA, Mann S, Murray CD, Segal AW, Levine AP. Rare coding variant analysis in a large cohort of Ashkenazi Jewish families with inflammatory bowel disease. Hum Genet 2018; 137:723-734. [PMID: 30167848 PMCID: PMC6153494 DOI: 10.1007/s00439-018-1927-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/31/2018] [Indexed: 02/08/2023]
Abstract
Rare variants are thought to contribute to the genetics of inflammatory bowel disease (IBD), which is more common amongst the Ashkenazi Jewish (AJ) population. A family-based approach using exome sequencing of AJ individuals with IBD was employed with a view to identify novel rare genetic variants for this disease. Exome sequencing was performed on 960 Jewish individuals including 513 from 199 multiplex families with up to eight cases. Rare, damaging variants in loci prioritized by linkage analysis and those shared by multiple affected individuals within the same family were identified. Independent evidence of association of each variant with disease was assessed. A number of candidate variants were identified, including in genes involved in the immune system. The ability to achieve statistical significance in independent case/control replication data was limited by power and was only achieved for variants in the well-established Crohn's disease gene, NOD2. This work demonstrates the challenges of identifying disease-associated rare damaging variants from exome data, even amongst a favorable cohort of familial cases from a genetic isolate. Further research of the prioritized rare candidate variants is required to confirm their association with the disease.
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Affiliation(s)
- E R Schiff
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - M Frampton
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - N Ben-Yosef
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
- Inflammatory Bowel Disease Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - B E Avila
- Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - F Semplici
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - N Pontikos
- UCL Genetics Institute, Division of Biosciences, University College London, London, UK
| | - S L Bloom
- Department of Gastroenterology, University College London Hospital, London, UK
| | - S A McCartney
- Department of Gastroenterology, University College London Hospital, London, UK
| | - R Vega
- Department of Gastroenterology, University College London Hospital, London, UK
| | - L B Lovat
- Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK
| | - E Wood
- Gastroenterology Department, Homerton University Hospital, London, UK
| | - A Hart
- Gastroenterology Department, St Mark's Hospital, London, UK
| | - E Israeli
- Inflammatory Bowel Disease Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - D Crespi
- Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK
| | - M A Furman
- Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK
| | - S Mann
- Gastroenterology Department, Barnet General Hospital, London, UK
| | - C D Murray
- Centre for Gastroenterology, Royal Free Hospital, London, UK
| | - A W Segal
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - A P Levine
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK.
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Socias M, Ti L, Wood E, Nosova E, Hull M, Hayashi K, Debeck K, Milloy MJ. Uptake of HCV treatment among people who inject drugs in the direct-acting antiviral era in a Canadian setting. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4282] [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: 12/01/2022] Open
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Ekena J, Wood E, Manchester A, Chun R, Trepanier LA. Glutathione-S-transferase-theta genotypes and the risk of cyclophosphamide toxicity in dogs. Vet Comp Oncol 2018; 16:529-534. [PMID: 29984447 DOI: 10.1111/vco.12411] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 01/15/2023]
Abstract
The antineoplastic agent cyclophosphamide (CP) has dose-limiting side effects including sterile haemorrhagic cystitis (SHC), bone marrow (BM) suppression and gastrointestinal (GI) toxicity in dogs. The metabolites acrolein and phosphoramide that mediate these toxicities are glutathione-S-transferase (GST) substrates, and low functioning GST alleles are associated with CP toxicity in humans. The aim of this study was to determine whether variants in 2 canine GST genes, GSTT1 and GSTT5, were over-represented in dogs that developed CP toxicity. Dogs undergoing pulse or metronomic CP chemotherapy were recruited (n = 101) and genotyped for 6 GSTT1 polymorphisms and 1 GSTT5 6-bp deletion that leads to non-functional enzyme. Median cumulative CP dosages for dogs with SHC (1350 mg/m2 ) were significantly higher than for dogs with GI/BM toxicity (871 mg/m2 ) or no toxicity (991 mg/m2 ; P = .0012). Dogs with SHC were more likely to have had metronomic (84.2%, 16 of 19 SHC cases) vs pulse (15.8%, 3 of 19 SHC cases) CP dosing (P < .0001). All dogs with BM or GI toxicity (n = 30) had pulse chemotherapy. GSTT1 and GSTT5 variant allele frequencies were not significantly different in CP-treated dogs with SHC or GI/BM toxicity compared to dogs without documented adverse effects. Work is underway to identify which canine GSTs detoxify acrolein and phosphoramide, so that better tools are available to predict the risk of CP toxicity in dogs.
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Affiliation(s)
- J Ekena
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - E Wood
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - A Manchester
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - R Chun
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - L A Trepanier
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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Langton D, Sha J, Ing A, Fielding D, Wood E. Bronchial thermoplasty in severe asthma in Australia. Intern Med J 2018; 47:536-541. [PMID: 28101900 DOI: 10.1111/imj.13372] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/04/2016] [Accepted: 01/12/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bronchial thermoplasty (BT) is an approved bronchoscopic intervention for the treatment of severe asthma. However, limited published experience exists outside of clinical trials regarding patient selection and outcomes achieved. AIMS To evaluate the effectiveness and safety of BT in patients with severe asthma encountered in clinical practice. METHODS This is a retrospective analysis of the first 'real world' data from Australia. The following outcomes were measured prior to, and 6 months following BT: spirometry, Asthma Control Questionnaire-5 (ACQ-5) score, reliever and preventer medication use and exacerbation history. RESULTS Twenty patients were treated from June 2014 to December 2015 at three university teaching hospitals. All subjects met the European Respiratory Society/American Thoracic Society definition of severe asthma. Mean pre-bronchodilator forced expiratory volume in 1 s was 62.8 ± 16.6% predicted (range: 33-95%). All patients were being treated with high dose inhaled corticosteroids, long-acting beta2 agonists and long-acting muscarinic antagonists. Ten patients (50%) were taking maintenance oral prednisolone. Most subjects also required at least one of montelukast (65%), omalizumab (30%) and methotrexate (20%). ACQ-5 improved from 3.6 ± 1.1 at baseline to 1.6 ± 1.2 at 6 months, P < 0.001. Short-acting reliever use decreased from a median of 8.0-0.25 puffs/day, P < 0.001, and exacerbations requiring corticosteroids also significantly reduced. Five of 10 patients completely discontinued maintenance oral corticosteroids. Ten patients with a baseline forced expiratory volume in 1 s of <60% predicted significantly improved from 49.2 ± 9.6% to 61.8 ± 17.6%, P < 0.05. Only two procedures required hospitalisation beyond the planned overnight admission. CONCLUSION BT is a safe procedure which can achieve clinical improvement in those with uncontrolled symptoms and severe airflow obstruction.
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Affiliation(s)
- David Langton
- Department of Thoracic Medicine, Frankston Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joy Sha
- Department of Thoracic Medicine, Frankston Hospital, Melbourne, Victoria, Australia
| | - Alvin Ing
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David Fielding
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Erica Wood
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
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44
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Rowsell L, Lade S, Kumar B, Juneja S, Morey A, Jain S, Kearney D, Ellis D, Nath L, Jessup P, Young E, Hitchins S, Lee K, Brown C, Leslie C, Parry J, Birch S, Norris D, Harvey Y, McQuilten Z, Wood E, Opat S, Talaulikar D. A national pathology review committee for the lymphoma and related diseases registry. Pathology 2018. [DOI: 10.1016/j.pathol.2017.12.302] [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: 11/15/2022]
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Klimas J, Small W, Ahamad K, Cullen W, Mead A, Rieb L, Wood E, McNeil R. Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors. Addict Sci Clin Pract 2017; 12:21. [PMID: 28927448 PMCID: PMC5606021 DOI: 10.1186/s13722-017-0086-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 04/19/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022] Open
Abstract
Background Although progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships. Methods We interviewed trainees and faculty from clinical and research training programmes in addiction medicine at St Paul’s Hospital in Vancouver, Canada (N = 26) about barriers and facilitators to implementation of physician training in addiction medicine. We included medical students, residents, fellows and supervising physicians from a variety of specialities. We analysed interview transcripts thematically by using NVivo software.
Results We identified six domains relating to training implementation: (1) organisational, (2) structural, (3) teacher, (4) learner, (5) patient and (6) community related variables either hindered or fostered addiction medicine education, depending on context. Human resources, variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time and space limitations hindered implementation. Participant accounts underscored how faculty and staff facilitated the implementation of both the clinical and the research training. Conclusions Implementation of addiction medicine fellowships appears feasible, although a number of barriers exist. Research into factors within the local/practice environment that shape delivery of education to ensure consistent and quality education scale-up is a priority.
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Affiliation(s)
- J Klimas
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Medicine, Coombe Healthcare Centre, University College Dublin, Dolphins Barn, Dublin 8, Ireland
| | - W Small
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - K Ahamad
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, University of British Columbia, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.,Department of Family and Community Medicine, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - W Cullen
- School of Medicine, Coombe Healthcare Centre, University College Dublin, Dolphins Barn, Dublin 8, Ireland
| | - A Mead
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, University of British Columbia, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.,Department of Family and Community Medicine, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - L Rieb
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, University of British Columbia, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.,Department of Family and Community Medicine, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - E Wood
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Medicine, Coombe Healthcare Centre, University College Dublin, Dolphins Barn, Dublin 8, Ireland
| | - R McNeil
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Crighton G, Wood E, Scarborough R, Ho PJ, Bowden D. Haemoglobin disorders in Australia: where are we now and where will we be in the future? Intern Med J 2017; 46:770-9. [PMID: 27040044 DOI: 10.1111/imj.13084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 11/16/2015] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Abstract
Inherited disorders of haemoglobin (Hb), such as thalassaemia and sickle cell disease (SCD) are common and responsible for significant morbidity and mortality on a global scale. As Australia becomes increasingly ethnically diverse, their prevalence will increase. However, we lack important demographic and epidemiological data to manage these disorders and their consequences and to support affected individuals and communities. Thalassaemia and SCD are lifelong conditions. Affected individuals have reduced life expectancies, poorer quality of life and complex healthcare needs. Treatment strategies currently focus on prenatal diagnosis, red blood cell transfusion, iron chelation, management of iron-related complications, haemopoietic stem cell transplantation (HSCT) and hydroxyurea. Currently, the only curative therapy is HSCT; however, gene therapy offers the possibility of cure and trials are currently underway. These therapies are associated with significant complications and substantial costs; there is also evidence of variation in approaches to diagnosis and care. Optimal strategies for many aspects of management are not yet defined and more research is necessary to inform clinical care and health service delivery.
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Affiliation(s)
- G Crighton
- Transfusion Outcomes Research Collaborative, Australian Red Cross Blood Service, Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - E Wood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Medical Centre, Melbourne, Victoria, Australia
| | - R Scarborough
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - P J Ho
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Bosch Institute, University of Sydney, Sydney, New South Wales, Australia
| | - D Bowden
- Monash Medical Centre, Melbourne, Victoria, Australia
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47
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Baxter A, Wood E, Kay DB, Higley JD, Suomi SJ. 0048 CEREBRAL SEROTONIN EXPRESSION PREDICTS DAYTIME SLEEP AND SLEEP DEVELOPMENT IN INFANT RHESUS MONKEYS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.047] [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: 11/14/2022] Open
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48
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Chapman K, Wood E, McKune S, Madsen V. Perceptions of Vaginal Illness Related to Water Quality in the Coastal
Ouest Region of Haiti. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.164] [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: 10/19/2022] Open
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49
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Wood E, Chapman K, Beau de Rochars V, McKune S. Community-Based Health Needs Assessment in Léogâne and Gressier, Haiti:
Six Years Post-Earthquake. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.337] [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: 10/19/2022] Open
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50
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Ti L, Dong H, Kerr T, Turje RB, Parashar S, Min JE, Montaner J, Wood E, Milloy MJ. The effect of engagement in an HIV/AIDS integrated health programme on plasma HIV-1 RNA suppression among HIV-positive people who use illicit drugs: a marginal structural modelling analysis. HIV Med 2017; 18:580-586. [PMID: 28317290 DOI: 10.1111/hiv.12493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES HIV treatment-as-prevention campaigns emphasize early diagnosis and immediate access to care and antiretroviral therapy for HIV-positive individuals in order to increase levels of plasma HIV RNA viral load (VL) suppression. However, the possible role of harm reduction-based programmes in this objective has not yet been well evaluated. The objective of the study was to examine the relationship between being a client of the Dr. Peter Centre (DPC; an HIV/AIDS-focused adult integrated health programme) and VL suppression among highly active antiretroviral therapy (HAART)-exposed HIV-positive people who use illicit drugs (PWUD) in Vancouver, Canada. METHODS Data were derived from the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) study, a study of a community-recruited cohort of HIV-positive PWUD. A marginal structural model using inverse probability of treatment weights was used to estimate the longitudinal relationship between being a DPC client and exhibiting a VL < 50 HIV-1 RNA copies/mL plasma. RESULTS Between 2005 and 2014, 746 HAART-exposed participants were included in the study, of whom 269 (36.1%) reported being a DPC client at some time during the study period. A marginal structural model estimated a 1.54 greater odds of achieving VL suppression (95% confidence interval 1.20-1.99) among DPC clients. CONCLUSIONS Our findings demonstrate that participating in an innovative HIV/AIDS-focused adult integrated health programme that provides a broad range of clinical, harm reduction, and support services may contribute to optimizing the benefits of HAART in terms of morbidity, mortality and viral transmission among PWUD, and as a result help to fulfill the goals of the treatment-as-prevention strategy.
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Affiliation(s)
- L Ti
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Dong
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - T Kerr
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R B Turje
- Dr. Peter AIDS Foundation, Vancouver, BC, Canada
| | - S Parashar
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - J E Min
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - J Montaner
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - E Wood
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M-J Milloy
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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