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Stahl A, Nakanishi H, Lepore D, Wu WC, Azuma N, Jacas C, Vitti R, Athanikar A, Chu K, Iveli P, Zhao F, Leal S, Schlief S, Schmelter T, Miller T, Köfüncü E, Fielder A. Intravitreal Aflibercept vs Laser Therapy for Retinopathy of Prematurity: Two-Year Efficacy and Safety Outcomes in the Nonrandomized Controlled Trial FIREFLEYE next. JAMA Netw Open 2024; 7:e248383. [PMID: 38687481 PMCID: PMC11061767 DOI: 10.1001/jamanetworkopen.2024.8383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/27/2024] [Indexed: 05/02/2024] Open
Abstract
Importance Prospective long-term data after retinopathy of prematurity (ROP) treatment with anti-vascular endothelial growth factor injections vs laser therapy are scarce. The FIREFLEYE (Aflibercept for ROP IVT Injection vs Laser Therapy) next trial is prospectively evaluating the long-term efficacy and safety outcomes following ROP treatment with intravitreal aflibercept vs laser therapy. Objective To evaluate 2-year ophthalmic and safety outcomes after 0.4-mg aflibercept injection or laser therapy in the 24-week randomized (2:1) FIREFLEYE trial (FIREFLEYE outcomes previously reported). Design, Setting, and Participants This prospective nonrandomized controlled trial performed in 24 countries in Asia, Europe, and South America (2020-2025) follows up participants treated in the FIREFLEYE randomized clinical trial (2019-2021) through 5 years of age. Participants included children born very or extremely preterm (gestational age ≤32 weeks) or with very or extremely low birth weight (≤1500 g) who were previously treated with a 0.4-mg injection of aflibercept compared with laser therapy for severe acute-phase ROP. Data for the present interim analysis were acquired from March 18, 2020, to July 25, 2022. Interventions Complications of ROP treated at investigator discretion (no study treatment). Main Outcomes and Measures Efficacy end points included ROP status, unfavorable structural outcomes, ROP recurrence, treatment for ROP complications, completion of vascularization, and visual function. Safety end points included adverse events and growth and neurodevelopmental outcomes. Results Overall, 100 children were enrolled (median gestational age, 26 [range, 23-31] weeks; 53 boys and 47 girls). Of these, 21 were Asian, 2 were Black, 75 were White, and 2 were of more than 1 race. At 2 years of age, 61 of 63 children (96.8%) in the aflibercept group vs 30 of 32 (93.8%) in the laser group had no ROP. Through 2 years of age, 62 of 66 (93.9%) in the aflibercept group and 32 of 34 (94.1%) in the laser group had no unfavorable structural outcomes. No new retinal detachment occurred during the study. Four children in the aflibercept group (6.1%) were treated for ROP complications before 1 year of age (2 had preexisting end-stage disease and total retinal detachment; 1 had reactivated plus disease; and 1 had recurrent retinal neovascularization not further specified). Most children were able to fix and follow a 5-cm toy (aflibercept group, 118 of 122 eyes [96.7%] among 63 children; laser group, 62 of 63 eyes [98.4%] among 33 children). High myopia was present in 9 of 115 eyes (7.8%) among 5 children in the aflibercept group and 13 of 60 eyes (21.7%) among 9 children in the laser group. No relevant differences in growth and neurodevelopmental outcomes by Bayley Scales of Infant and Toddler Development, Third Edition and Vineland Adaptive Behavior Scales, Second Edition were identified. Conclusions and Relevance In this nonrandomized follow-up of a randomized clinical trial comparing treatment of severe acute-phase ROP with 0.4-mg injection of aflibercept and laser, disease control was stable and visual function was appropriate in children through 2 years of age. No adverse effects on safety, including growth and neurodevelopment, were identified. These findings provide clinically relevant long-term information on intravitreal aflibercept injection therapy for ROP. Trial Registration ClinicalTrials.gov Identifier: NCT04015180.
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Affiliation(s)
- Andreas Stahl
- Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
| | - Hidehiko Nakanishi
- Research and Development Center for New Medical Frontiers, Division of Neonatal Intensive Care Medicine, Department of Advanced Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Domenico Lepore
- Department of Geriatrics and Neuroscience, Catholic University of the Sacred Heart, A. Gemelli Foundation Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Wei-Chi Wu
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Noriyuki Azuma
- Medical Research Institute, Department of Developmental and Regenerative Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Carlos Jacas
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Robert Vitti
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Karen Chu
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Fei Zhao
- Bayer Inc, Mississauga, Ontario, Canada
| | | | | | | | | | | | - Alistair Fielder
- Department of Optometry and Visual Science, City, University of London, London, United Kingdom
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Vitti JN, Vitti R, Chu K, Mellis S. The ethics of clinical research in the era of COVID-19. Front Public Health 2024; 12:1359654. [PMID: 38510356 PMCID: PMC10950982 DOI: 10.3389/fpubh.2024.1359654] [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: 12/21/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
There is an urgent need for increased understanding of COVID-19 and strategies for its prevention, treatment, and mitigation. All participants in the research enterprise, including institutional review boards, have an ethical duty to protect participants and ensure that the benefits gained from such research do not conflict with the core principles that guided researchers prior to the pandemic. In this review, we discuss the ethical issues surrounding initiation and conduct of clinical trials, focusing on novel COVID-19 therapeutic, vaccine, or biospecimen research, using the principles of autonomy, beneficence, and justice. We discuss strategies to manage the practical challenges associated with the conduct of clinical trials, with an emphasis on maintaining the rights and welfare of research participants.
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Affiliation(s)
| | - Robert Vitti
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
| | - Karen Chu
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
| | - Scott Mellis
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
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Leung LB, Zhang E, Chu K, Yoo C, Gabrielian S, Der-Martirosian C. Characteristics of Veterans Experiencing Homelessness using Telehealth for Primary Care Before and After COVID-19 Pandemic Onset. J Gen Intern Med 2024; 39:53-59. [PMID: 38252239 PMCID: PMC10937850 DOI: 10.1007/s11606-023-08462-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/06/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The COVID-19 pandemic expanded telehealth use across healthcare systems, including the Veterans Health Administration (VA). Little is known about how large-scale telehealth rollout affected access to primary care for patients experiencing homelessness. OBJECTIVE To examine the extent to which homeless-experienced veterans used telehealth services in primary care and to characterize users before and after the onset of the COVID-19 pandemic. DESIGN Retrospective cohort study, 3/16/2019-3/15/2022. PARTICIPANTS 394,731 veterans with homelessness diagnoses nationally using 4,068,109 primary care visits. MAIN MEASURES The outcomes were use of 1 + telehealth visits (video, phone, secure messaging) for primary care during each year. Through multivariable regression models, we examined associations between telehealth use, patient characteristics (e.g., age, sex, race-ethnicity, comorbidity), and VA homeless services use (e.g., homeless-tailored primary care (HPACT), permanent supportive housing). KEY RESULTS Compared to pre-pandemic, telehealth in primary care among homeless-experienced veterans increased substantially 2 years post-pandemic (video: 1.37% versus 20.56%, phone: 60.74% versus 76.58%). Secure messaging was low over time (1.57-2.63%). In adjusted models, video users were more likely to be young (65 + years: OR = 0.43, CI: 0.42-0.44), women (OR = 1.74, CI: 1.70-1.78), Black (OR = 1.14, CI: 1.12-1.16), Hispanic (OR = 1.34, CI: 1.30-1.38), and with more comorbidities (2 + on the Charlson Comorbidity Index; OR = 1.16, CI: 1.14-1.19), compared to video non-users. HPACT patients were less likely to use video (OR = 0.68, CI: 0.66-0.71) than other primary care patients. This was not observed among users of other VA homeless services. CONCLUSIONS Despite decreased access to health information technology and low pre-pandemic telehealth use, veterans experiencing homelessness still sustained high use of telehealth in primary care post-pandemic. Women and racial-ethnic minorities had higher video uptake proportionately, suggesting that telehealth may address access disparities among these homeless-experienced patient groups. Identifying and targeting organizational characteristics (e.g., HPACT users) that predict telehealth use for improvement may be key to increasing adoption among VA primary care patients experiencing homelessness.
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Affiliation(s)
- Lucinda B Leung
- Center for the Study of Healthcare Innovation, Implementation & Policy, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Division of General Internal Medicine, UCLA David Geffen School of Medicine/Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Eunice Zhang
- Center for the Study of Healthcare Innovation, Implementation & Policy, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Karen Chu
- Center for the Study of Healthcare Innovation, Implementation & Policy, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, CA, USA
| | - Caroline Yoo
- Center for the Study of Healthcare Innovation, Implementation & Policy, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Sonya Gabrielian
- Center for the Study of Healthcare Innovation, Implementation & Policy, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
| | - Claudia Der-Martirosian
- Center for the Study of Healthcare Innovation, Implementation & Policy, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, CA, USA
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Tisdale R, Der-Martirosian C, Yoo C, Chu K, Zulman D, Leung L. Disparities in Video-Based Primary Care Use Among Veterans with Cardiovascular Disease. J Gen Intern Med 2024; 39:60-67. [PMID: 38252244 PMCID: PMC10937859 DOI: 10.1007/s11606-023-08475-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/11/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Cardiovascular disease (CVD) is prevalent among Veterans, and video care enhances access to CVD care. However, it is unknown which patients with CVD conditions receive video care in primary care clinics, where a large proportion of CVD services is delivered. OBJECTIVE Characterize use of VA video primary care for Veterans with two common CVDs, heart failure and hypertension. DESIGN Retrospective cohort study. PATIENTS Veterans seen in VA primary care with diagnoses of heart failure and/or hypertension in the year prior to the COVID-19 pandemic and for the first two pandemic-years. MAIN MEASURES The primary outcome was use of any video-based primary care visits. Using multilevel regressions, we examined the association between video care use and patient sociodemographic and clinical characteristics, controlling for time and adjusting for patient- and site-level clustering. KEY RESULTS Of 3.8M Veterans with 51.9M primary care visits, 456,901 Veterans had heart failure and hypertension, 50,753 had heart failure only, and 3,300,166 had hypertension only. Veterans with heart failure and hypertension had an average age of 71.6 years. 2.9% were female, and 34.8% lived in rural settings. Patients who were male, aged 75 or older, or rural-dwelling had lower odds of using video care than female patients, 18-44-year-olds, and urban-dwellers, respectively (male patients' adjusted odds ratio [AOR] 0.73, 95% confidence interval [CI] 0.72-0.74; 75 years or older, AOR 0.38, 95% CI 0.37-0.38; rural-dwellers, AOR 0.71, 95% CI 0.70-0.71). Veterans with heart failure had higher odds of video care use than those with hypertension only (AOR 1.05, 95% CI 1.04-1.06). CONCLUSIONS Given lower odds of video primary care use among some patient groups, continued expansion of video care could make CVD services increasingly inequitable. These insights can inform equitable triage of patients, for example by identifying patients who may benefit from additional support to use virtual care.
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Affiliation(s)
- Rebecca Tisdale
- Veterans Affairs Palo Alto Healthcare System/Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA.
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
| | - Claudia Der-Martirosian
- Veterans Affairs Greater Los Angeles Healthcare System/Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), Los Angeles, CA, USA
| | - Caroline Yoo
- Veterans Affairs Greater Los Angeles Healthcare System/Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), Los Angeles, CA, USA
| | - Karen Chu
- Veterans Affairs Greater Los Angeles Healthcare System/Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), Los Angeles, CA, USA
- Veterans Emergency Management Evaluation Center (VEMEC), North Hills, CA, USA
| | - Donna Zulman
- Veterans Affairs Palo Alto Healthcare System/Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Lucinda Leung
- Veterans Affairs Greater Los Angeles Healthcare System/Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine & Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Ye ZH, Jiang HB, Tan SW, Shi HB, Chu K, Zhang DD. [Prevalence of medicare antiviral drugs use and related factors in HIV-infected people in Ningbo]. Zhonghua Liu Xing Bing Xue Za Zhi 2024; 45:123-127. [PMID: 38228534 DOI: 10.3760/cma.j.cn112338-20230606-00353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Objective: To analyze the use of medicare antiviral drugs (ART) and related factors among HIV-infected people in Ningbo City. Methods: The retrospective data was collected related to infection and treatment of HIV-infected people in ART in Ningbo up to February 2023 through the National Infectious Disease Surveillance System. Binary logistic regression was used to analyze the factors related to medicare antiviral drug use in HIV-infected people. R 4.2.2 software was used for statistical analysis. Results: A total of 6 433 HIV-infected people with ART records were collected, among which 5 783 were in ART. The prevalence of medicare drugs use among people in ART was 24.8% (1 435/5 783, 95%CI: 23.7%-25.9%). Beilun District (8.7%, 43/497) and Fenghua District (5.7%, 14/247) had the lowest level in medicare drugs use. Among people in ART using medicare or out-of-pocket drugs, the prevalence of those who had at least one viral load test in the last year (84.9%, 1 352/1 593) was significantly lower than that of those using free drugs (91.4%, 3 829/4 190) (χ2=52.50, P<0.001). The results of multivariate logistic analysis showed that the factors influencing medicare drug use included low educational level (junior high school and below: aOR=0.24, 95%CI:0.17-0.34), farmer or worker (farmer: aOR=0.60, 95%CI: 0.39-0.91; worker: aOR=0.42, 95%CI: 0.27-0.64), low monthly income (<3 000 Yuan: aOR=0.29, 95%CI: 0.18-0.45), the longer interval time between diagnosis and treatment (≥21 days: aOR=0.47, 95%CI: 0.30-0.74). Conclusions: Significant regional differences on the prevalence of medicare antiviral drugs use in HIV-infected people exist in Ningbo City. Follow-up management program of patients should be improved to strengthen patient compliance to mobilize medicare drug promotion. Meanwhile, publicity of medicare drugs should be strengthened for farmers or workers with low education level and patients with delayed treatment.
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Affiliation(s)
- Z H Ye
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - H B Jiang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - S W Tan
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - H B Shi
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - K Chu
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
| | - D D Zhang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China
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O’Hanlon CE, Walling AM, McClean M, Chu K, Lindvall C, Lee M, Stockdale SE, Leung LB. Depression care quality among patients with solid tumor cancers detected to have depression in Veterans Health Administration primary care clinics. Psychol Serv 2023; 20:764-769. [PMID: 37616079 PMCID: PMC10843783 DOI: 10.1037/ser0000795] [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] [Indexed: 08/25/2023]
Abstract
Patients with cancer, especially advanced cancer, experience depression at high rates. We aimed to evaluate the quality of depression care received by patients with solid tumor cancer and advanced solid tumor cancer in Veterans Affairs (VA) primary care clinics. This is a retrospective cohort study of patients seen in 82 VA primary care clinics who newly screened positive for depression on the Patient Health Questionnaire (PHQ-2). Outcomes included timely follow-up within 84 or 180 days (3+ mental health specialty, 3+ psychotherapy, or 3+ primary care visits with depression diagnosis codes) and minimum treatment within 1 year (60+ days antidepressants prescribed, 4+ mental health specialty visits, or 3+ psychotherapy visits). 608,042 individuals were seen in VA primary care clinics during this period; 49,839 patients (8.2%) had solid tumor cancer and 9,278 (1.5%) had advanced or poor-prognosis solid tumor cancer. For 686 observations of patients with cancer and new depression, rates of appropriate follow-up were 22.3% within 84 days and 38.2% within 180 days. For 73 observations of patients with advanced or poor-prognosis cancer and new depression, rates of appropriate follow-up were 21.9% within 84 days and 34.3% within 180 days. Rates of minimum treatment within 1 year were 68.4% and 64.4% for patients with cancer and patients with advanced or poor-prognosis cancer, respectively. Quality of timely depression management is low in patients with solid tumor cancers. Even in health systems with well-integrated mental health services, care gaps remain for patients with cancer and depression. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Claire E. O’Hanlon
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy
| | - Anne M. Walling
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy, UCLA Department of General Internal Medicine and Health Services Research
| | - Michael McClean
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy
| | - Karen Chu
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy
| | - Charlotta Lindvall
- Dana-Farber Cancer Institute Department of Psychosocial Oncology and Palliative Care (POPC), Brigham and Women’s Hospital Department of Medicine
| | - Martin Lee
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy
| | - Susan E. Stockdale
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy
| | - Lucinda B. Leung
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy, UCLA Department of General Internal Medicine and Health Services Research
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Jones AL, Chu K, Rose DE, Gelberg L, Kertesz SG, Gordon AJ, Wells KB, Leung L. Quality of Depression Care for Veterans Affairs Primary Care Patients with Experiences of Homelessness. J Gen Intern Med 2023; 38:2436-2444. [PMID: 36810631 PMCID: PMC10465405 DOI: 10.1007/s11606-023-08077-8] [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: 09/21/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Persons who experience homelessness (PEH) have high rates of depression and incur challenges accessing high-quality health care. Some Veterans Affairs (VA) facilities offer homeless-tailored primary care clinics, although such tailoring is not required, within or outside VA. Whether services tailoring enhances care for depression is unstudied. OBJECTIVE To determine whether PEH in homeless-tailored primary care settings receive higher quality of depression care, compared to PEH in usual VA primary care. DESIGN Retrospective cohort study of depression treatment among a regional cohort of VA primary care patients (2016-2019). PARTICIPANTS PEH diagnosed or treated for a depressive disorder. MAIN MEASURES The quality measures were timely follow-up care (3 + completed visits with a primary care or mental health specialist provider, or 3 + psychotherapy sessions) within 84 days of a positive PHQ-2 screen result, timely follow-up care within 180 days, and minimally appropriate treatment (4 + mental health visits, 3 + psychotherapy visits, 60 + days antidepressant) within 365 days. We applied multivariable mixed-effect logistic regressions to model differences in care quality for PEH in homeless-tailored versus usual primary care settings. KEY RESULTS Thirteen percent of PEH with depressive disorders received homeless-tailored primary care (n = 374), compared to usual VA primary care (n = 2469). Tailored clinics served more PEH who were Black, who were non-married, and who had low income, serious mental illness, and substance use disorders. Among all PEH, 48% received timely follow-up care within 84 days of depression screening, 67% within 180 days, and 83% received minimally appropriate treatment. Quality metric attainment was higher for PEH in homeless-tailored clinics, compared to PEH in usual VA primary care: follow-up within 84 days (63% versus 46%; adjusted odds ratio [AOR] = 1.61, p = .001), follow-up within 180 days (78% versus 66%; AOR = 1.51, p = .003), and minimally appropriate treatment (89% versus 82%; AOR = 1.58, p = .004). CONCLUSIONS Homeless-tailored primary care approaches may improve depression care for PEH.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center and Vulnerable Veteran Innovative Patient-Aligned Care Team (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, UT, 84148, USA.
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Karen Chu
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) and Veterans Assessment and Improvement Laboratory (VAIL), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Danielle E Rose
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) and Veterans Assessment and Improvement Laboratory (VAIL), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Lillian Gelberg
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) and Veterans Assessment and Improvement Laboratory (VAIL), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California-Los Angeles (UCLA), Los Angeles, CA, USA
- UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Stefan G Kertesz
- Birmingham VA Health Care System, Birmingham, AL, USA
- Heersink University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center and Vulnerable Veteran Innovative Patient-Aligned Care Team (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, UT, 84148, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kenneth B Wells
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) and Veterans Assessment and Improvement Laboratory (VAIL), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California-Los Angeles (UCLA), Los Angeles, CA, USA
- UCLA Fielding School of Public Health, Los Angeles, CA, USA
- UCLA Center for Health Services and Society, Los Angeles, CA, USA
| | - Lucinda Leung
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) and Veterans Assessment and Improvement Laboratory (VAIL), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California-Los Angeles (UCLA), Los Angeles, CA, USA
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Francis P, Chu K, Isiagi M, Fieggen G, Gordon C, Maswime S. Developing a Pipeline of African Global Surgery Scholars. S Afr Med J 2023; 113:10-11. [PMID: 37882035 DOI: 10.7196/samj.2023.v113i7.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Indexed: 10/27/2023] Open
Abstract
Global surgery is developing as new discipline in many countries. Global surgery primarily aims to improve access to quality surgery in low-and-middle Income countries (LMICs). Thus, ensuring appropriate LMIC representation and leadership in global surgery research, projects, and innovations, is essential. There is a paucity of pathways for students and young clinicians in LMICs to attain training in and exposure to global surgery research and projects. If equity in global surgery leadership and scholarship is truly desired, steps need to be taken to ensure that more students and young clinicians in LMICs are exposed to global surgery as an academic discipline and are offered pathways to practice and leadership. This paper explores ways of ensuring this through increased exposure, increased training and increased funding.
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Affiliation(s)
- P Francis
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - K Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Isiagi
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - G Fieggen
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - C Gordon
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - S Maswime
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
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Vinekar K, Chu K, Tan GJ, Jackson NJ, Washington DL, Cordasco KM. Using Primary Care Geographic Network Adequacy Metrics for VA Obstetric Referrals: a Foundation for Equitable, Timely, and Veteran-Centered Care. J Gen Intern Med 2023:10.1007/s11606-023-08191-7. [PMID: 37340261 DOI: 10.1007/s11606-023-08191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/24/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Kavita Vinekar
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA.
- Division of Gynecology, Department of Surgery & Perioperative Services, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- Department of Obstetrics & Gynecology, University of California Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Karen Chu
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
| | - Gracielle J Tan
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
| | - Nicholas J Jackson
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, CA, USA
| | - Donna L Washington
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
| | - Kristina M Cordasco
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
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Paul W, Burlina P, Mocharla R, Joshi N, Li Z, Gu S, Nanegrungsunk O, Lin K, Bressler SB, Cai CX, Kong J, Liu TYA, Moini H, Du W, Amer F, Chu K, Vitti R, Sepehrband F, Bressler NM. Accuracy of Artificial Intelligence in Estimating Best-Corrected Visual Acuity From Fundus Photographs in Eyes With Diabetic Macular Edema. JAMA Ophthalmol 2023:2805759. [PMID: 37289463 PMCID: PMC10251243 DOI: 10.1001/jamaophthalmol.2023.2271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Importance Best-corrected visual acuity (BCVA) is a measure used to manage diabetic macular edema (DME), sometimes suggesting development of DME or consideration of initiating, repeating, withholding, or resuming treatment with anti-vascular endothelial growth factor. Using artificial intelligence (AI) to estimate BCVA from fundus images could help clinicians manage DME by reducing the personnel needed for refraction, the time presently required for assessing BCVA, or even the number of office visits if imaged remotely. Objective To evaluate the potential application of AI techniques for estimating BCVA from fundus photographs with and without ancillary information. Design, Setting, and Participants Deidentified color fundus images taken after dilation were used post hoc to train AI systems to perform regression from image to BCVA and to evaluate resultant estimation errors. Participants were patients enrolled in the VISTA randomized clinical trial through 148 weeks wherein the study eye was treated with aflibercept or laser. The data from study participants included macular images, clinical information, and BCVA scores by trained examiners following protocol refraction and VA measurement on Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Main Outcomes Primary outcome was regression evaluated by mean absolute error (MAE); the secondary outcome included percentage of predictions within 10 letters, computed over the entire cohort as well as over subsets categorized by baseline BCVA, determined from baseline through the 148-week visit. Results Analysis included 7185 macular color fundus images of the study and fellow eyes from 459 participants. Overall, the mean (SD) age was 62.2 (9.8) years, and 250 (54.5%) were male. The baseline BCVA score for the study eyes ranged from 73 to 24 letters (approximate Snellen equivalent 20/40 to 20/320). Using ResNet50 architecture, the MAE for the testing set (n = 641 images) was 9.66 (95% CI, 9.05-10.28); 33% of the values (95% CI, 30%-37%) were within 0 to 5 letters and 28% (95% CI, 25%-32%) within 6 to 10 letters. For BCVA of 100 letters or less but more than 80 letters (20/10 to 20/25, n = 161) and 80 letters or less but more than 55 letters (20/32 to 20/80, n = 309), the MAE was 8.84 letters (95% CI, 7.88-9.81) and 7.91 letters (95% CI, 7.28-8.53), respectively. Conclusions and Relevance This investigation suggests AI can estimate BCVA directly from fundus photographs in patients with DME, without refraction or subjective visual acuity measurements, often within 1 to 2 lines on an ETDRS chart, supporting this AI concept if additional improvements in estimates can be achieved.
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Affiliation(s)
- William Paul
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | - Philippe Burlina
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
- Department of Computer Science and Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland
- Zoox, Foster City, California
| | - Rohita Mocharla
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | - Neil Joshi
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | - Zhuolin Li
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie Gu
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York
| | - Onnisa Nanegrungsunk
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kira Lin
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Ruiz Department of Ophthalmology and Visual Science at McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Susan B Bressler
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cindy X Cai
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jun Kong
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - T Y Alvin Liu
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hadi Moini
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Weiming Du
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Fouad Amer
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Karen Chu
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Robert Vitti
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Neil M Bressler
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Editor, JAMA Ophthalmology
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11
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Ye Z, Chu K, Zhang J, Sun Y, Lu F. [Prevalence and influencing factors of human soil-transmitted nematode infections in Ningbo City from 2016 to 2021]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2023; 35:286-290. [PMID: 37455101 DOI: 10.16250/j.32.1374.2022217] [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] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To investigate the prevalence and influencing factors of soil-transmitted nematode infections in Ningbo City from 2016 to 2021, so as to provide insights into the development of targeted control measures against soil-transmitted nematodiasis. METHODS Permanent residents at ages of 3 years and older were sampled in Ningbo City using a multi-stage sampling method each year during the period from 2016 to 2021. Soil-transmitted nematode eggs were detected in stool samples using a modified Kato-Katz thick smear method (two slides for each stool sample), and Enterobius vermicularis eggs were additionally identified among children at ages of 3 to 12 years using the adhesive cellophane-tape perianal swab method. The time- and regions-specific prevalence of soil-transmitted nematode infections was calculated, and the factors affecting hookworm infections were identified using a multivariate logistic regression model. RESULTS A total of 11 573 person-times were detected for soil-transmitted nematode infections in Ningbo City from 2016 to 2021, and 296 egg-positives were detected, with a mean prevalence rate of 2.56% [95% confidential interval (CI): (2.28%, 2.87%)]. Hookworm was the predominant species of soil-transmitted nematode among egg-positives in Ningbo City (98.31%, 291/296), and there was a significant difference in the prevalence of hook-worm infections among years (χ2 = 190.27, P < 0.01). The highest prevalence of hook-worm infections was observed in Ninghai County (4.06%), and there was a region-specific prevalence rate of hookworm infection in Ningbo City (χ2 = 148.43, P < 0.01). Multivariate logistic regression analysis showed that elderly residents at ages of over 60 years [odds ratio (OR)= 1.94, 95% CI: (1.07, 3.54), P < 0.05], males [OR = 2.19, 95% CI: (1.72, 2.80), P < 0.01], farmers [OR = 6.94, 95% CI: (3.37, 14.29), P < 0.01] and residents with a low education level [illiteracy or semi-illiterate: OR = 3.82, 95% CI: (1.56, 9.35), P < 0.05; primary school: OR = 2.70, 95% CI: (1.11, 6.59), P < 0.05] were at a higher risk for hookworm infections. CONCLUSIONS The overall prevalence of soil-transmitted nematode infections was low among residents in Ningbo City from 2016 to 2021. The surveillance and health education for human hookworm disease remain to be reinforced among male farmers with a low education level at ages of over 60 years in Ninghai County.
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Affiliation(s)
- Z Ye
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang 315010, China
| | - K Chu
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang 315010, China
| | - J Zhang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang 315010, China
| | - Y Sun
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang 315010, China
| | - F Lu
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang 315010, China
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12
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Chu K. The impact of a decentralised orthopaedic service on tertiary referrals in Cape Town, South Africa. S Afr Med J 2023; 113:e833. [PMID: 37283158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND In South Africa (SA), district hospitals (DHs) have limited capacity to manage the high burden of traumatic injuries. Scaling-up decentralised orthopaedic care could strengthen trauma systems and improve timely access to essential and emergency surgical care (EESC). Khayelitsha township in Cape Town, SA has the highest trauma burden of the Cape Metro East health district. Objectives. The primary objectives of this study were to describe the impact of the Khayelitsha District Hospital (KDH) on acute orthopaedic services for the health district with a focus on the volume and type of orthopaedic services provided without tertiary referral. Methods. This retrospective analysis described acute orthopaedic cases and their management from Khayelitsha township between 1 January 2018 to 31 December 2019. Orthopaedic resources and the proportion of cases referred to the tertiary hospital by all DHs in the Cape Metro East health district were described. Results. In 2018-2019, KDH performed 2040 orthopaedic operations of which 91.3% were urgent or emergencies. KDH had the most orthopaedic resources and the lowest referral ratio (0.18) compared to other DHs (0.92-1.35). In the Khayelitsha township, 2402 acute orthopaedic cases presented to community health clinics. Trauma (86.1%) was the most common mechanism for acute orthopaedic referrals. 2229 (92.8%) clinic cases were referred to KDH and 173 (7.2%) directly to the tertiary hospital. The most common reason for direct tertiary referral was condition related (n=157, 90.8%). Conclusions. This study outlines a successful example of a decentralised orthopaedic surgical service that increased EESC accessibility and alleviated the high burden of tertiary referrals compared to other DHs with fewer resources. Further research on the barriers to scaling-up orthopaedic DH capacity in SA is needed to improve equitable access to surgical care.
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Affiliation(s)
- K Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Department of Surgery, University of Botswana, Gaborone, Botswana.
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13
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MacQuene T, Du Toit J, Hugo D, Alexander M, Ramasar S, Letswalo M, Swanepoel M, Brown C, Chu K. The impact of a decentralised orthopaedic service on tertiary referrals in Cape Town, South Africa. S Afr Med J 2023; 113:e833. [PMID: 37283150 DOI: 10.7196/samj.2023.v113i4.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND In South Africa (SA), district hospitals (DHs) have limited capacity to manage the high burden of traumatic injuries. Scaling up decentralised orthopaedic care could strengthen trauma systems and improve timely access to essential and emergency surgical care (EESC). Khayelitsha township in Cape Town, SA, has the highest trauma burden in the Cape Metro East health district. OBJECTIVES The primary objective of this study was to describe the impact of Khayelitsha District Hospital (KDH) on acute orthopaedic services in the health district, with a focus on the volume and type of orthopaedic services provided without tertiary referral. METHODS This retrospective analysis described acute orthopaedic cases from Khayelitsha and their management between 1 January 2018 and 31 December 2019. Orthopaedic resources and the proportion of cases referred to the tertiary hospital by all DHs in the Cape Metro East health district are described. RESULTS In 2018 - 2019, KDH performed 2 040 orthopaedic operations, of which 91.3% were urgent or emergencies. KDH had the most orthopaedic resources and the lowest referral ratio (0.18) compared with other DHs (0.92 - 1.35). In Khayelitsha, 2 402 acute orthopaedic cases presented to community health clinics. Trauma (86.1%) was the most common mechanism of injury for acute orthopaedic referrals. Of clinic cases, 2 229 (92.8%) were referred to KDH and 173 (7.2%) directly to the tertiary hospital. The most common reason for direct tertiary referral was condition related (n=157; 90.8%). CONCLUSION This study outlines a successful example of a decentralised orthopaedic surgical service that increased EESC accessibility and alleviated the high burden of tertiary referrals compared with other DHs with fewer resources. Further research on the barriers to scaling up orthopaedic DH capacity in SA is needed to improve equitable access to surgical care.
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Affiliation(s)
- T MacQuene
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - J Du Toit
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - D Hugo
- Department of Orthopaedic Surgery, Khayelitsha District Hospital, Cape Town, South Africa.
| | - M Alexander
- Department of Orthopaedic Surgery, Khayelitsha District Hospital, Cape Town, South Africa.
| | - S Ramasar
- 6th-year medical student, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Letswalo
- 5th-year medical student, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Swanepoel
- 6th-year medical student, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - C Brown
- Department of Orthopaedic Surgery, Khayelitsha District Hospital, Cape Town, South Africa.
| | - K Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
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Leung LB, Yoo C, Chu K, O’Shea A, Jackson NJ, Heyworth L, Der-Martirosian C. Rates of Primary Care and Integrated Mental Health Telemedicine Visits Between Rural and Urban Veterans Affairs Beneficiaries Before and After the Onset of the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e231864. [PMID: 36881410 PMCID: PMC9993180 DOI: 10.1001/jamanetworkopen.2023.1864] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
IMPORTANCE Telemedicine can increase access to care, but uptake has been low among people living in rural areas. The Veterans Health Administration initially encouraged telemedicine uptake in rural areas, but telemedicine expansion efforts have broadened since the COVID-19 pandemic. OBJECTIVE To examine changes over time in rural-urban differences in telemedicine use for primary care and for mental health integration services among Veterans Affairs (VA) beneficiaries. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined 63.5 million primary care and 3.6 million mental health integration visits across 138 VA health care systems nationally from March 16, 2019, to December 15, 2021. Statistical analysis took place from December 2021 to January 2023. EXPOSURES Health care systems with most clinic locations designated as rural. MAIN OUTCOMES AND MEASURES For every system, monthly visit counts for primary care and mental health integration specialties were aggregated from 12 months before to 21 months after pandemic onset. Visits were categorized as in person or telemedicine, including video. A difference-in-difference approach was used to examine associations in visit modality by health care system rurality and pandemic onset. Regression models also adjusted for health care system size as well as relevant patient characteristics (eg, demographic characteristics, comorbidities, broadband internet access, and tablet access). RESULTS The study included 63 541 577 primary care visits (6 313 349 unique patients) and 3 621 653 mental health integration visits (972 578 unique patients) (6 329 124 unique patients among the cohort; mean [SD] age, 61.4 [17.1] years; 5 730 747 men [90.5%]; 1 091 241 non-Hispanic Black patients [17.2%]; and 4 198 777 non-Hispanic White patients [66.3%]). In fully adjusted models for primary care services before the pandemic, rural VA health care systems had higher proportions of telemedicine use than urban ones (34% [95% CI, 30%-38%] vs 29% [95% CI, 27%-32%]) but lower proportions of telemedicine use than urban health care systems after pandemic onset (55% [95% CI, 50%-59%] vs 60% [95% CI, 58%-62%]), signifying a 36% reduction in the odds of telemedicine use (odds ratio [OR], 0.64; 95% CI, 0.54-0.76). The rural-urban telemedicine gap was even larger for mental health integration (OR, 0.49; 95% CI, 0.35-0.67) than for primary care services. Few video visits occurred across rural and urban health care systems (unadjusted percentages: before the pandemic, 2% vs 1%; after the pandemic, 4% vs 8%). Nonetheless, there were rural-urban divides for video visits in both primary care (OR, 0.28; 95% CI, 0.19-0.40) and mental health integration services (OR, 0.34; 95% CI, 0.21-0.56). CONCLUSIONS AND RELEVANCE This study suggests that, despite initial telemedicine gains at rural VA health care sites, the pandemic was associated with an increase in the rural-urban telemedicine divide across the VA health care system. To ensure equitable access to care, the VA health care system's coordinated telemedicine response may benefit from addressing rural disparities in structural capacity (eg, internet bandwidth) and from tailoring technology to encourage adoption among rural users.
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Affiliation(s)
- Lucinda B. Leung
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine–Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | - Caroline Yoo
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Karen Chu
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, California
| | - Amy O’Shea
- Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Nicholas J. Jackson
- Division of General Internal Medicine–Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | - Leonie Heyworth
- Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC
- Department of Medicine, University of California San Diego School of Medicine, San Diego
| | - Claudia Der-Martirosian
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, California
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Sarici K, Yordi S, Martin A, Lunasco L, Mugnaini C, Chu K, Moini H, Vitti R, Srivastava SK, Ehlers JP. Longitudinal Quantitative Ultrawide-field Fluorescein Angiography Dynamics in the RUBY Diabetic Macular Edema Study. Ophthalmol Retina 2023:S2468-6530(23)00037-4. [PMID: 36736895 DOI: 10.1016/j.oret.2023.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/17/2022] [Revised: 12/17/2022] [Accepted: 01/23/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the longitudinal change in quantitative ultrawide-field angiographic (UWFA) parameters and correlate them with functional outcomes and spectral domain-OCT metrics. DESIGN This study is a post hoc analysis of the phase II RUBY study: a prospective, randomized trial of patients with diabetic macular edema (DME) treated with either intravitreal aflibercept injection (IAI) or combined IAI/nesvacumab (antiangiopoietin 2 mAb). SUBJECTS Subjects with DME that underwent UWFA across all treatment groups (n = 44). METHODS A machine learning-enabled feature extraction system generated panretinal quantitative UWFA metrics, including leakage, ischemia, and microaneurysm (MA) burden. Zonal assessments were performed corresponding to the macula, midperiphery, and far periphery. MAIN OUTCOME MEASURES Changes in ischemic area and index (proportion of nonperfusion in analyzable retina), leakage area and index (proportion of leakage in analyzable retina), and MA count at baseline, week 12, week 24, and week 36 were analyzed. Spectral-domain-OCT quantitative metrics, such as central subfield thickness, ellipsoid zone (EZ) integrity parameters, intraretinal fluid (IRF) volume, and subretinal fluid (SRF) volume were extracted via a machine learning-enhanced OCT feature extraction platform and analyzed. Additionally, the effect of these changes on best-corrected visual acuity (BCVA) was evaluated. RESULTS Mean panretinal leakage index, zonal leakage area, and panretinal MA count improved significantly between baseline and week 36. Panretinal ischemic index decreased between baseline and week 36, with some aspects showing significant improvement. Mean BCVA significantly improved from baseline to week 36. There was a significant inverse correlation between change in BCVA and change in macular leakage area. A direct correlation was observed between both baseline macular leakage area and panretinal leakage index with IRF volume, SRF volume, and EZ disruption on OCT. CONCLUSIONS Assessment of UWFA parameters demonstrates a significant improvement in panretinal leakage index, leakage area, and MA burden in eyes treated with IAI with or without nesvacumab. A numeric reduction in panretinal ischemic index and area was noted. The analysis also shows the critical association of leakage with visual and OCT features. This highlights the potential role of UWFA in disease burden assessment, with leakage parameters serving as a primary end point. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Kubra Sarici
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sari Yordi
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alison Martin
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leina Lunasco
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christopher Mugnaini
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Karen Chu
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Hadi Moini
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Robert Vitti
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
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16
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Maratos FA, Chu K, Lipka S, Stupple EJN, Parente F. Exploring pattern recognition: what is the relationship between the recognition of words, faces and other objects? Cogn Process 2023; 24:59-70. [PMID: 36376612 PMCID: PMC9898371 DOI: 10.1007/s10339-022-01111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/04/2022] [Indexed: 11/16/2022]
Abstract
Debate surrounds processes of visual recognition, with no consensus as to whether recognition of distinct object categories (faces, bodies, cars, and words) is domain specific or subserved by domain-general visual recognition mechanisms. Here, we investigated correlations between the performance of 74 participants on recognition tasks for words, faces and other object categories. Participants completed a counter-balanced test battery of the Cambridge Face, Car and Body Parts Memory tests, as well as a standard four category lexical decision task, with response time and recognition accuracy as dependent variables. Results revealed significant correlations across domains for both recognition accuracy and response time, providing some support for domain-general pattern recognition. Further exploration of the data using principal component analysis (PCA) revealed a two-component model for both the response time and accuracy data. However, how the various word and object recognition tasks fitted these components varied considerably but did hint at familiarity/expertise as a common factor. In sum, we argue a complex relationship exists between domain-specific processing and domain-general processing, but that this is shaped by expertise. To further our understanding of pattern recognition, research investigating the recognition of words, faces and other objects in dyslexic individuals is recommended, as is research exploiting neuroimaging methodologies, with excellent temporal resolution, to chart the temporal specifics of different forms of visual pattern recognition.
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Affiliation(s)
- F. A. Maratos
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - K. Chu
- Hong Kong Polytechnic University, Hong Kong, China
| | - S. Lipka
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - E. J. N. Stupple
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - F. Parente
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby, UK
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Wei MW, Li JX, Chu K, Zhu JH, Zhu FC. [Five-year immunity persistence following immunization with haemophilus influenzae type b conjugate vaccine]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:1768-1772. [PMID: 36444460 DOI: 10.3760/cma.j.cn112338-20220526-00467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To evaluate the immunity persistence five years later after immunization with Haemophilus influenzae type b (Hib) conjugate vaccine in healthy infants/children aged 3 months to 5 years in China. Methods: The children were subjects who completed the whole-schedule immunization in the phase Ⅲ clinical trial in Lianshui county of Jiangsu povince was selected for the collection of blood samples at 5 years after vaccination from November to December, 2019. The enzyme-linked immunosorbent assay (ELISA) was used to detect Hib polyribosyl-ribitol-phosphate antibody (anti-Hib-PRP), and the long-term/short-term protection rate, geometric mean concentration (GMC) and geometric mean concentration increase fold (GMFI) of serum anti-Hib-PRP were calculated. Results: A total of 580 children were enrolled in this study, of which 158, 207 and 215 belonged to 3-5 month age group, 6-11 month age group and 1-5 year age group, respectively. The short-term (≥0.15 μg/ml)/long-term (≥1.0 μg/ml) protection rates of serum anti-PRP in the three groups after immunization were 89.24%, 90.34% and 98.60%, respectively; the GMC were 3.95 μg/ml, 3.11 μg/ml and 10.01 μg/ml respectively, and the GMFI were 29.04, 11.01 and 3.26 respectively. Conclusions: Hib conjugate vaccine can still have good immunogenicity after 5 years of primary immunization in healthy infants/children aged 3 months to 5 years in China.
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Affiliation(s)
- M W Wei
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - J X Li
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - K Chu
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - J H Zhu
- Program Office, Lianshui County Center for Disease Control and Prevention, Huai'an 223499, China
| | - F C Zhu
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
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Stahl A, Sukgen EA, Wu WC, Lepore D, Nakanishi H, Mazela J, Moshfeghi DM, Vitti R, Athanikar A, Chu K, Iveli P, Zhao F, Schmelter T, Leal S, Koefuencue E, Azuma N. Effect of Intravitreal Aflibercept vs Laser Photocoagulation on Treatment Success of Retinopathy of Prematurity: The FIREFLEYE Randomized Clinical Trial. JAMA 2022; 328:348-359. [PMID: 35881122 PMCID: PMC9327573 DOI: 10.1001/jama.2022.10564] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Laser photocoagulation, which is the standard treatment for retinopathy of prematurity (ROP), can have adverse events. Studies of anti-vascular endothelial growth factor injections have suggested efficacy in the treatment of ROP, but few studies have directly compared them with laser treatments. OBJECTIVE To compare intravitreal aflibercept vs laser photocoagulation in infants with ROP requiring treatment. DESIGN, SETTING, AND PARTICIPANTS This noninferiority, phase 3, 24-week, randomized clinical trial was conducted in 27 countries (64 hospital sites) throughout Asia, Europe, and South America. Overall, 118 infants (gestational age ≤32 weeks at birth or birth weight ≤1500 g) with ROP severity (zone I stage 1+ [stage 1 plus increased disease activity], zone I stage 2+, zone I stage 3, zone I stage 3+, zone II stage 2+, or zone II stage 3+) requiring treatment or with aggressive posterior ROP in at least 1 eye were enrolled between September 25, 2019, and August 28, 2020 (the last visit occurred on February 12, 2021). INTERVENTIONS Infants were randomized 2:1 to receive a 0.4-mg dose of intravitreal aflibercept (n = 75) or laser photocoagulation (n = 43) at baseline. Additional treatment was allowed as prespecified. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of infants without active ROP and unfavorable structural outcomes 24 weeks after starting treatment (assessed by investigators). The requirement for rescue treatment was considered treatment failure. Intravitreal aflibercept was deemed noninferior if the lower limit of the 1-sided 95% bayesian credible interval for the treatment difference was greater than -5%. RESULTS Among 118 infants randomized, 113 were treated (mean gestational age, 26.3 [SD, 1.9] weeks; 53 [46.9%] were female; 16.8% had aggressive posterior ROP, 19.5% had zone I ROP, and 63.7% had zone II ROP) and 104 completed the study. Treatment (intravitreal aflibercept: n = 75; laser photocoagulation: n = 38) was mostly bilateral (92.9%), and 82.2% of eyes in the intravitreal aflibercept group received 1 injection per eye. Treatment success was 85.5% with intravitreal aflibercept vs 82.1% with laser photocoagulation (between-group difference, 3.4% [1-sided 95% credible interval, -8.0% to ∞]). Rescue treatment was required in 4.8% (95% CI, 1.9% to 9.6%) of eyes in the intravitreal aflibercept group vs 11.1% (95% CI, 4.9% to 20.7%) of eyes in the laser photocoagulation group. The serious adverse event rates were 13.3% (ocular) and 24.0% (systemic) in the intravitreal aflibercept group compared with 7.9% and 36.8%, respectively, in the laser photocoagulation group. Three deaths, which occurred 4 to 9 weeks after intravitreal aflibercept treatment, were considered unrelated to aflibercept by the investigators. CONCLUSIONS AND RELEVANCE Among infants with ROP, intravitreal aflibercept compared with laser photocoagulation did not meet criteria for noninferiority with respect to the primary outcome of the proportion of infants achieving treatment success at week 24. Further data would be required for more definitive conclusions regarding the comparative effects of intravitreal aflibercept and laser photocoagulation in this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04004208.
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Affiliation(s)
- Andreas Stahl
- Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
| | - Emine A. Sukgen
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
| | - Wei-Chi Wu
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Domenico Lepore
- Department of Geriatrics and Neuroscience, Catholic University of the Sacred Heart, A. Gemelli Foundation IRCSS, Rome, Italy
| | - Hidehiko Nakanishi
- Research and Development Center for New Medical Frontiers, Department of Advanced Medicine, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Jan Mazela
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Darius M. Moshfeghi
- Byers Eye Institute, Stanford University School of Medicine, Stanford, California
| | | | | | - Karen Chu
- Regeneron Pharmaceuticals, Tarrytown, New York
| | | | - Fei Zhao
- Bayer Inc, Toronto, Ontario, Canada
| | | | | | | | - Noriyuki Azuma
- Department of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan
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Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, 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Upcott M, Vijayasingam D, Anarfi S, Dauncey J, Devindaran A, Havalda P, Komninos G, Mwendwa E, Norman C, Richards J, Urquhart A, Allan J, Cahya E, Hunt H, McWhirter C, Norton R, Roxburgh C, Tan JY, Ali Butt S, Hansdot S, Haq I, Mootien A, Sanchez I, Vainas T, Deliyannis E, Tan M, Vipond M, Chittoor Satish NN, Dattani A, De Carvalho L, Gaston-Grubb M, Karunanithy L, Lowe B, Pace C, Raju K, Roope J, Taylor C, Youssef H, Munro T, Thorn C, Wong KHF, Yunus A, Chawla S, Datta A, Dinesh AA, Field D, Georgi T, Gwozdz A, Hamstead E, Howard N, Isleyen N, Jackson N, Kingdon J, Sagoo KS, Schizas A, Yin L, Aung E, Aung YY, Franklin S, Han SM, Kim WC, Martin Segura A, Rossi M, Ross T, Tirimanna R, Wang B, Zakieh O, Ben-Arzi H, Flach A, Jackson E, Magers S, Olu abara C, Rogers E, Sugden K, Tan H, Veliah S, Walton U, Asif A, Bharwada Y, Bowley D, Broekhuizen A, Cooper L, Evans N, Girdlestone H, Ling C, Mann H, Mehmood N, Mulvenna CL, Rainer N, Trout I, Gujjuri R, Jeyaraman D, Leong E, Singh D, Smith 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Jones O, Killen A, Millo J, Thomas S, Ward J, Wilkins M, Zaki F, Zilber E, Bhavra K, Bilolikar A, Charalambous M, Elawad A, Eleni A, Fawdon R, Gibbins A, Livingstone D, Mala D, Oke SE, Padmakumar D, Patsalides MA, Payne D, Ralphs C, Roney A, Sardar N, Stefanova K, Surti F, Timms R, Tosney G, Bannister J, Clement NS, Cullimore V, Kamal F, Lendor J, McKay J, Mcswiggan J, Minhas N, Seneviratne K, Simeen S, Valverde J, Watson N, Bloom I, Dinh TH, Hirniak J, Joseph R, Kansagra M, Lai CKN, Melamed N, Patel J, Randev J, Sedighi T, Shurovi B, Sodhi J, Vadgama N, Abdulla S, Adabavazeh B, Champion A, Chennupati R, Chu K, Devi S, Haji A, Schulz J, Testa F, Davies P, Gurung B, Howell S, Modi P, Pervaiz A, Zahid M, Abdolrazaghi S, Abi Aoun R, Anjum Z, Bawa G, Bhardwaj R, Brown S, Enver M, Gill D, Gopikrishna D, Gurung D, Kanwal A, Kaushal P, Khanna A, Lovell E, McEvoy C, Mirza M, Nabeel S, Naseem S, Pandya K, Perkins R, Pulakal R, Ray M, Reay C, Reilly S, Round A, Seehra J, Shakeel NM, Singh B, 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G, Raheel F, Rajaseharan A, Ramgopal A, Risbrooke C, Selvaratnam K, Sethunath G, Tabassum R, Taylor J, Thakker A, Wijesingha N, Wybrew R, Yasin T, Ahmed Osman A, Alfadhel S, Carberry E, Chen JY, Drake I, Glen P, Jayasuriya N, Kawar L, Myatt R, Sinan LOH, Siu SSY, Tjen V, Adeboyejo O, Bacon H, Barnes R, Birnie C, D'Cunha Kamath A, Hughes E, Middleton S, Owen R, Schofield E, Short C, Smith R, Wang H, Willett M, Zimmerman M, Balfour J, Chadwick T, Coombe-Jones M, Do Le HP, Faulkner G, Hobson K, Shehata Z, Beattie M, Chmielewski G, Chong C, Donnelly B, Drusch B, Ellis J, Farrelly C, Feyi-Waboso J, Hibell I, Hoade L, Ho C, Jones H, Kodiatt B, Lidder P, Ni Cheallaigh L, Norman R, Patabendi I, Penfold H, Playfair M, Pomeroy S, Ralph C, Rottenburg H, Sebastian J, Sheehan M, Stanley V, Welchman J, Ajdarpasic D, Antypas A, Azouaghe O, Basi S, Bettoli G, Bhattarai S, Bommireddy L, Bourne K, Budding J, Cookey-Bresi R, Cummins T, Davies G, Fabelurin C, Gwilliam R, Hanley J, Hird A, Kruczynska A, Langhorne B, Lund J, Lutchman I, McGuinness R, Neary M, Pampapathi S, Pang E, Podbicanin S, Rai N, Redhouse White G, Sujith J, Thomas P, Walker I, Winterton R, Anderson P, Barrington M, Bhadra K, Clark G, Fowler G, Gibson C, Hudson S, Kaminskaite V, Lawday S, Longshaw A, MacKrill E, McLachlan F, Murdeshwar A, Nieuwoudt R, Parker P, Randall R, Rawlins E, Reeves SA, Rye D, Sirkis T, Sykes B, Ventress N, Wosinska N, Akram B, Burton L, Coombs A, Long R, Magowan D, Ong C, Sethi M, Williams G, Chan C, Chan LH, Fernando D, Gaba F, Khor Z, Les JW, Mak R, Moin S, Ng Kee Kwong KC, Paterson-Brown S, Tew YY, Bardon A, Burrell K, Coldwell C, Costa I, Dexter E, Hardy A, Khojani M, Mazurek J, Raymond T, Reddy V, Reynolds J, Soma A, Agiotakis S, Alsusa H, Desai N, Peristerakis I, Adcock A, Ayub H, Bennett T, Bibi F, Brenac S, Chapman T, Clarke G, Clark F, Galvin C, Gwyn-Jones A, Henry-Blake C, Kerner S, Kiandee M, Lovett A, Pilecka A, Ravindran R, Siddique H, Sikand T, Treadwell K, Akmal K, Apata A, Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Der-Martirosian C, Steers WN, Northcraft H, Chu K, Dobalian A. Vaccinating Veterans for COVID-19 at the U.S. Department of Veterans Affairs. Am J Prev Med 2022; 62:e317-e324. [PMID: 35184947 PMCID: PMC8806154 DOI: 10.1016/j.amepre.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/18/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION With the COVID-19 (most recent) Omicron variant surge across the U.S., more research is needed to better understand how vaccination and booster uptake can be increased. COVID-19 vaccinations have proven to help decrease the likelihood of becoming seriously ill, getting hospitalized, or dying. Studies examining patient characteristics of individuals who received COVID-19 vaccinations are limited. This study examines the patient characteristics of veterans who were vaccinated during the first 8 months (December 2020-July 2021) of the vaccination rollout at the U.S. Department of Veterans Affairs. METHODS Using the U.S. Department of Veterans Affairs administrative and clinical data, bivariate and multivariate analyses were conducted to determine sociodemographic and health factors associated with the likelihood of receiving COVID-19 vaccination at the U.S. Department of Veterans Affairs. RESULTS The analytic sample included 5,914,741 U.S. Department of Veterans Affairs users (49.7% vaccinated). Among the U.S. Department of Veterans Affairs medical facilities nationwide, COVID-19 vaccination rates (≥1 dose) varied from 33.9% to 73.7%. Veterans who were non-Hispanic American Indian/Alaskan natives, younger, living in rural areas, male, and unmarried; had U.S. Department of Veterans Affairs health insurance only; had fewer chronic conditions; did not receive the seasonal influenza vaccine; and were not living in community living centers or nursing homes were less likely to get vaccinated. CONCLUSIONS Understanding which groups of veterans are less likely to be vaccinated allows the U.S. Department of Veterans Affairs to develop targeted interventions to improve uptake in these groups. These results can also guide non-U.S. Department of Veterans Affairs organizations to create evidence-based educational outreach programs that reduce vaccine hesitancy among veterans who do not use U.S. Department of Veterans Affairs.
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Affiliation(s)
- Claudia Der-Martirosian
- Veterans Emergency Management Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, California.
| | - William Neil Steers
- Veterans Emergency Management Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, California; Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Heather Northcraft
- Veterans Emergency Management Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, California
| | - Karen Chu
- Veterans Emergency Management Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, California
| | - Aram Dobalian
- Veterans Emergency Management Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, California; Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, Tennessee
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Chu K, Teoh S, Maughan T, Robinson M, Drabble J, Whyntie T, Mukherjee S. PO-1677 Planning feasibility study of three and single fraction Pancreas MR-Linac SBRT - Phase 1 trial setup. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03641-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Good J, George B, Teoh S, Gaya A, Owens R, Aznar Garcia L, Robinson M, Martin A, Chu K, Mukherjee S, Maughan T. OC-0112 Feasibility and safety of daily adapted MR-guided SABR for pancreatic cancer in the UK. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02488-4] [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: 10/18/2022]
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Narasimman M, Chu K, Plano G, Ory J, Bartra SS, Ramasamy R. Evaluation of Gram Positive and Gram Negative Bacteria in a Novel In Vitro Biofilm Model of Penile Prosthesis. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.030] [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: 11/17/2022]
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Leung LB, Chu K, Rose D, Stockdale S, Post EP, Wells KB, Rubenstein LV. Electronic Population-Based Depression Detection and Management Through Universal Screening in the Veterans Health Administration. JAMA Netw Open 2022; 5:e221875. [PMID: 35267029 PMCID: PMC8914576 DOI: 10.1001/jamanetworkopen.2022.1875] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE In 2016, the US Preventive Services Task Force newly recommended universal screening for depression, with the expectation that screening would be associated with appropriate treatment. Few studies have been able to assess the population-based trajectory from screening to receipt of follow-up and treatment for individuals with depression. OBJECTIVE To examine adherence to guidelines for follow-up and treatment among primary care patients who newly screened positive for depression in the Veterans Health Administration (VA). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used VA electronic data to identify patients who newly screened positive for depression on the 2-item Patient Health Questionnaire at 82 primary care VA clinics in California, Arizona, and New Mexico between October 1, 2015, and September 30, 2019. Data analysis was performed from December 2020 to August 2021. MAIN OUTCOMES AND MEASURES Receipt of guideline-concordant care for screen-positive patients who were determined by clinicians as having depression was assessed. Timely follow-up (within 84 days of screening) was defined as receiving 3 or more mental health specialty visits, 3 or more psychotherapy visits, or 3 or more primary care visits with a depression diagnosis according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Completing at least minimal treatment (within 12 months) was defined as having 60 days or more of antidepressant prescriptions filled, 4 or more mental health specialty visits, or 3 or more psychotherapy visits. RESULTS The final cohort included 607 730 veterans (mean [SD] age, 59.4 [18.2] years; 546 516 men [89.9%]; 339 811 non-Hispanic White [55.9%]); 8%, or 82 998 of 997 185 person-years, newly screened positive for depression. Clinicians identified fewer than half with depression (15 155 patients), of whom 32% (5034 of 15 650 person-years) met treatment guidelines for timely follow-up and 77% (12 026 of 15 650 person-years) completed at least minimal treatment. Younger age (odds ratio, 0.990; 95% CI, 0.986-0.993; P < .001), Black race (odds ratio, 1.19; 95% CI, CI 1.05-1.34; P = .01), and having comorbid psychiatric diagnoses were significantly associated with timely follow-up. Individual quality metric components (eg, medication or psychotherapy) were associated differently with overall quality results among patient groups, except for age. CONCLUSIONS AND RELEVANCE In this cohort study, most patients met the guidelines for completing at least minimal treatment, but only a minority received timely follow-up after screening positive and being identified as having depression. More research is needed to understand whether the discrepancy between patients who screened positive and patients identified as having depression reflects a gap in recognition of needed care.
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Affiliation(s)
- Lucinda B. Leung
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Karen Chu
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Danielle Rose
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Susan Stockdale
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Edward P. Post
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
| | - Kenneth B. Wells
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Lisa V. Rubenstein
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California
- RAND Corporation, Santa Monica, California
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Pan HX, Huang BY, Deng Y, Chu K, Hu JL, Zhu DD, Wu JL, Zhang L, Wang M, Huang WJ, Tan WJ. [Immunogenicity and safety of a booster vaccination with an inactivated severe acute respiratory syndrome coronavirus 2 vaccine in adults aged 18 to 59 years]. Zhonghua Yi Xue Za Zhi 2022; 102:279-285. [PMID: 35073677 DOI: 10.3760/cma.j.cn112137-20210926-02162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To assess the immunogenicity and safety of a booster vaccination with an inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Methods: The phase Ⅱ trial of an inactivated SARS-CoV-2 vaccine was conducted by Jiangsu Provincial Center for Disease Control and Prevention (CDC) since October 2020. The subjects were healthy adults aged 18-59 years, excluding pregnant, and not breastfeeding women. The primary vaccination schedule groups were 0-14 d 5 μg, 0-14 d 10 μg, 0-28 d 5 μg and 0-28 d 10 μg, respectively. And 50 participants in each group, a total of 200, who have received 2-doses primary vaccination were selected in ascending order of the study number and vaccinated with a booster dose (same dosage as primary vaccination) at the 6th months after post the primary vaccination (30-day window period). Blood samples were collected before and after boosting and tested for the geometric mean titers (GMT) and seroconversion of live virus neutralizing antibody, pseudovirus neutralizing antibody and receptor-binding-domain (RBD) IgG antibody. Adverse events (AE) were collected and assessed within 28 days after boosting. Results: The ages of subjects in group 0-14 d 5 μg, 0-14 d 10 μg, 0-28 d 5 μg and 0-28 d 10 μg were (43.98±9.58), (43.46±9.34), (42.56±9.08) and (43.94±11.05) years old, respectively (P=0.877). Sex ratios were balanced among the 4 groups (P=0.331). The live virus neutralizing antibody GMT (95%CI) in group 0-14 d 5 μg, 0-14 d 10 μg, 0-28 d 5 μg and 0-28 d 10 μg increased from 4.07 (3.30-5.04), 3.75 (3.08-4.55), 8.33 (7.01-11.11) and 7.69 (6.19-9.57) before the booster vaccination to 284.84 (215.28-376.86), 233.05 (178.61-304.08), 274.81 (223.64-337.68) and 280.77 (234.59-336.04) in 28 days after the booster vaccination, respectively. The rates of live virus neutralizing antibody seroconversion were all 100% in the 4 groups. The AE incidences following booster vaccination were 18.0% (9 cases), 4.0% (2 cases), 12% (6 cases), and 12% (6 cases) in the 4 groups(P=0.182). No AE was graded as level 3 or worse. No serious AE was reported. Conclusion: One booster vaccination of an inactivated SARS-CoV-2 vaccine administered 6 months after primary vaccination showed good immunogenicity and safety.
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Affiliation(s)
- H X Pan
- NHC Key Laboratory of Enteric Pathogenic Microbiology (Jiangsu Provincial Center for Disease Control and Prevention), Nanjing 210009, China
| | - B Y Huang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Y Deng
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - K Chu
- NHC Key Laboratory of Enteric Pathogenic Microbiology (Jiangsu Provincial Center for Disease Control and Prevention), Nanjing 210009, China
| | - J L Hu
- NHC Key Laboratory of Enteric Pathogenic Microbiology (Jiangsu Provincial Center for Disease Control and Prevention), Nanjing 210009, China
| | - D D Zhu
- Huaiyin District Center for Disease Control and Prevention, Huaian 223399, China
| | - J L Wu
- Huaiyin District Center for Disease Control and Prevention, Huaian 223399, China
| | - L Zhang
- China National Institute for Food and Drug Control, Beijing 102629, China
| | - M Wang
- China National Institute for Food and Drug Control, Beijing 102629, China
| | - W J Huang
- China National Institute for Food and Drug Control, Beijing 102629, China
| | - W J Tan
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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Balut MD, Wyte-Lake T, Steers WN, Chu K, Dobalian A, Ziaeian B, Heyworth L, Der-Martirosian C. Expansion of telemedicine during COVID-19 at a VA specialty clinic. Healthc (Amst) 2021; 10:100599. [PMID: 34999492 PMCID: PMC8616735 DOI: 10.1016/j.hjdsi.2021.100599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
Background COVID-19 rapidly accelerated the implementation of telemedicine in U.S. Department of Veterans Affairs (VA) specialty care clinics. This mixed-methods study was conducted at a VA medical center to understand the use of telemedicine, and the barriers and facilitators to its implementation, in cardiology outpatient clinics. Methods Quantitative analyses modeled monthly trends of telemedicine use over 24-months (March 2019–March 2021) with segmented logistic regression and adjusted for socio-demographic predictors of patient-level telemedicine use. Qualitative interviews were conducted (July–October 2020) with eight cardiology clinicians. Results At the onset of COVID-19, likelihood of telemedicine use was ∼12 times higher than it was pre-COVID-19 (p < 0.001). White (OR = 1.38, 95% CI:1.23–1.54), married (OR = 1.25, 95% CI:1.11–1.40), Veterans with other health insurance (OR = 1.19, 95% CI:1.06–1.35), were more likely to use telemedicine. Veterans with higher health risk factors were less likely (OR = 0.95, 95% CI:0.93–0.97). Facilitators to rapid expansion of telemedicine included prior telemedicine experience; provider trainings; and staff champions. In contrast, lack of technical support and scheduling grids for virtual visits and patient ability/preference served as barriers. Conclusions Findings suggest that once mutable barriers were addressed, the medical center was able to expand its telemedicine efforts during COVID-19. Beyond the pandemic, a hybrid of virtual and face-to-face care might be feasible and likely beneficial for healthcare providers and patients in specialty care. Implications The ability to rapidly transition from in-person to virtual visits can potentially assist with the continuity of care and management of chronic disease during infectious outbreaks and other major disasters that obstruct traditional care models.
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Affiliation(s)
- Michelle D Balut
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA.
| | - Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA
| | - William Neil Steers
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA
| | - Karen Chu
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA; Division of Health Systems Management and Policy, University of Memphis School of Public Health, 3825 DeSoto Ave. Memphis, TN, USA
| | - Boback Ziaeian
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA; Division of Cardiology, UCLA David Geffen School of Medicine, 10833 Le Conte Ave, Los Angeles, CA, USA
| | - Leonie Heyworth
- Office of Connected Care, Veterans Health Administration (VHA), US Department of Veterans Affairs, 50 Irving St. NW, Washington, DC, USA; Department of Medicine, University of California, San Diego. 9500 Gilman Dr, San Diego, CA, USA
| | - Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. North Hills, CA, USA
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Yu CH, Medleg F, Choi D, Spagnuolo CM, Pinnaduwage L, Straus SE, Cantarutti P, Chu K, Frydrych P, Hoang-Kim A, Ivers N, Kaplan D, Leung FH, Maxted J, Rezmovitz J, Sale J, Sodhi S, Stacey D, Telner D. Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial. BMC Med Inform Decis Mak 2021; 21:323. [PMID: 34809626 PMCID: PMC8609876 DOI: 10.1186/s12911-021-01673-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background MyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams. Objective Assess the feasibility of (1) conducting a cluster randomized controlled trial (RCT) and (2) integrating MyDiabetesPlan into interprofessional primary care clinics. Methods We conducted a cluster RCT in 10 interprofessional primary care clinics with patients living with diabetes and at least two other comorbidities; half of the clinics were assigned to MyDiabetesPlan and half were assigned to usual care. To assess recruitment, retention, and resource use, we used RCT conduct logs and financial account summaries. To assess intervention fidelity, we used RCT conduct logs and website usage logs. To identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team, we used audiotapes of clinical encounters in the intervention groups. Results One thousand five hundred and ninety-seven potentially eligible patients were identified through searches of electronic medical records, of which 1113 patients met the eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n = 102; control: n = 111), for a recruitment rate of 50.1%. One hundred and fifty-one patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. A total of 179 appointments occurred (out of 204 expected appointments—two per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%), and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times, respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 min. From the clinical encounter transcripts, we identified diverse strategies used by clinicians and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport building and individualization. Barriers to use included clinician-related, patient-related, and technical factors. Conclusion An interprofessional approach to SDM using a decision aid was feasible. Lower than expected numbers of diabetes-specific appointments and use of MyDiabetesPlan were observed. Addressing facilitators and barriers identified in this study will promote more seamless integration into clinical care. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: February 11, 2015. Protocol version: Version 1; February 26, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01673-w.
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Affiliation(s)
- Catherine H Yu
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Farid Medleg
- Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland
| | - Dorothy Choi
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Catherine M Spagnuolo
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,School of Medicine, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Lakmini Pinnaduwage
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Paul Cantarutti
- Southlake Regional Health Centre, 596 Davis Dr, Newmarket, ON, 3Y 2P9, Canada
| | - Karen Chu
- Bridgepoint Active Healthcare (Sinai Health System), 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
| | - Paul Frydrych
- Mount Dennis Weston Health Centre, Humber River Family Health Team, 2050 Weston Rd, York, ON, M9N 3M4, Canada
| | - Amy Hoang-Kim
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Noah Ivers
- Department of Family Medicine, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.,University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
| | - David Kaplan
- University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.,North York Family Health Team, 240 Duncan Mill Rd, North York, ON, M3B 3S6, Canada
| | - Fok-Han Leung
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - John Maxted
- Markham Stouffville Hospital, 381 Church St, Markham, ON, L3P 7P3, Canada
| | - Jeremy Rezmovitz
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Joanna Sale
- Musculoskeletal Health and Outcomes Research - Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Sumeet Sodhi
- Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, 440 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, 501 Smyth, Ottawa, ON, K1H 8L6, Canada
| | - Deanna Telner
- South East Toronto Family Health Team (Toronto East Health Network), 833 Coxwell Avenue, Toronto, ON, M4C 3E8, Canada
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Yu C, Chu K, McCready J, Downey S, Pham TNT. Leveraging Innovative Leadership Models within Community and Healthcare Organizations to Support Safe School Reopening during the COVID-19 Pandemic. Healthc Q 2021; 24:34-41. [PMID: 34792446 DOI: 10.12927/hcq.2021.26621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Little has been published on successful leadership models within integrated care systems. Within East Toronto Health Partners, there have been considerable efforts at the executive leadership level to empower local leadership, particularly physician leaders, to develop and execute effective solutions across the community. What does distributed leadership look like, and what does it take to implement it? A number of activities demonstrating the impact of a distributed leadership model in East Toronto are outlined in this paper, offering an effective defence against the enormous challenge posed by the COVID-19 pandemic.
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Affiliation(s)
- Catherine Yu
- An assistant professor at the Department of Family and Community Medicine in the University of Toronto and chair of East-FPN in Toronto, ON
| | - Karen Chu
- The lead physician for the Bridgepoint Family Health Team and a board member of EasT-FPN in Toronto, ON
| | - Janine McCready
- An infectious diseases physician, associate medical director of Infection Prevention and Control and director of Antimicrobial Stewardship at Michael Garron Hospital and a lecturer in the Department of Medicine, University of Toronto in Toronto, ON
| | - Sarah Downey
- The president and CEO of Michael Garron Hospital, Toronto East Health Network in Toronto, ON
| | - Thuy-Nga Tia Pham
- An associate professor at the Department of Family and Community Medicine, University of Toronto, and vice-chair of the East-FPN in Toronto, ON. She can be contacted by e-mail at
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Balut MD, Chu K, Gin JL, Dobalian A, Der-Martirosian C. Predictors of COVID-19 Vaccination among Veterans Experiencing Homelessness. Vaccines (Basel) 2021; 9:1268. [PMID: 34835200 PMCID: PMC8619196 DOI: 10.3390/vaccines9111268] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 10/08/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 12/19/2022] Open
Abstract
Sufficient uptake of the COVID-19 vaccine is key to slowing the spread of the coronavirus among the most vulnerable in society, including individuals experiencing homelessness. However, COVID-19 vaccination rates among the Veteran homeless population are currently unknown. This study examines the COVID-19 vaccination rate among homeless Veterans who receive care at the U.S. Department of Veterans Affairs (VA), and the factors that are associated with vaccine uptake. Using VA administrative and clinical data, bivariate and multivariate analyses were conducted to identify the sociodemographic, health-related, and healthcare and housing services utilization factors that influenced COVID-19 vaccine uptake during the first eight months of the vaccine rollout (December 2020-August 2021). Of the 83,528 Veterans experiencing homelessness included in the study, 45.8% were vaccinated for COVID-19. Non-white, older Veterans (65+), females, those who received the seasonal flu vaccine, and Veterans with multiple comorbidities and mental health conditions were more likely to be vaccinated. There was a strong association between COVID-19 vaccination and Veterans who utilized VA healthcare and housing services. VA healthcare and homeless service providers are particularly well-positioned to provide trusted information and overcome access barriers for homeless Veterans to receive the COVID-19 vaccine.
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Affiliation(s)
- Michelle D. Balut
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, CA 91343, USA; (K.C.); (J.L.G.); (A.D.); (C.D.-M.)
| | - Karen Chu
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, CA 91343, USA; (K.C.); (J.L.G.); (A.D.); (C.D.-M.)
| | - June L. Gin
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, CA 91343, USA; (K.C.); (J.L.G.); (A.D.); (C.D.-M.)
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, CA 91343, USA; (K.C.); (J.L.G.); (A.D.); (C.D.-M.)
- Division of Health Systems Management and Policy, University of Memphis School of Public Health, Memphis, TN 38152, USA
| | - Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, North Hills, CA 91343, USA; (K.C.); (J.L.G.); (A.D.); (C.D.-M.)
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Chang ET, Yoon J, Esmaeili A, Zulman DM, Ong MK, Stockdale SE, Jimenez EE, Chu K, Atkins D, Denietolis A, Asch SM. Outcomes of a randomized quality improvement trial for high-risk Veterans in year two. Health Serv Res 2021; 56 Suppl 1:1045-1056. [PMID: 34145564 PMCID: PMC8515223 DOI: 10.1111/1475-6773.13674] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The Veterans Health Administration (VHA) conducted a randomized quality improvement evaluation to determine whether augmenting patient-centered medical homes with Primary care Intensive Management (PIM) decreased utilization of acute care and health care costs among patients at high risk for hospitalization. PIM was cost-neutral in the first year; we analyzed changes in utilization and costs in the second year. DATA SOURCES VHA administrative data for five demonstration sites from August 2013 to March 2019. DATA SOURCES Administrative data extracted from VHA's Corporate Data Warehouse. STUDY DESIGN Veterans with a risk of 90-day hospitalization in the top 10th percentile and recent hospitalization or emergency department (ED) visit were randomly assigned to usual primary care vs primary care augmented by PIM. PIM included interdisciplinary teams, comprehensive patient assessment, intensive case management, and care coordination services. We compared the change in mean VHA inpatient and outpatient utilization and costs (including PIM expenses) per patient for the 12-month period before randomization and 13-24 months after randomization for PIM vs usual care using difference-in-differences. PRINCIPAL FINDINGS Both PIM patients (n = 1902) and usual care patients (n = 1882) had a mean of 5.6 chronic conditions. PIM patients had a greater number of primary care visits compared to those in usual care (mean 4.6 visits/patient/year vs 3.7 visits/patient/year, p < 0.05), but ED visits (p = 0.45) and hospitalizations (p = 0.95) were not significantly different. We found a small relative increase in outpatient costs among PIM patients compared to those in usual care (mean difference + $928/patient/year, p = 0.053), but no significant differences in mean inpatient costs (+$245/patient/year, p = 0.97). Total mean health care costs were similar between the two groups during the second year (mean difference + $1479/patient/year, p = 0.73). CONCLUSIONS Approaches that target patients solely based on the high risk of hospitalization are unlikely to reduce acute care use or total costs in VHA, which already offers patient-centered medical homes.
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Affiliation(s)
- Evelyn T. Chang
- VA Center for the Study of Healthcare InnovationImplementation and Policy (CSHIIP)Los AngelesCaliforniaUSA
- Department of MedicineVA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- Department of MedicineDavid Geffen School of Medicine, University of California at Los AngelesLos AngelesCaliforniaUSA
| | - Jean Yoon
- VA Health Economics Resource Center (HERC)Menlo ParkCaliforniaUSA
- Department of General Internal MedicineUCSF School of MedicineSan FranciscoCaliforniaUSA
| | - Aryan Esmaeili
- VA Health Economics Resource Center (HERC)Menlo ParkCaliforniaUSA
| | - Donna M. Zulman
- VA HSR&D Center for Innovation to ImplementationMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineMenlo ParkCaliforniaUSA
| | - Michael K. Ong
- Department of MedicineVA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- Department of MedicineDavid Geffen School of Medicine, University of California at Los AngelesLos AngelesCaliforniaUSA
- Department of Health Policy and ManagementFielding School of Public Health, University of California at Los AngelesLos AngelesCaliforniaUSA
| | - Susan E. Stockdale
- VA Center for the Study of Healthcare InnovationImplementation and Policy (CSHIIP)Los AngelesCaliforniaUSA
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Elvira E. Jimenez
- VA Center for the Study of Healthcare InnovationImplementation and Policy (CSHIIP)Los AngelesCaliforniaUSA
- Behavioral NeurologyGeffen School of Medicine, University of California at Los AngelesLos AngelesCaliforniaUSA
| | - Karen Chu
- VA Center for the Study of Healthcare InnovationImplementation and Policy (CSHIIP)Los AngelesCaliforniaUSA
| | - David Atkins
- VA Health Services Research and DevelopmentWashingtonDistrict of ColumbiaUSA
| | | | - Steven M. Asch
- VA HSR&D Center for Innovation to ImplementationMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineMenlo ParkCaliforniaUSA
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31
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Der-Martirosian C, Wyte-Lake T, Balut M, Chu K, Heyworth L, Leung L, Ziaeian B, Tubbesing S, Mullur R, Dobalian A. Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study. JMIR Form Res 2021; 5:e29429. [PMID: 34477554 PMCID: PMC8462492 DOI: 10.2196/29429] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 04/06/2021] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022] Open
Abstract
Background At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020. Objective We compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020). Methods We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes. Results Prior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted. Conclusions Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic.
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Affiliation(s)
- Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States.,Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States
| | - Michelle Balut
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States
| | - Karen Chu
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States
| | - Leonie Heyworth
- Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC, United States.,Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Lucinda Leung
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Boback Ziaeian
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Sarah Tubbesing
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Rashmi Mullur
- Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Division of Diabetes, Endocrinology & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States.,Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, TN, United States
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Chu K, Punjani N, Nassau D, Kashanian J, Ramasamy R. P–067 Utility of evaluating semen samples from adolescents with Klinefelter Syndrome for cryopreservation: A multi-institution evaluation. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Should physicians continue to evaluate semen analysis from adolescents with Klinefelter Syndrome for fertility preservation?
Summary answer
In the largest multi-institutional retrospective database to-date for this patient population, no sperm was found in ejaculate for cryopreservation amongst adolescent males with Klinefelter Syndrome.
What is known already
Klinefelter Syndrome is the most common genetic condition leading to male infertility and non-obstructive azoospermia. The condition causes decreased testicular growth, leading to lower production of testosterone and resulting deficiencies in secondary sexual characteristics. While testosterone therapy may be required for hypogonadism, there may be impact on future fertility potential. Current practice is to have KS adolescent patients provide semen analyses to identify potential sperm for cryopreservation. While the incidence is low, current epidemiological studies have been with limited sample size.
Study design, size, duration
This was a retrospective study of all adolescent Klinefelter Syndrome patients seen at the male infertility clinics of two large academic institutions between the years of 2015 to 2020. Adolescence was defined as the ages of 10 – 19 years old, as per the World Health Organization.
Participants/materials, setting, methods
A total of 116 patients were identified for the retrospective study database. Demographic information including weight, height, comorbidities, concurrent medications were collected. Hormone levels such as FSH, LH, testosterone, and estrogen were included for 77 patients. Additionally, semen analyses were available for 49 patients. Main results and the role of chance: Of the 49 patients with semen analyses, only 3 patients had rare sperm in ejaculate not sufficient for cryopreservation while the remaining had azoospermia. The average ejaculate volume of the provided semen samples was 0.9 cc. The average serum total testosterone level of adolescent Klinefelter Syndrome patients was 236 ng/dL. As expected, gonadotropin levels were found to be elevated (mean: 18.47 IU/L for FSH and 9.12 IU/L for LH).
Limitations, reasons for caution
The main limitation for this study was the sample size.
Wider implications of the findings: The findings from the largest retrospective study of this patient population imply a need to revisit counseling regarding the need for semen analyses in adolescent Klinefelter Syndrome patients.
Trial registration number
Not applicable
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Affiliation(s)
- K Chu
- University of Miami Miller School of Medicine, Department of Urology, Miami- FL, USA
| | - N Punjani
- Weill Cornell Medicine, Department of Urology, New York- NY, USA
| | - D Nassau
- University of Miami Miller School of Medicine, Department of Urology, Miami- FL, USA
| | - J Kashanian
- Weill Cornell Medicine, Department of Urology, New York- NY, USA
| | - R Ramasamy
- University of Miami Miller School of Medicine, Department of Urology, Miami- FL, USA
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Brown DM, Wykoff CC, Boyer D, Heier JS, Clark WL, Emanuelli A, Higgins PM, Singer M, Weinreich DM, Yancopoulos GD, Berliner AJ, Chu K, Reed K, Cheng Y, Vitti R. Evaluation of Intravitreal Aflibercept for the Treatment of Severe Nonproliferative Diabetic Retinopathy: Results From the PANORAMA Randomized Clinical Trial. JAMA Ophthalmol 2021; 139:946-955. [PMID: 34351414 PMCID: PMC8343518 DOI: 10.1001/jamaophthalmol.2021.2809] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Question Does treatment of moderately severe to severe nonproliferative diabetic retinopathy (NPDR) with intravitreal aflibercept injections result in 2-step or greater improvement on the Diabetic Retinopathy Severity Scale in more eyes, fewer vision-threatening complications, and fewer center-involved diabetic macular edema events from baseline through 100 weeks compared with sham injections? Findings In this randomized clinical trial of 402 patients with moderately severe to severe NPDR without diabetic macular edema, more eyes treated with intravitreal aflibercept injections showed a 2-step or greater improvement on the Diabetic Retinopathy Severity Scale at 24, 52, and 100 weeks, with significantly fewer vision-threatening complications and center-involved diabetic macular edema events. No differences in mean change in best-corrected visual acuity at weeks 52 and 100 were observed. Meaning In this study, anatomic improvement was more likely to occur in eyes with moderately severe to severe NPDR that were treated with intravitreal aflibercept injections; in year 2, fixed dosing appeared necessary to maintain anatomic benefit. Importance Proactive treatment of nonproliferative diabetic retinopathy (NPDR) reduces the risk of progression to vision-threatening complications. Objective To evaluate vascular endothelial growth factor blockade therapy with intravitreal aflibercept injections in eyes with severe NPDR without diabetic macular edema (DME). Design, Setting, and Participants The Study of the Efficacy and Safety of Intravitreal Aflibercept for the Improvement of Moderately Severe to Severe Nonproliferative Diabetic Retinopathy (PANORAMA) was a double-masked 100-week randomized clinical trial conducted in multiple centers worldwide. The study included 402 adults with Diabetic Retinopathy Severity Scale (DRSS) level 47 or 53 with no DME and best-corrected visual acuity of 20/40 or better. Interventions Intravitreal injections of aflibercept, 2 mg, every 16 weeks after 3 initial monthly doses and one 8-week interval (aflibercept 2q16 group); intravitreal injections of aflibercept, 2 mg, every 8 weeks after 5 initial monthly doses, with pro re nata (PRN) dosing beginning at week 56 (aflibercept 2q8/PRN group); or sham injections (control group). Main Outcomes and Measures Proportions of eyes with a 2-step or greater improvement in DRSS level, vision-threatening complications, and center-involved DME from baseline to weeks 24, 52, and 100. Results Among 402 participants (1 eye per participant), the mean (SD) age was 55.7 (10.5) years; 225 (56.0%) were male, and 310 (77.1%) were White. A total of 135 were randomized to the aflibercept 2q16 group, 134 to the aflibercept 2q8/PRN group, and 133 to the control group. At 24 weeks, treatment with aflibercept resulted in a 2-step or greater improvement in DRSS level in 157 of 269 eyes (58.4%) in the combined aflibercept groups vs 8 of 133 eyes (6.0%) in the control group (adjusted difference, 52.3%; 95% CI, 45.2%-59.5%; P < .001). At 52 weeks, 88 of 135 eyes (65.2%) in the aflibercept 2q16 group (adjusted difference, 50.1%; 95% CI, 40.1%-60.1%) and 107 of 134 eyes (79.9%) in the aflibercept 2q8/PRN group (adjusted difference, 64.8%; 95% CI, 55.8%-73.9%) compared with 20 of 133 eyes (15.0%) in the control group (P < .001 for both comparisons) showed a 2-step or greater improvement in DRSS level. Fewer eyes treated with aflibercept vs sham injections developed vision-threatening complications and/or center-involved DME through week 100 (22 of 135 eyes [16.3%] in the 2q16 group [adjusted difference, −34.2%; 95% CI, −44.6 to −23.8] and 25 of 134 eyes [18.7%] in the 2q8/PRN group [adjusted difference, −31.7%; 95% CI, −42.5 to −20.9] compared with 67 of 133 eyes [50.4%] in the control group; P < .001 for both comparisons). No new safety signals were identified. Conclusions and Relevance In this study, significantly more eyes with moderately severe to severe NPDR that were treated with aflibercept showed a 2-step or greater improvement in DRSS level at 24, 52, and 100 weeks, and significantly fewer eyes treated with aflibercept vs sham developed vision-threatening complications and center-involved DME. Outcomes on the DRSS between year 1 and 2 emphasize the need for ongoing vascular endothelial growth factor suppression and adherence. Trial Registration ClinicalTrials.gov Identifier: NCT02718326
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Affiliation(s)
- David M Brown
- Retina Consultants of Texas (Retina Consultants of America), Houston, Texas
| | - Charles C Wykoff
- Retina Consultants of Texas (Retina Consultants of America), Houston, Texas.,Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - David Boyer
- Retina-Vitreous Associates Medical Group, Los Angeles, California
| | | | | | - Andres Emanuelli
- Retina Care, Arecibo, Puerto Rico.,Emanuelli Research and Development Center, Arecibo, Puerto Rico
| | | | - Michael Singer
- Medical Center Ophthalmology Associates, San Antonio, Texas
| | | | | | | | - Karen Chu
- Regeneron Pharmaceuticals, Tarrytown, New York
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Robinson M, Muirhead R, Chu K, Jacobs C, Ng S, Hawkins M. PO-1276 Differential Response of FDG Uptake in Pelvic Bone Marrow to Concurrent Chemoradiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07727-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Libowitz MR, Wei K, Tran T, Chu K, Moncrieffe K, Harrington MG, King K. Regional brain volumes relate to Alzheimer's disease cerebrospinal fluid biomarkers and neuropsychometry: A cross-sectional, observational study. PLoS One 2021; 16:e0254332. [PMID: 34292973 PMCID: PMC8297871 DOI: 10.1371/journal.pone.0254332] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/27/2021] [Indexed: 11/18/2022] Open
Abstract
We hypothesized that automated assessment of brain volumes on MRI can predict presence of cerebrospinal fluid abnormal ß-amyloid42 and Tau protein levels and thus serve as a useful screening test for possible Alzheimer's disease. 113 participants ranging from cognitively healthy to Alzheimer's disease underwent MRI exams to obtain measurements of hippocampus, prefrontal cortex, precuneus, parietal cortex, and occipital lobe volumes. A non-exclusive subset (n = 107) consented to lumbar punctures to obtain cerebrospinal fluid for ß-amyloid42 and Tau protein assessment including cognitively health (n = 75), mild cognitively impaired (n = 22), and Alzheimer's disease (n = 10). After adjustment for false discovery rate, ß-amyloid42 was significantly associated with volumes in the hippocampus (p = 0.043), prefrontal cortex (p = 0.010), precuneus (p = 0.024), and the posterior cingulate (p = 0.002). No association between Tau levels and regional brain volume survived multiple test correction. Secondary analysis was performed to determine associations between MRI brain volumes and CSF protein levels to neuropsychological impairment. A non-exclusive subset (n = 96) including cognitively healthy (n = 72), mild cognitively impaired (n = 21), and Alzheimer's disease (n = 3) participants underwent Stroop Interference and Boston Naming neuropsychological testing. A higher score on the Boston Naming Test was optimally predicted in a selective regression model by greater hippocampus volume (p = 0.002), a higher ratio of ß-amyloid42 to Tau protein levels (p < 0.001), greater posterior cingulate volume (p = 0.0193), age (p = 0.0271), and a higher education level (p = 0.002). A better performance on the Stroop Interference Test was optimally predicted by greater hippocampus volume (p = 0.0003) and a higher education level (p < 0.001). Lastly, impaired cognitive status (mild cognitive impairment and Alzheimer's Disease) was optimally predicted in a selective regression model by a worse performance on the Stroop Interference Test (p < 0.001), a worse performance on the Boston Naming Test (p < 0.001), along with lower prefrontal cortex volume (p = 0.002) and lower hippocampus volume (p = 0.007).
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Affiliation(s)
- Mark R. Libowitz
- Magnetic Resonance Program, Huntington Medical Research Institutes, Pasadena, California, United States of America
- * E-mail:
| | - Ke Wei
- Magnetic Resonance Program, Huntington Medical Research Institutes, Pasadena, California, United States of America
| | - Thao Tran
- Magnetic Resonance Program, Huntington Medical Research Institutes, Pasadena, California, United States of America
| | - Karen Chu
- Magnetic Resonance Program, Huntington Medical Research Institutes, Pasadena, California, United States of America
| | - Kristina Moncrieffe
- Fuller Graduate School of Psychology, Pasadena, California, United States of America
| | - Michael G. Harrington
- Molecular Neurology Program, Huntington Medical Research Institutes, Pasadena, California, United States of America
| | - Kevin King
- Barrow Neurological Institute, Phoenix, Arizona, United States of America
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Der-Martirosian C, Heyworth L, Chu K, Mudoh Y, Dobalian A. Patient Characteristics of VA Telehealth Users During Hurricane Harvey. J Prim Care Community Health 2021; 11:2150132720931715. [PMID: 32507009 PMCID: PMC7278288 DOI: 10.1177/2150132720931715] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 12/27/2022] Open
Abstract
Introduction: Research on patient characteristics of telehealth users is relatively new. More studies are needed to understand the characteristics of telehealth users during disasters. This study attempts to bridge this gap and examines patient characteristics of telehealth users compared with nontelehealth users at the Houston VA Medical Center (VAMC) immediately before and after Hurricane Harvey (2017). Methods: Since use of telehealth services reached its peak and gradually declined within 2 weeks after the landfall, the data analyses focused on 14 days before/14 days after Harvey. Two sets of analyses were conducted using chi-square, t test, and one-way analysis of variance: (1) Patient characteristics of telehealth users were compared with nontelehealth users. (2) Patient characteristics were compared between 3 subgroups of telehealth users. Results: Compared with nontelehealth users, telehealth users were older (mean age: 60.8 vs 58.5 years, P < .001) and had a higher mean Nosos health risk score (1.9 vs 1.4, P < .001). They also had a higher mean number of outpatient visits (28.0 vs 19.8, P < .001), higher emergency room use (37% vs 29%, P < .001), and higher rates of hospitalizations (21% vs 13%, P < .001) during the 12 months before Harvey. When compared to less frequent telehealth users, the most frequent telehealth users were the oldest and most medically complex patients. Conclusions: As the largest integrated health care system in the United States, the VA has many advantages favoring successful implementation of telehealth services during disasters. However, more research is needed to better understand how VA telehealth could meet the varying needs of veterans to lower risk of harm during differing types of disasters.
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Affiliation(s)
- Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | | | - Karen Chu
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | - Yvonne Mudoh
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA.,University of Memphis School of Public Health, Memphis, TN, USA
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Dunnell L, Chu K, Barnard A, Walker G. 467 FRAILTY IN SITU SIMULATION. Age Ageing 2021. [DOI: 10.1093/ageing/afab116.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The ability to recognise and manage frailty and its associated presentations is variable among acute hospital staff. Patients living with frailty who are admitted to hospital are more likely to suffer adverse effects than those without. We created an inter-professional in-situ simulation programme designed to improve recognition and management of frailty and its common adverse events. The programme objectives align with recommendations from the British Geriatric Society’s ‘Frailty Hub’ and Royal College of Physicians’ ‘Acute Care Toolkit’ for frailty.
Method
Over a two month period, seven sessions were completed on the Older Persons Unit (OPU) at St Thomas’ Hospital. These comprised a simulated scenario followed by facilitated debrief—including technical skills and human factors highlighted by the scenario. Quantitative data was collected through pre and post session questionnaires using the Human Factors Skills for Healthcare Instrument (HuFSHI) and frailty based questions. Post session qualitative data was also collected.
Results
30 participants attended the sessions (nursing, medical and allied health professional). All participants completing the post course questionnaire found the sessions useful. When comparing pre and post session data, participant confidence in 10/12 sections of the HuFSHI and 8/9 frailty based questions demonstrated improvement. The qualitative data showed common learning themes around improved communication, teamwork and escalation. Participants found that the sessions were a valuable ‘opportunity to reflect’ and ‘debrief’, and learn together as a multidisciplinary team.
Conclusion
In-situ simulation is an effective tool for improving knowledge and confidence in managing frail patients. It increases awareness and understanding of human factors, which are key to the multidisciplinary approach frail patients require. The course is being expanded across the OPU and now has funding for a departmental manikin. The programme can be disseminated to other units to help improve the care and safety of those with frailty in hospital.
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Affiliation(s)
- L Dunnell
- Older Persons' Unit, Guy's and St Thomas' NHS Foundation Trust
| | - K Chu
- Older Persons' Unit, Guy's and St Thomas' NHS Foundation Trust
| | - A Barnard
- Older Persons' Unit, Guy's and St Thomas' NHS Foundation Trust
| | - G Walker
- Older Persons' Unit, Guy's and St Thomas' NHS Foundation Trust
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Ehlers JP, Uchida A, Sevgi DD, Hu M, Reed K, Berliner A, Vitti R, Chu K, Srivastava SK. Retinal Fluid Volatility Associated With Interval Tolerance and Visual Outcomes in Diabetic Macular Edema in the VISTA Phase III Trial. Am J Ophthalmol 2021; 224:217-227. [PMID: 33253664 DOI: 10.1016/j.ajo.2020.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/07/2020] [Accepted: 11/13/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe longitudinal retinal fluid dynamics on spectral domain OCT and to identify imaging biomarkers that predict the worsening of DME with interval extension during anti-vascular endothelial growth factor (VEGF) therapy. DESIGN A post hoc sub-analysis of phase III, VISTA-DME study. METHODS Eyes received either intravitreal aflibercept injection 2 mg every 4 weeks (2q4) or every 8 weeks after 5 initial monthly injections (2q8), and eyes imaged with the Cirrus HD-OCT system were included. The macular cube was analyzed for 10 time-points from baseline through week 100. Retinal OCT images were evaluated using a novel software platform to extract retinal fluid features for calculation of volumetric fluid parameters, including the retinal fluid index (RFI): the percentage of retinal volume that was occupied by intraretinal fluid. RESULTS Fifty-five eyes were included in the 2q4 group, and 58 eyes were included in the 2q8 group. Early RFI volatility with a central macular RFI increase by ≥5 points from week 4 to 8 (P = .004, odds ratio [OR] 31.3, 95% confidence interval [CI] 3.0 to 329) and cumulative RFI volatility with an aggregate increase in macular RFI by ≥10 points from those timepoints with increased RFI between baseline to week 20, P = .005, OR 10.2, 95% CI 2.1 to 51.3) were both significant predictors for the worsening of DME and visual acuity when the treatment interval was extended to 8 weeks in the 2q8 group. CONCLUSIONS Early fluid dynamics as measured by (1) early RFI volatility and (2) cumulative RFI instability with aggregate increased RFI were associated with intolerance of interval extension.
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Schmidt-Ott U, Hughes D, Chu K, Reed K, Leal S, Amer F, Moini H, Bussfeld P, Vitti R. Differing Risks of Occlusive Retinal Vasculitis with Concurrent Intraocular Inflammation Among Intravitreal Antivascular Endothelial Growth Factor Therapies. Retina 2021; 41:669-670. [PMID: 33165295 DOI: 10.1097/iae.0000000000003015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Diana Hughes
- Regeneron Pharmaceuticals, Inc.,Tarrytown, New York
| | - Karen Chu
- Regeneron Pharmaceuticals, Inc.,Tarrytown, New York
| | | | | | - Fouad Amer
- Regeneron Pharmaceuticals, Inc.,Tarrytown, New York
| | - Hadi Moini
- Regeneron Pharmaceuticals, Inc.,Tarrytown, New York
| | | | - Robert Vitti
- Regeneron Pharmaceuticals, Inc.,Tarrytown, New York
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Chen T, Xiao M, Chu K, Tang XJ, Yang J, Shu YL. [Meta-analysis on association between TNF-α and CCR5Δ32 gene polymorphisms and influenza A(H1N1)pdm09]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 41:1909-1914. [PMID: 33297660 DOI: 10.3760/cma.j.cn112338-20200209-00082] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the associations between TNF-α and CCR5Δ32 gene polymorphisms and influenza A(H1N1)pdm09. Methods: Studies in PubMed, Cochrane Library, OVID, EBSCO, Web of Science published before February 7, 2019 were retrieved comprehensively. Observational studies related to TNF-alpha and CCR5 gene polymorphisms and influenza A(H1N1) pdm09 were collected. A strict quality evaluation was carried out according to NOS scale. Meta-analysis was performed using software Revman 5.0 and Stata 11.0. Results: After screening, a total of 8 studies were included in this Meta-analysis. The results showed that TNF-α gene polymorphism rs361525 might be associated with the risk of influenza A(H1N1)pdm09 virus infection (A vs. G: OR=2.25, 95%CI: 1.09-4.65, P=0.03; AA vs. GG: OR=4.34, 95%CI: 1.65-11.41, P=0.003; AA vs. AG+GG: OR=4.38, 95%CI: 1.67-11.48, P=0.003), similar trend also found in rs1800750 (AA+AG vs. GG: OR=2.42, 95%CI: 1.24-4.71, P=0.01). The results of subgroup analysis indicated that A allele and AA+AG genotypes of rs361525 were risk factors for influenza A(H1N1) pdm09 virus infection in Caucasians. AA genotype was a risk factor for influenza A(H1N1) pdm09 virus infection in Mexican (P<0.05). There was no significant difference in the genetic polymorphism of CCR5 and the severity of influenza A (H1N1) pdm09 virus indection (P>0.05). Conclusion: People with allele A or genotype AA at rs361525, genotype AA+AG at rs1800750 of TNF-α gene might be more susceptible to influenza A(H1N1) pdm09.
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Affiliation(s)
- T Chen
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention; WHO Collaborating Center for Reference and Research on Influenza, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - M Xiao
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - K Chu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - X J Tang
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - J Yang
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention; WHO Collaborating Center for Reference and Research on Influenza, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Y L Shu
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention; WHO Collaborating Center for Reference and Research on Influenza, Chinese Center for Disease Control and Prevention, Beijing 102206, China; School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou 510275, China
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Chang HJ, Algar U, Chu K, Goldberg P. Bowel preparation for colonoscopy: is diet restriction necessary? S AFR J SURG 2020; 58:217. [PMID: 34096211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Bowel preparation is essential for quality colonoscopy. Although most bowel preparation regimens recommend dietary restriction for 24 to 48 hours before the procedure, the evidence for this is poor. This study aimed to investigate whether dietary restriction during bowel preparation improves the quality of colonoscopy. METHODS A prospective, randomised controlled pilot study in which the dietary restriction (DR) group (control) was instructed not to ingest high fibre foods for 48 hours prior to the use of a polyethylene glycol (PEG) bowel preparation. The non-dietary restriction (NDR) group were given no dietary instruction but received instructions for the use of the PEGbased preparation. On the day of colonoscopy, the quality of the bowel effluent was assessed, and additional preparation given as necessary. The primary endpoint was quality of bowel cleansing using the Harefield Cleansing Scale during colonoscopy. The secondary endpoints were the need for additional bowel preparation and the quantity of additional bowel preparation given prior to endoscopy. Data were analysed on an intention to treat basis. RESULTS Twenty-three participants were randomised to the intervention group and thirty-four to the control group. Patient demographics were similar in both groups. Dietary restriction did not influence the success rate of bowel preparation: 97% successful bowel preparation in the DR group, vs 91% successful bowel preparation in the NDR group (p = 0.559). Additional bowel preparation requirement were similar in both groups: 35% in the DR group vs 39% in the NDR group (p = 0.768). Mean amount of additional bowel preparation required was similar: 560 ml in the DR group vs 460 ml in the NDR group (p = 0.633). CONCLUSION The quality of bowel preparation was comparable in patients with and without dietary restrictions prior to colonoscopy. Non-restrictive diets prior to bowel preparation should be considered to increase compliance. The sample size of this pilot study prohibited definite statistical conclusions but demonstrated this to be a reasonable methodology for a larger study.
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Affiliation(s)
- H-J Chang
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - U Algar
- Colorectal Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - K Chu
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa and Centre for Global Surgery, Department of Global Health, Stellenbosch University, South Africa
| | - P Goldberg
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa and Colorectal Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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Wyte-Lake T, Der-Martirosian C, Chu K, Johnson-Koenke R, Dobalian A. Preparedness and response activities of the US Department of Veterans Affairs (VA) home-based primary care program around the fall 2017 hurricane season. BMC Public Health 2020; 20:1796. [PMID: 33243229 PMCID: PMC7690102 DOI: 10.1186/s12889-020-09888-8] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large-scale natural disasters disproportionally affect both the medically complex and the older old, groups that are responsible for most medical surge after a disaster. To understand how to ameliorate this surge, we examined the activities of the nine US Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) programs impacted during the 2017 Fall Hurricane Season. METHODS Convergent mixed methods design, incorporating independently conducted qualitative and quantitative analyses. Phase One: 34 clinical staff were interviewed from the nine VA HBPC programs impacted by Hurricanes Harvey, Irma, and Maria to examine the experiences of their HBPC programs in response to the Hurricanes. Phase Two: Secondary quantitative data analysis used the VA's Corporate Data Warehouse (CDW) to examine the electronic health records of patients for these same nine sites. RESULTS The emergency management activities of the HBPC programs emerged as two distinct phases: preparedness, and response and recovery. The early implementation of preparedness procedures, and coordinated post-Hurricane patient tracking, limited disruption in care and prevented significant hospitalizations among this population. CONCLUSIONS Individuals aged 75 or older, who often present with multiple comorbidities and decreased functional status, typically prefer to age in their homes. Additionally, as in-home medical equipment evolves, more medically vulnerable individuals are able to receive care at home. HBPC programs, and similar programs under Medicare, connect the homebound, medically complex, older old to the greater healthcare community. Engaging with these programs both pre- and post-disasters is central to bolstering community resilience for these at-risk populations.
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Affiliation(s)
- Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA. .,Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
| | - Karen Chu
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
| | - Rachel Johnson-Koenke
- Denver-Seattle Center of Innovation, Rocky Mountain Regional VA Medical Center, U.S. Department of Veterans Affairs, 1700 North Wheeling Street, Aurora, CO, 80045-7211, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA.,Division of Health Systems Management and Policy, University of Memphis School of Public Health, 3720 Alumni Ave, Memphis, TN, 38152, USA
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Wei K, Tran TT, Chang PW, Malekie A, Chu K, Alhilali L, Borzage MT, Mena E, Harrington MG, King KS. MRI Automated T1 Signal Intensity Detection of Diffuse Brain Manganese Accumulation in Cirrhosis. J Neuroimaging 2020; 31:186-191. [PMID: 33146918 DOI: 10.1111/jon.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Cirrhosis is associated with diffuse brain manganese deposition, which results in increased signal intensity (SI) in the brain on T1-weighted images, most often visualized in the globus pallidus. The purpose of this study was to determine if automated image intensity measurements can detect SI differences in the basal ganglia and other regions reported to have manganese deposition in patients with cirrhosis compared with controls. METHODS T1 FSPGR images were acquired on 28 patients with cirrhosis and 28 age-sex-matched controls. FreeSurfer T1 SI values were obtained for the globus pallidus, putamen, cerebral white matter, cerebral cortex, and brainstem. SI ratios were computed for globus pallidus normalized to white matter and brainstem. SI values and SI ratios were compared between groups using t-tests. RESULTS Among people with cirrhosis, T1 SI was significantly increased in the globus pallidus, putamen, cerebral white matter, cerebral cortex, and brainstem (P< .001), and the globus pallidus to brainstem ratio was significantly increased (P< .001). No significant difference was seen for globus pallidus to cerebral white matter T1 SI ratio (P = .38). CONCLUSIONS Automatic assessment of T1 SI allows for rapid, objective identification of widespread T1 shortening associated with manganese deposition in cirrhosis, consistent with the global deposition of neurotoxic manganese seen in pathology studies. This automated T1 assessment may have broader utility for other conditions beyond cirrhosis impacting T1 SI.
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Affiliation(s)
- Ke Wei
- Imaging Center, Huntington Medical Research Institutes, Pasadena, CA
| | - Thao T Tran
- Imaging Center, Huntington Medical Research Institutes, Pasadena, CA
| | - Patrick W Chang
- Internal Medicine, Keck School of Medicine at USC, Los Angeles, CA
| | - Annie Malekie
- Imaging Center, Huntington Medical Research Institutes, Pasadena, CA
| | - Karen Chu
- Imaging Center, Huntington Medical Research Institutes, Pasadena, CA
| | - Lea Alhilali
- Neuroradiology, Barrow Neurological Institute, Phoenix, AZ
| | - Matthew T Borzage
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Kevin S King
- Imaging Center, Huntington Medical Research Institutes, Pasadena, CA
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Yu C, Choi D, Bruno BA, Thorpe KE, Straus SE, Cantarutti P, Chu K, Frydrych P, Hoang-Kim A, Ivers N, Kaplan D, Leung FH, Maxted J, Rezmovitz J, Sale J, Sodhi-Helou S, Stacey D, Telner D. Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid on Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial. J Med Internet Res 2020; 22:e16984. [PMID: 32996893 PMCID: PMC7557444 DOI: 10.2196/16984] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/04/2020] [Accepted: 08/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Person-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM. OBJECTIVE This study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level. METHODS A two-step, parallel, 10-site cluster randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later) was conducted. Participants were adults 18 years and older with diabetes and 2 other comorbidities at 10 family health teams (FHTs) in Southwestern Ontario. FHTs were randomly assigned to MyDiabetesPlan (n=5) or control (n=5) through a computer-generated algorithm. MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) followed by patients (second step) were trained on its use. Control participants received static generic Diabetes Canada resources. Patients were not blinded. Participants completed validated questionnaires at baseline, 6 months, and 12 months. The primary outcome at the individual patient level was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care, and clinician intention to practice interprofessional SDM. Multilevel hierarchical regression models were used. RESULTS At the end of the study, the intervention group (5 clusters, n=111) had a modest reduction in total decisional conflicts compared with the control group (5 clusters, n=102; -3.5, 95% CI -7.4 to 0.42). Although there was no difference in diabetes distress or health-related quality of life, there was an increase in patient assessment of chronic illness care (0.7, 95% CI 0.4 to 1.0). CONCLUSIONS Use of goal-setting decision aids modestly improved decision quality and chronic illness care but not quality of life. Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral support. The next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT02379078; https://clinicaltrials.gov/ct2/show/NCT02379078.
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Affiliation(s)
- Catherine Yu
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Dorothy Choi
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Brigida A Bruno
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Sharon E Straus
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | | | - Karen Chu
- Bridgepoint Active Healthcare (Sinai Health System), Toronto, ON, Canada
| | - Paul Frydrych
- Mount Dennis Weston Health Centre, Humber River Family Health Team, Toronto, ON, Canada
| | - Amy Hoang-Kim
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David Kaplan
- University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Fok-Han Leung
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - John Maxted
- Markham Stouffville Hospital, Markham, ON, Canada
| | | | - Joanna Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Sumeet Sodhi-Helou
- Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Deanna Telner
- South East Toronto Family Health Team (Toronto East Health Network), Toronto, ON, Canada
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Fairchild A, Li P, Ma D, Ghosh S, Watanabe S, Danielson B, Huot A, Chu K, Huang F, Severin D, Debenham B. 170: Prevalence of Oligometastatic Disease Based on the 2019 International Consensus Statement. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)31062-8] [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: 11/26/2022]
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Mogadam E, King K, Shriner K, Chu K, Sondergaard A, Young K, Naghavi M, Kloner RA. The association of nadir CD4-T cell count and endothelial dysfunction in a healthy HIV cohort without major cardiovascular risk factors. SAGE Open Med 2020; 8:2050312120924892. [PMID: 32537154 PMCID: PMC7268551 DOI: 10.1177/2050312120924892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/13/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives: HIV-infected population may have increased risk of cardiovascular disease.
The prevalence of traditional cardiovascular disease risk factors such as
hypertension, diabetes and dyslipidemia in HIV-infected individuals has made
it difficult to assess the direct effects of HIV and immune factors on
endothelial dysfunction and associated increased risk of atherosclerosis.
The purpose of this study was to investigate indicators of endothelial
dysfunction in an HIV cohort without hypertension and diabetes. Methods: We studied 19 HIV-infected patients between the ages of 25–76 years old with
effectively suppressed viral load and without diagnosis of hypertension or
diabetes. Endothelial function was measured by digital thermal monitoring of
vascular reactivity using the VENDYS technique. Endothelial function was
reported as vascular reactivity index. Systolic blood pressure and diastolic
blood pressure at the time of VENDYS test were measured and latest lipid
panels were recorded. The association between vascular reactivity index and
CD4-T cells count, different antiretroviral therapy types (non-nucleoside
reverse transcriptase, nucleoside reverse transcriptase, protease
inhibitors, integrase inhibitors), vitamins use, systolic blood pressure,
diastolic blood pressure, high-density lipoprotein cholesterol and
low-density lipoprotein cholesterol was investigated. Results: Mean vascular reactivity index was 1.87 ± 0.53. Vascular reactivity index,
marker of endothelial dysfunction, showed a significant correlation with
lower nadir CD4 count (p = 0.003) as well as low-density lipoprotein
cholesterol (p = 0.02). No additional significant correlation between
vascular reactivity index and the rest of the investigated variables was
found. Conclusion: Vascular reactivity index, a clinical predictor of endothelial dysfunction,
is associated with lower nadir CD4-T cell and low-density lipoprotein
cholesterol in HIV-infected men with no history of hypertension or diabetes
and before clinical evidence of cardiovascular disease.
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Affiliation(s)
- Emad Mogadam
- Division of Cardiovascular Medicine, Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kevin King
- Huntington Medical Research Institutes, Pasadena, CA, USA
| | | | - Karen Chu
- Huntington Medical Research Institutes, Pasadena, CA, USA
| | | | - Kristal Young
- Division of Cardiology, Department of Medicine, Huntington Hospital, Pasadena, CA, USA
| | | | - Robert A Kloner
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA, USA.,Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Sharma P, Davidson R, Davidson J, Keane C, Liu C, Ritchie SR, Chu K, Sutherland G, Bissett IP, O'Grady G. Novel chyme reinfusion device for gastrointestinal fistulas and stomas: feasibility study. Br J Surg 2020; 107:1199-1210. [DOI: 10.1002/bjs.11516] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/07/2019] [Accepted: 01/03/2020] [Indexed: 12/11/2022]
Abstract
Abstract
Background
High-output enterostomies and enteroatmospheric fistulas are common causes of intestinal failure, and may necessitate parenteral nutrition and prolonged hospital stay. Reinfusing lost chyme into the distal gut is known to be beneficial, but implementation has been limited because manual reinfusion is unpleasant and labour-intensive, and no devices are available. A new device is presented for reinfusing chyme easily and efficiently, with first-in-human data.
Methods
The device comprises a compact centrifugal pump that fits inside a standard stoma appliance. The pump is connected to an intestinal feeding tube inserted into the distal intestinal limb. The pump is activated across the appliance by magnetic coupling to a hand-held driver unit, effecting intermittent bolus reinfusion while avoiding effluent contact. Safety, technical and clinical factors were evaluated.
Results
Following microbiological safety testing, the device was evaluated in ten patients (median duration of installation 39·5 days; total 740 days). Indications included remediation of high-output losses (8 patients), dependency on parenteral nutrition (5), and gut rehabilitation before surgery (10). Reinfusion was well tolerated with use of regular boluses of approximately 200 ml, and no device-related serious adverse events occurred. Clinical benefits included resumption of oral diet, cessation of parenteral nutrition (4 of 5 patients), correction of electrolytes and liver enzymes, and hospital discharge (6 of 10). Of seven patients with intestinal continuity restored, one experienced postoperative ileus.
Conclusion
A novel chyme reinfusion device was developed and found to be safe, demonstrating potential benefits in remediating high-output losses, improving fluid and electrolyte balance, weaning off parenteral nutrition and improving surgical recovery. Pivotal trials and regulatory approvals are now in process.
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Affiliation(s)
- P Sharma
- Department of Surgery, Auckland, New Zealand
| | - R Davidson
- The Insides Company, Auckland, New Zealand
| | - J Davidson
- The Insides Company, Auckland, New Zealand
| | - C Keane
- Department of Surgery, Auckland, New Zealand
| | - C Liu
- Department of Surgery, Auckland, New Zealand
| | - S R Ritchie
- Infection and Immunity, University of Auckland, Auckland, New Zealand
| | - K Chu
- The Insides Company, Auckland, New Zealand
| | | | - I P Bissett
- Department of Surgery, Auckland, New Zealand
- The Insides Company, Auckland, New Zealand
| | - G O'Grady
- Department of Surgery, Auckland, New Zealand
- The Insides Company, Auckland, New Zealand
- Auckland Bioengineering Institute, Auckland, New Zealand
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Pahlevan NM, Yao T, Chu K, Cole S, Tran T, Wood JC, King KS. Group delay method for MRI aortic pulse wave velocity measurements in clinical protocols with low temporal resolution: Validation in a heterogeneous cohort. Magn Reson Imaging 2020; 69:8-15. [PMID: 32105671 DOI: 10.1016/j.mri.2020.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND MRI assessment of aortic pulse wave velocity (PWV) helps predict the risk of vascular events, but the recommended phase contrast sampling rate is faster than what is utilized in most clinical sequences. There are many existing MRI databases obtained for assessment of cardiac output using lower temporal frequency sampling where information might be obtained about aortic stiffness (PWV). In this work, we sought to evaluate whether the Group Delay (GD) method can generate a reproducible measure of stiffness and describe expected age-related stiffening of the aortic arch using lower sampling rates in standard clinical sequences. METHODS Phase contrast (PC) MRI was obtained on the ascending and descending aortic arch in a heterogeneous adult cohort (n = 23; 9 women) spanning over a wide range of ages (ages 24-89, mean 49.4 ± 18.4). Data was collected with standard cardiac MRI protocols for cardiac output evaluation (repetition time = 7.8 ms, views-per-segment = 4, encoding velocity = 200 cm/s). Pulse wave transit times (TT) were computed using the GD method, two other validated automated approaches (cross correlation TT Algorithm by Gaddum and Segment by Medviso), and the manual tangent method. Pressure waveforms from tonometry and flow waveforms from PC MRI were used to assess wave reflections. RESULTS Group Delay and TT-Algorithm showed significant and high retest reproducibility (r = 0.86 for both) as well as high PWV correlation with age (r = 0.93, P-value < 0.00005 and r = 0.96, P-value < 0.00005 respectively) and with each other (r = 0.94, P-value < 0.00001, RMSE = 0.94 m/s). Arbitrary altering of the image acquisition trigger in the GD method introduced error of 10%-13%, but the TT-algorithm error range was 11%-25%. CONCLUSION Group Delay enables reproducible assessment of transit time to derive PWV from low temporal resolution clinical cardiac MRI sequences that can also identify age-related stiffening.
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Affiliation(s)
- Niema M Pahlevan
- Department of Aerospace & Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
| | - Timothy Yao
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
| | - Karen Chu
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
| | - Soren Cole
- Department of Aerospace & Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA; Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
| | - Thao Tran
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
| | - John C Wood
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; Division of Pediatric Cardiology, Children's Hospital Los Angeles, CA 90027, USA.
| | - Kevin S King
- Advanced Imaging and Spectroscopy Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
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Zhang X, Lai W, Ying X, Xu L, Chu K, Brown J, Chen L, Hong G. Salidroside Reduces Inflammation and Brain Injury After Permanent Middle Cerebral Artery Occlusion in Rats by Regulating PI3K/PKB/Nrf2/NFκB Signaling Rather than Complement C3 Activity. Inflammation 2020; 42:1830-1842. [PMID: 31230155 DOI: 10.1007/s10753-019-01045-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Salidroside, an active constituent of Rhodiola rosea, is neuroprotective after transient middle cerebral artery occlusion (tMCAO). However, its effects in other experimental stroke models are less understood. Here, we investigated the effect of daily intraperitoneal injections of salidroside in rats after permanent MCAO (pMCAO). Cerebral infarct volumes at 1 day after pMCAO were significantly reduced by treatment with 100 mg/kg/day salidroside, but not by 25 or 50 mg/kg/day, and this benefit of salidroside increased significantly over at least 7 days of treatment, when it was also accompanied by decreased neurological deficit scores. These observations led us to investigate the underlying mechanism of action of salidroside. 100 mg/kg salidroside for 1 day increased NeuN, Nrf2, and its downstream mediator HO-1, while it reduced nuclear NFκB p50, IL-6, and TNFα. Brusatol, a Nrf2 inhibitor, blocked the actions of salidroside on Nrf2, NFκB p50, IL-6, and TNFα. Salidroside also increased the ratio of p-PKB/PKB at 1 day after pMCAO even in the presence of brusatol. LY294002, a PI3K inhibitor, prevented all these effects of salidroside, including those on NeuN, p-PKB/PKB, Nrf2, HO-1, and pro-inflammatory mediators. In contrast, salidroside had no significant effect on the level of cerebral complement C3 after pMCAO, or on the activity of C3 as measured by the expression of cerebral Egr1. Our findings therefore suggest that salidroside reduces neuroinflammation and neural damage by regulating the PI3K/PKB/Nrf2/NFκB signaling pathway after pMCAO, and that this neuroprotective effect does not involve modulation of complement C3 activity.
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Affiliation(s)
- X Zhang
- Centre of Biomedical Research & Development, Fujian University of Traditional Chinese Medicine, No. 1 Huatou Road, Minhou Shangjie, Fuzhou, China
| | - W Lai
- Centre of Biomedical Research & Development, Fujian University of Traditional Chinese Medicine, No. 1 Huatou Road, Minhou Shangjie, Fuzhou, China
| | - X Ying
- Centre of Biomedical Research & Development, Fujian University of Traditional Chinese Medicine, No. 1 Huatou Road, Minhou Shangjie, Fuzhou, China
| | - L Xu
- Centre of Biomedical Research & Development, Fujian University of Traditional Chinese Medicine, No. 1 Huatou Road, Minhou Shangjie, Fuzhou, China
| | - K Chu
- Centre of Biomedical Research & Development, Fujian University of Traditional Chinese Medicine, No. 1 Huatou Road, Minhou Shangjie, Fuzhou, China
| | - J Brown
- Centre of Biomedical Research & Development, Fujian University of Traditional Chinese Medicine, No. 1 Huatou Road, Minhou Shangjie, Fuzhou, China
| | - L Chen
- Centre of Biomedical Research & Development, Fujian University of Traditional Chinese Medicine, No. 1 Huatou Road, Minhou Shangjie, Fuzhou, China
| | - G Hong
- Centre of Biomedical Research & Development, Fujian University of Traditional Chinese Medicine, No. 1 Huatou Road, Minhou Shangjie, Fuzhou, China.
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Chu K, Kulandavelu S, Masterson T, Ibrahim E, Arora H, Ramasamy R. 044 Short-acting Exogenous Testosterone Appears to have a Lesser Effect on Gonadotropins Compared to Long-acting Testosterone: A Pilot Study Using Mouse Models. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.046] [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: 11/17/2022]
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