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Izumi SS, Caron D, Guay-Bélanger S, Archambault P, Michaels L, Heinlein J, Dorr DA, Totten A, Légaré F. Development and Evaluation of Serious Illness Conversation Training for Interprofessional Primary Care Teams. J Palliat Med 2023; 26:1198-1206. [PMID: 37040304 DOI: 10.1089/jpm.2022.0268] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Background: Early advance care planning (ACP) conversations are essential to deliver patient-centered care. While primary care is an ideal setting to initiate ACP, such as Serious Illness Conversations (SICs), many barriers exist to implement such conversations in routine practice. An interprofessional team approach holds promises to address barriers. Objective: To develop and evaluate SIC training for interprofessional primary care teams (IP-SIC). Design: An existing SIC training was adapted for IP-SIC and then implemented and evaluated for acceptability and effectiveness. Setting/Context: Interprofessional teams in 15 primary care clinics in five US states. Measures: Acceptability of the IP-SIC training and participants' self-reported likelihood to engage in ACP after the training. Results: The 156 participants were a mix of physicians and advanced practice providers (APPs) (44%), nurses and social workers (31%), and others (25%). More than 90% of all participants rated the IP-SIC training positively. While nurse/social worker and other groups were less likely than physician and APP group to engage in ACP before training (4.4, 3.7, and 6.4 on a 1-10 scale, respectively), all groups showed significant increase in likelihood to engage in ACP after the IP-SIC training (8.5, 7.7, and 9.2, respectively). Both physician/APP and nurse/social worker groups showed significant increase in likelihood to use the SIC Guide after the IP-SIC training, whereas an increase in likelihood to use SIC Guide among other groups was not statistically significant. Conclusion: The new IP-SIC training was well accepted by interprofessional team members and effective to improve their likelihood to engage in ACP. Further research exploring how to facilitate collaboration among interprofessional team members to maximize opportunities for more and better ACP is warranted. ClinicalTrials.gov ID: NCT03577002.
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Affiliation(s)
- Shigeko Seiko Izumi
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
| | - Danielle Caron
- VITAM-Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Sabrina Guay-Bélanger
- VITAM-Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Patrick Archambault
- VITAM-Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Centre de Recherche, Centre Intégré en Santé et Services Sociaux de Chaudière-Appalaches, Lévis, Quebec, Canada
| | - LeAnn Michaels
- Oregon Rural Practice-Based Research Network, Oregon Health and Science University, Portland, Oregon, USA
| | - Julia Heinlein
- Oregon Rural Practice-Based Research Network, Oregon Health and Science University, Portland, Oregon, USA
| | - David A Dorr
- Oregon Rural Practice-Based Research Network, Oregon Health and Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Annette Totten
- Oregon Rural Practice-Based Research Network, Oregon Health and Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - France Légaré
- VITAM-Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
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Oser TK, Hall TL, Dickinson LM, Callen E, Carroll JK, Nease DE, Michaels L, Oser SM. Continuous Glucose Monitoring in Primary Care: Understanding and Supporting Clinicians' Use to Enhance Diabetes Care. Ann Fam Med 2022; 20:541-547. [PMID: 36443083 PMCID: PMC9705045 DOI: 10.1370/afm.2876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/30/2022] [Accepted: 07/29/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Diabetes affects approximately 34 million Americans and many do not achieve glycemic targets. Continuous glucose monitoring (CGM) is associated with improved health outcomes for patients with diabetes. Most adults with diabetes receive care for their diabetes in primary care practices, where uptake of CGM is unclear. METHODS We used a cross-sectional web-based survey to assess CGM prescribing behaviors and resource needs among primary care clinicians across the United States. We used descriptive statistics and multivariable regression to identify characteristics associated with prescribing behaviors, openness to prescribing CGM, and to understand resources needed to support use of CGM in primary care. RESULTS Clinicians located more than 40 miles from the nearest endocrinologist's office were more likely to have prescribed CGM and reported greater likelihood to prescribe CGM in the future than those located within 10 miles of an endocrinologist. Clinicians who served more Medicare patients reported favorable attitudes toward future prescribing and higher confidence using CGM to manage diabetes than clinicians with lower Medicare patient volume. The most-needed resources to support CGM use in primary care were consultation on insurance issues and CGM training. CONCLUSIONS Primary care clinicians are interested in using CGM for patients with diabetes, but many lack the resources to implement use of this diabetes technology. Use of CGM can be supported with education in the form of workshops and consultation on insurance issues targeted toward residents, recent graduates, and practices without a nearby endocrinologist. Continued expansion of Medicare and Medicaid coverage for CGM can also support CGM use in primary care.
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Affiliation(s)
- Tamara K Oser
- University of Colorado Department of Family Medicine, Aurora, Colorado
| | - Tristen L Hall
- University of Colorado Department of Family Medicine, Aurora, Colorado
| | | | | | - Jennifer K Carroll
- University of Colorado Department of Family Medicine, Aurora, Colorado.,American Academy of Family Physicians, Leawood, Kansas
| | - Donald E Nease
- University of Colorado Department of Family Medicine, Aurora, Colorado
| | | | - Sean M Oser
- University of Colorado Department of Family Medicine, Aurora, Colorado
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Shaw RJ, Boazak M, Tiase V, Porter G, Wosik J, Bumatay S, Michaels L, Stone J, Cohen D, Dolor R. Integrating Patient-generated Digital Health Data into Electronic Health Records (EHRs) in Ambulatory Care Settings: EHR Vendor Survey and Interviews. AMIA Jt Summits Transl Sci Proc 2022; 2022:439-445. [PMID: 35854713 PMCID: PMC9285170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Data traditionally collected in a clinic or hospital setting is now collected electronically in everyday environments from patients, known as patient-generated health data (PGHD). We conducted informal interviews and collected survey data from major ambulatory care EHR vendors that serve the majority of the U.S. market to collect information on how their clients are integrating PGHD into EHRs. Of the 9 EHR vendors contacted, 6 completed the survey and 5 participated in a 45-minute interview. Feedback from the vendors included how PGHD use has steadily risen over the past decade and how the COVID-19 pandemic accelerated PGHD use. Pathways for data from devices or surveys to be brought securely into the EHR are increasing. While promising, adoption of health IT systems has its challenges. There are disparities in EHRs, devices, and applications. We concluded that more supportive policies are needed to advance PGHD integration.
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Affiliation(s)
- Ryan J Shaw
- Duke Mobile App Gateway, Clinical & Translational Science Institute, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Mina Boazak
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Victoria Tiase
- The Value Institute, New York-Presbyterian Hospital, New York, NY, USA
| | | | - Jedrek Wosik
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Sarah Bumatay
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - LeAnn Michaels
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | | | - Deborah Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Rowena Dolor
- Duke Primary Care Research Consortium, Duke Clinical & Translational Science Institute, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Hall T, Dickinson LM, Callen E, Nease D, Carroll J, Oser T, Warman M, Michaels L, Oser S. Relationship of primary care clinician characteristics with continuous glucose monitoring use and confidence. Ann Fam Med 2022; 20:2745. [PMID: 36701160 PMCID: PMC10549171 DOI: 10.1370/afm.20.s1.2745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Context: Continuous glucose monitoring (CGM) provides clearer readings of blood glucose levels than traditional finger-stick glucose tests and is associated with improved diabetes outcomes such as reduced HbA1c. CGM can inform insulin dosing and diet decisions, and alert patients to hypoglycemia. A lack of endocrinologists in the majority of U.S. counties, particularly rural areas, and long wait times in many endocrinologists' offices create disparities in CGM access for patients with diabetes. Expanding use of CGM in primary care can improve care and patient diabetes outcomes. Objective: Understand primary care clinicians' experience with CGM to determine feasibility and resources needed to prescribe CGM. Study Design: Quantitative phase of explanatory sequential mixed methods study using cross-sectional online survey. Setting: Primary care. Population studied: Primary care physicians and advanced practice providers across the U.S. Outcome Measures: Past CGM prescribing behaviors, future likelihood to prescribe, resources needed to prescribe. Results: 632 respondents. Role: 72% attending physicians. Organization: Federally Qualified Health-Center (or similar) (27%), hospital-owned (27%), private practice (22%). Half (47%) had seen patients with CGM but never prescribed; two-fifths (39%) had prescribed CGM. Three-fifths (62%) moderately or very likely to prescribe CGM in the future. Likelihood to have prescribed CGM: Post-training physicians more likely than residents (OR=0.303, CI=.160-.575) or PA/NPs (OR=0.356, CI=.165-.766), part-time practice less likely than full-time (OR=0.546, CI=.305-.978), <75% time delivering primary care less likely than 75%+ (OR=0.595, CI=.371-.955), and location greater than 40 miles from an endocrinologist more likely than endocrinologist within 10 miles (OR=1.941, CI=1.17-3.21). Likelihood to prescribe with access to various resources greatest for consultation on insurance issues (72% moderately/very likely) and CGM education/training (72% moderately/very likely). Conclusions: Primary care clinicians have interest in prescribing CGM for patients with diabetes. Clinician type, percentage of time spent practicing, portion of time delivering primary care, and distance from endocrinologist are related to likelihood to prescribe CGM. Previous experience prescribing CGM may improve confidence and likelihood of future prescribing. Consultation, education and training on CGM for primary care clinicians may increase access to CGM.
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5
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Coleman KF, Krakauer C, Anderson M, Michaels L, Dorr DA, Fagnan LJ, Hsu C, Parchman ML. Improving Quality Improvement Capacity and Clinical Performance in Small Primary Care Practices. Ann Fam Med 2021; 19:499-506. [PMID: 34750124 PMCID: PMC8575517 DOI: 10.1370/afm.2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We undertook a study to assess whether implementing 7 evidence-based strategies to build improvement capacity within smaller primary care practices was associated with changes in performance on clinical quality measures (CQMs) for cardiovascular disease. METHODS A total of 209 practices across Washington, Oregon, and Idaho participated in a pragmatic clinical trial that focused on building quality improvement capacity as measured by a validated questionnaire, the 12-point Quality Improvement Capacity Assessment (QICA). Clinics reported performance on 3 cardiovascular CQMs-appropriate aspirin use, blood pressure (BP) control (<140/90 mm Hg), and smoking screening/cessation counseling-at baseline (2015) and follow-up (2017). Regression analyses with change in CQM as the dependent variable allowed for clustering by practice facilitator and adjusted for baseline CQM performance. RESULTS Practices improved QICA scores by 1.44 points (95% CI, 1.20-1.68; P <.001) from an average baseline of 6.45. All 3 CQMs also improved: aspirin use by 3.98% (average baseline = 66.8%; 95% CI for change, 1.17%-6.79%; P = .006); BP control by 3.36% (average baseline = 61.5%; 95% CI for change, 1.44%-5.27%; P = .001); and tobacco screening/cessation counseling by 7.49% (average baseline = 73.8%; 95% CI for change, 4.21%-10.77%; P <.001). Each 1-point increase in QICA score was associated with a 1.25% (95% CI, 0.41%-2.09%, P = .003) improvement in BP control; the estimated likelihood of reaching a 70% BP control performance goal was 1.24 times higher (95% CI, 1.09-1.40; P <.001) for each 1-point increase in QICA. CONCLUSION Improvements in clinic-level performance on BP control may be attributed to implementation of 7 evidence-based strategies to build quality improvement capacity. These strategies were feasible to implement in small practices over 15 months.
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Affiliation(s)
- Katie F Coleman
- Center for Accelerating Care Transformation (previously MacColl Center), Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Chloe Krakauer
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Melissa Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - LeAnn Michaels
- Oregon Rural Practice Research Network, Oregon Health & Science University, Portland, Oregon
| | - David A Dorr
- Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Lyle J Fagnan
- Oregon Rural Practice Research Network, Oregon Health & Science University, Portland, Oregon
| | - Clarissa Hsu
- Center for Accelerating Care Transformation (previously MacColl Center), Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Michael L Parchman
- Center for Accelerating Care Transformation (previously MacColl Center), Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Schofield M, Rodriguez D, Cassin E, Kidman A, Michaels L, Jorth P, Campbell E, Tseng B. 442: The anti-sigma factor MucA is required for viability in Pseudomonas aeruginosa. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01866-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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7
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Davis MM, Gunn R, Kenzie E, Dickinson C, Conway C, Chau A, Michaels L, Brantley S, Check DK, Elder N. Integration of Improvement and Implementation Science in Practice-Based Research Networks: a Longitudinal, Comparative Case Study. J Gen Intern Med 2021; 36:1503-1513. [PMID: 33852140 PMCID: PMC8175491 DOI: 10.1007/s11606-021-06610-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Implementation science (IS) and quality improvement (QI) inhabit distinct areas of scholarly literature, but are often blended in practice. Because practice-based research networks (PBRNs) draw from both traditions, their experience could inform opportunities for strategic IS-QI alignment. OBJECTIVE To systematically examine IS, QI, and IS/QI projects conducted within a PBRN over time to identify similarities, differences, and synergies. DESIGN Longitudinal, comparative case study of projects conducted in the Oregon Rural Practice-based Research Network (ORPRN) from January 2007 to January 2019. APPROACH We reviewed documents and conducted staff interviews. We classified projects as IS, QI, IS/QI, or other using established criteria. We abstracted project details (e.g., objective, setting, theoretical framework) and used qualitative synthesis to compare projects by classification and to identify the contributions of IS and QI within the same project. KEY RESULTS Almost 30% (26/99) of ORPRN's projects included IS or QI elements; 54% (14/26) were classified as IS/QI. All 26 projects used an evidence-based intervention and shared many similarities in relation to objective and setting. Over half of the IS and IS/QI projects used randomized designs and theoretical frameworks, while no QI projects did. Projects displayed an upward trend in complexity over time. Project used a similar number of practice change strategies; however, projects classified as IS predominantly employed education/training while all IS/QI and most QI projects used practice facilitation. Projects including IS/QI elements demonstrated the following contributions: QI provides the mechanism by which the principles of IS are operationalized in order to support local practice change and IS in turn provides theories to inform implementation and evaluation to produce generalizable knowledge. CONCLUSIONS Our review of projects conducted over a 12-year period in one PBRN demonstrates key synergies for IS and QI. Strategic alignment of IS/QI within projects may help improve care quality and bridge the research-practice gap.
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Affiliation(s)
- Melinda M Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, 97239, USA.
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Rose Gunn
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Erin Kenzie
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Caitlin Dickinson
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Cullen Conway
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Alex Chau
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, 97239, USA
| | - LeAnn Michaels
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Steven Brantley
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Devon K Check
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nancy Elder
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, 97239, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, Wilson R, Asif U, Connor M, Dindyal S, Math N, Pagarkar A, Saleem H, Seth I, Sharma S, Standfield N, Swartbol T, Adamson R, Choi JE, El Tokhy O, Ho W, Javaid NR, Kelly M, Mehdi AS, Menon D, Plumptre I, Sturrock S, Turner J, Warren O, Crane E, Ferris B, Gadsby C, Smallwood J, Vipond M, Wilson V, Amarnath T, Doshi A, Gregory C, Kandiah K, Powell B, Spoor H, Toh C, Vizor R, Common M, Dunleavy K, Harris S, Luo C, Mesbah Z, Kumar AP, Redmond A, Skulsky S, Walsh T, Daly D, Deery L, Epanomeritakis E, Harty M, Kane D, Khan K, Mackey R, McConville J, McGinnity K, Nixon G, Ang A, Kee JY, Leung E, Norman S, Palaniappan SV, Sarathy PP, Yeoh T, Frost J, Hazeldine P, Jones L, Karbowiak M, Macdonald C, Mutarambirwa A, Omotade A, Runkel M, Ryan G, Sawers N, Searle C, Suresh S, Vig S, Ahmad A, McGartland R, Sim R, Song A, Wayman J, Brown R, Chang LH, Concannon K, Crilly C, Arnold TJ, Burgin A, Cadden F, Choy CH, Coleman M, Lim D, Luk J, Mahankali-Rao P, Prudence-Taylor AJ, Ramakrishnan D, Russell J, Fawole A, Gohil J, Green B, Hussain A, McMenamin L, McMenamin L, Tang M, Azmi F, Benchetrit S, Cope T, Haque A, Harlinska A, Holdsworth R, Ivo T, Martin J, Nisar T, Patel A, Sasapu K, Trevett J, Vernet G, Aamir A, Bird C, Durham-Hall A, Gibson W, Hartley J, May N, Maynard V, Johnson S, Wood CM, O'Brien M, Orbell J, Stringfellow TD, Tenters F, Tresidder S, Cheung W, Grant A, Tod N, Bews-Hair M, Lim ZH, Lim SW, Vella-Baldacchino M, Auckburally S, Chopada A, Easdon S, Goodson R, McCurdie F, Narouz M, Radford A, Rea E, Taylor O, Yu T, Alfa-Wali M, Amani L, Auluck I, Bruce P, Emberton J, Kumar R, Lagzouli N, Mehta A, Murtaza A, Raja M, Dennahy IS, Frew K, Given A, He YY, Karim MA, MacDonald E, McDonald E, McVinnie D, Ng SK, Pettit A, Sim DPY, Berthaume-Hawkins SD, Charnley R, Fenton K, Jones D, Murphy C, Ng JQ, Reehal R, Robinson H, Seraj SS, Shang E, Tonks A, White P, Yeo A, Chong P, Gabriel R, Patel N, Richardson E, Symons L, Aubrey-Jones D, Dawood S, Dobrzynska M, Faulkner S, Griffiths H, Mahmood F, Patel P, Perry M, Power A, Simpson R, Ali A, Brobbey P, Burrows A, Elder P, Ganyani R, Horseman C, Hurst P, Mann H, Marimuthu K, McBride S, Pilsworth E, Powers N, Stanier P, Innes R, Kersey T, Kopczynska M, Langasco N, Patel N, Rajagopal R, Atkins B, Beasley W, Lim ZC, Gill A, Ang HL, Williams H, Yogeswara T, Carter R, Fam M, Fong J, Latter J, Long M, Mackinnon S, McKenzie C, Osmanska J, Raghuvir V, Shafi A, Tsang K, Walker L, Bountra K, Coldicutt O, Fletcher D, Hudson S, Iqbal S, Bernal TL, Martin JWB, Moss-Lawton F, Smallwood J, Vipond M, Cardwell A, Edgerton K, Laws J, Rai A, Robinson K, Waite K, Ward J, Youssef H, Knight C, Koo PY, Lazarou A, Stanger S, Thorn C, Triniman MC, Botha A, Boyles L, Cumming S, Deepak S, Ezzat A, Fowler AJ, Gwozdz AM, Hussain SF, Khan S, Li H, Morrell BL, Neville J, Nitiahpapand R, Pickering O, Sagoo H, Sharma E, Welsh K, Denley S, Khan S, Agarwal M, Al-Saadi N, Bhambra R, Gupta A, Jawad ZAR, Jiao LR, Khan K, Mahir G, Singagireson S, Thoms 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Patil P, Peck FS, Reza N, Swan I, Whyte M, Chaudhry S, Hernon J, Khawar H, O'Brien J, Pullinger M, Rothnie K, Ujjal S, Bhatte S, Curtis J, Green S, Mayer A, Watkinson G, Chapple K, Hawthorne T, Khaliq M, Majkowski L, Malik TAM, Mclauchlan K, En BNW, Parton S, Robinson SD, Saat MI, Shurovi BN, Varatharasasingam K, Ward AE, Behranwala K, Bertelli M, Cohen J, Duff F, Fafemi O, Gupta R, Manimaran M, Mayhew J, Peprah D, Wong MHY, Farmer N, Houghton C, Kandhari N, Khan K, Ladha D, Mayes J, McLennan F, Panahi P, Seehra H, Agrawal R, Ahmed I, Ali S, Birkinshaw F, Choudhry M, Gokani S, Harrogate S, Jamal S, Nawrozzadeh F, Swaray A, Szczap A, Warusavitarne J, Abdalla M, Asemota N, Cullum R, Hartley M, Maxwell-Armstrong C, Mulvenna C, Phillips J, Yule A, Ahmed L, Clement KD, Craig N, Elseedawy E, Gorman D, Kane L, Livie J, Livie V, Moss E, Naasan A, Ravi F, Shields P, Zhu Y, Archer M, Cobley H, Dennis R, Downes C, Guevel B, Lamptey E, Murray H, Radhakrishnan A, Saravanabavan S, Sardar M, Shaw C, Tilliridou V, Wright R, Ye W, Alturki N, Helliwell R, Jones E, Kelly D, Lambotharan S, Scott K, Sivakumar R, Victor L, Boraluwe-Rallage H, Froggatt P, Haynes S, Hung YMA, Keyte A, Matthews L, Evans E, Haray P, John I, Mathivanan A, Morgan L, Oji O, Okorocha C, Rutherford A, Spiers H, Stageman N, Tsui A, Whitham R, Amoah-Arko A, Cecil E, Dietrich A, Fitzpatrick H, Guy C, Hair J, Hilton J, Jawad L, McAleer E, Taylor Z, Yap J, Akhbari M, Debnath D, Dhir T, Elbuzidi M, Elsaddig M, Glace S, Khawaja H, Koshy R, Lal K, Lobo L, McDermott A, Meredith J, Qamar MA, Vaidya A, Acquaah F, Barfi L, Carter N, Gnanappiragasam D, Ji C, Kaminski F, Lawday S, Mackay K, Sulaiman SK, Webb R, Ananthavarathan P, Dalal F, Farrar E, Hashemi R, Hossain M, Jiang J, Kiandee M, Lex J, Mason L, Matthews JH, McGeorge E, Modhwadia S, Pinkney T, Radotra A, Rickard L, Rodman L, Sales A, Tan KL, Bachi A, Bajwa DS, Battle J, Brown LR, Butler A, Calciu A, Davies E, Gardner I, Girdlestone T, Ikogho O, Keelan G, O'Loughlin P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Thompson J, Davis M, Michaels L, Rivelli J, Castro M, Younger B, Castillo M, Reich S, Coronado G. Abstract B046: Incorporating Latino patient input in patient-facing materials for a mailed fecal test outreach program. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-b046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Colorectal cancer screening rates are disproportionately low among Latinos. In 2015, only 63% of eligible adults, and 50% of Latinos, were up-to-date with colon cancer screening recommendations. One factor thought to contribute to the low screening rate is that patient-facing health information for Latinos is difficult to understand and patients face challenges in taking health action. As part of the Participatory Research to Advance Colon Cancer Prevention (PROMPT) study, we used boot camp translation (BCT), a community based participatory strategy, to elicit input from stakeholders and refine materials for a clinic-based mailed fecal immunochemical test (FIT) outreach program. Eligible patient participants were Latino, ages 50 to 75 years, able to speak English or Spanish, and willing to participate in an in-person meeting and follow-up phone calls. Separate sessions were held for English- and Spanish-speaking participants. The in-person session included presentations by a national expert on colon cancer prevention and screening messages, and interactive small group sessions to discuss optimal timing and modality for delivering reminders to a mailed FIT program. The phone calls consisted of iterative conversations to refine bilingual materials to encourage screening. BCT participants desired messages that increased awareness about colon cancer and prevention, stressed the importance of screening, emphasized the motivating influence of family, and used personalized statements such an “I” or “we” in letters or automated phone calls. These preferences were incorporated into outreach materials. (Samples will be provided.) 1-Patient Introductory Letter Included in the FIT Kit Mailing. Revisions recommended by BCT participants included 1) details about colon cancer and the need for prevention, 2) emphasis on a free test, 3) inclusion of a photograph of a multigenerational Latino family, 4) the addition of a colon diagram for visual appeal and education, and 5) messages about how screenings can save lives. The group also wanted emphasis on the test being “simple” and “something you can do at home.” 2-Educational Fact Sheet. We also developed a bilingual fact sheet using participant-preferred messages and simple infographics from the BCT expert presentation. The fact sheet presented statistics about colon cancer diagnoses and deaths, and answered the following questions: “What is colon cancer? When should I get tested? How do I get tested?” 3-FIT Kit Wordless Instructions. We found that patients generally preferred simple, wordless instructions, reporting they were less intimidating and helpful as they showed the small amount of fecal matter needed for the test. We developed FIT wordless instructions based on these findings and included the document with the mailing. Using BCT, we successfully incorporated feedback from English- and Spanish-speaking Latino patients to design and enhance culturally relevant materials to promote FIT testing among patients served by community clinics.
Citation Format: Jamie Thompson, Melinda Davis, LeAnn Michaels, Jennifer Rivelli, Marta Castro, Brittany Younger, Melissa Castillo, Sacha Reich, Gloria Coronado. Incorporating Latino patient input in patient-facing materials for a mailed fecal test outreach program [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B046.
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Affiliation(s)
- Jamie Thompson
- 1Kaiser Permanente Center for Health Research, Portland, OR, USA,
| | - Melinda Davis
- 2Oregon Health & Science University, Portland, OR, USA,
| | | | - Jennifer Rivelli
- 1Kaiser Permanente Center for Health Research, Portland, OR, USA,
| | | | | | | | - Sacha Reich
- 1Kaiser Permanente Center for Health Research, Portland, OR, USA,
| | - Gloria Coronado
- 1Kaiser Permanente Center for Health Research, Portland, OR, USA,
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Al-Naqeeb J, Danner S, Fagnan LJ, Ramsey K, Michaels L, Mitchell J, Branca K, Morris C, Nease DE, Zittleman L, Levy B, Daly J, Hahn D, Dolor RJ, Williams HC, Chalmers JR, Hanifin J, Tofte S, Zuckerman KE, Hansis K, Gundersen M, Block J, Karr F, Dunbrasky S, Siebe K, Dillon K, Cibotti R, Lapidus J, Simpson EL. The Burden of Childhood Atopic Dermatitis in the Primary Care Setting: A Report from the Meta-LARC Consortium. J Am Board Fam Med 2019; 32:191-200. [PMID: 30850455 DOI: 10.3122/jabfm.2019.02.180225] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 08/06/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Little is known about the burden of atopic dermatitis (AD) encountered in US primary care practices and the frequency and type of skin care practices routinely used in children. OBJECTIVE To estimate the prevalence of AD in children 0 to 5 years attending primary care practices in the United States and to describe routine skin care practices used in this population. DESIGN A cross-sectional survey study of a convenience sample of children under the age of 5 attending primary care practices for any reason. SETTING Ten primary care practices in 5 US states. RESULTS Among 652 children attending primary care practices, the estimated prevalence of ever having AD was 24% (95% CI, 21-28) ranging from 15% among those under the age of 1 to 38% among those aged 4 to 5 years. The prevalence of comorbid asthma was higher among AD participants compared to those with no AD, namely, 12% and 4%, respectively (P < .001). Moisturizers with high water:oil ratios were most commonly used (ie, lotions) in the non-AD population, whereas moisturizers with low water:oil content (ie, ointments) were most common when AD was present. CONCLUSIONS Our study found a large burden of AD in the primary care practice setting in the US. The majority of households reported skin care practices that may be detrimental to the skin barrier, such as frequent bathing and the routine use of moisturizers with high water: oil ratios. Clinical trials are needed to identify which skin care practices are optimal for reducing the significant burden of AD in the community.
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Affiliation(s)
- Jinan Al-Naqeeb
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Sankirtana Danner
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Lyle J Fagnan
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Katrina Ramsey
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - LeAnn Michaels
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Julie Mitchell
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Kelsey Branca
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Cynthia Morris
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Donald E Nease
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Linda Zittleman
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Barcey Levy
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Jeanette Daly
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - David Hahn
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Rowena J Dolor
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Hywel C Williams
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Joanne R Chalmers
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Jon Hanifin
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Susan Tofte
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Katharine E Zuckerman
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Karen Hansis
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Mollie Gundersen
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Julie Block
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Francie Karr
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Sandra Dunbrasky
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Kathy Siebe
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Kristen Dillon
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Ricardo Cibotti
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Jodi Lapidus
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC)
| | - Eric L Simpson
- From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC).
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Thompson J, Davis M, Michaels L, Rivelli J, Castro M, Escaron A, Younger B, Castillo M, Reich S, Coronado G. Abstract A13: Using boot camp translation to design a system-based intervention to improve rates of colon cancer screening using fecal immunochemical testing among Latino patients in community health centers. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-a13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: Colon cancer is the second-leading cause of cancer death in the United States, and screening rates are disproportionately low among Latinos. In 2015, only 63% of eligible adults, and 50% of Latinos, were up to date with colon cancer screening recommendations. One factor thought to contribute to the low screening rate is that patient-facing health information for Latinos is difficult to understand and patients face challenges in taking appropriate health action. As part of the Participatory Research to Advance Colon Cancer Prevention (PROMPT) study that seeks to raise rates of colon cancer screening in a Latino-serving community health center in California, we used boot camp translation (BCT), a validated community-based participatory strategy, to elicit input from diverse stakeholders and refine the messages and format of colon cancer screening reminders for a clinic-based direct mail fecal immunochemical test (FIT) program.
Methods: We adapted BCT to engage Latino patients and clinic staff in this research. Eligible patient participants were Latino, aged 50 to 75 years, able to speak English or Spanish, and willing to participate in a 6-hour in-person meeting and three 30-minute follow-up phone calls. Materials were developed in English and Spanish, and separate sessions were held for English- and Spanish-speaking participants. As part of the in-person sessions, a national bilingual colon cancer expert delivered a presentation on colon health, cancer screening, and messages to improve screening participation, specific to Latino populations. Following the presentation, BCT experts facilitated brainstorming sessions to obtain feedback on the presented information, followed by an interactive small-group session where participants reviewed sample written materials and reminder messages using various modalities (e.g., text, letter, automated and live calls). We asked participants to consider what information about colon cancer screening is important to share with other patients, what the best methods are to share these messages, and the frequency with which these messages should be delivered to patients to encourage FIT completion. Participants then engaged in a hands-on exercise to share input about the timing and frequency of reminder delivery. Results from the exercise were used to define the intervention for the PROMPT pilot.
Results: A total of 25 adults participated in an in-person session (12 in the English-language session; 13 in the Spanish-language session). Participants were mostly clinic patients (84%) and the majority were female (80%). Among the patient participants, 57% were enrolled in Medicaid, and 67% reported an annual household income of less than $20,000. Key themes from the sessions included increasing awareness about colon cancer and screening options, stressing the urgency of screening, and using personalized messages such as “I” statements in letters or human voices on automated phone call reminders. Both sessions noted the importance of receiving an alert (automated or live) before the FIT kit is mailed, and of receiving a reminder within 2 weeks of FIT kit mailing.
Conclusions: Our BCT process allowed English- and Spanish-speaking Latino patients to directly inform which approaches get tested in the pilot study by refining message content and selecting their modality and timing to encourage patients who are mailed a FIT to complete it and mail it back. Using BCT, we successfully incorporated participant feedback to design culturally relevant health messages to promote FIT testing among patients served by community clinics.
Citation Format: Jamie Thompson, Melinda Davis, LeAnn Michaels, Jennifer Rivelli, Marta Castro, Anne Escaron, Brittany Younger, Melissa Castillo, Sacha Reich, Gloria Coronado. Using boot camp translation to design a system-based intervention to improve rates of colon cancer screening using fecal immunochemical testing among Latino patients in community health centers [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A13.
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Affiliation(s)
- Jamie Thompson
- 1Kaiser Permanente Center for Health Research, Portland, OR,
| | | | | | | | - Marta Castro
- 3AltaMed Health Services Corporation, Los Angeles, CA
| | - Anne Escaron
- 3AltaMed Health Services Corporation, Los Angeles, CA
| | | | | | - Sacha Reich
- 1Kaiser Permanente Center for Health Research, Portland, OR,
| | - Gloria Coronado
- 1Kaiser Permanente Center for Health Research, Portland, OR,
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Al-naqeeb J, Danner S, Fagnan L, Ramsey K, Michaels L, Mitchell J, Branca K, Morris C, Nease D, Zittleman L, Levy B, Daly J, Hahn D, Dolor R, Hanifin J, Tofte S, Zuckerman K, Hansis K, Gundersen M, Dillon K, Block J, Karr F, Dunbrasky S, Lapidus J, Siebe K, Simpson E. 195 The burden of childhood atopic dermatitis in U.S. primary care settings. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.210] [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: 11/28/2022]
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Deyo RA, Buckley DI, Michaels L, Kobus A, Eckstrom E, Forro V, Morris C. Performance of a Patient Reported Outcomes Measurement Information System (PROMIS) Short Form in Older Adults with Chronic Musculoskeletal Pain. Pain Med 2017; 17:314-24. [PMID: 26814279 DOI: 10.1093/pm/pnv046] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess reliability, validity, and responsiveness of a 29-item short-form version of the Patient Reported Outcomes Measurement Information System (PROMIS) and a novel “impact score” calculated from those measures. DESIGN Prospective cohort study. SETTING Rural primary care practices. SUBJECTS Adults aged ≥ 55 years with chronic musculoskeletal pain, not currently receiving prescription opioids. METHODS Subjects completed the PROMIS short form at baseline and after 3 months. Patient subsets were compared to assess reliability and responsiveness. Construct validity was tested by comparing baseline scores among patients who were or were not applying for Worker's Compensation; those with higher or lower catastrophizing scores; and those with or without recent falls. Responsiveness was assessed with mean score changes, effect sizes, and standardized response means. RESULTS Internal consistency was good to excellent, with Cronbach's alpha between 0.81 and 0.95 for all scales. Among patients who rated their pain as stable, test-retest scores at 3 months were around 0.70 for most scales. PROMIS scores were worse among patients seeking or receiving worker's compensation, those with high catastrophizing scores, and those with recent falls. Among patients rating pain as “much less” at 3 months, absolute effect sizes for the various scales ranged from 0.24 (Depression) to 1.93 (Pain Intensity). CONCLUSIONS Results indicate that the PROMIS short 29-item form may be useful for the study of patients with chronic musculoskeletal pain. Our findings also support use of the novel “impact score” recommended by the National Institutes of Health (NIH) Task Force on Research Standards for Chronic Low Back Pain.
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Dorr DA, Anastas T, Ramsey K, Wagner J, Sachdeva B, Michaels L, Fagnan LJ. Effect of a Pragmatic, Cluster-randomized Controlled Trial on Patient Experience With Care: The Transforming Outcomes for Patients Through Medical Home Evaluation and reDesign (TOPMED) Study. Med Care 2016; 54:745-51. [PMID: 27116107 PMCID: PMC4945405 DOI: 10.1097/mlr.0000000000000552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/27/2022]
Abstract
BACKGROUND Health reform programs like the patient-centered medical home are intended to improve the triple aim. Previous studies on patient-centered medical homes have shown mixed effects, but high value elements (HVEs) are expected to improve the triple aim. OBJECTIVE The aim of this study is to understand whether focusing on HVEs would improve patient experience with care. METHODS Eight clinics were cluster-randomized in a year-long trial. Both arms received practice facilitation, IT-based reporting, and financial incentives. Intervention practices were encouraged to choose HVEs for quality improvement goals. To assess patient experience, 1597 Consumer Assessment of Healthcare Providers and Systems surveys were sent pretrial and posttrial to a stratified random sample of patients. Difference-in-difference multivariate analysis was used to compare patient responses from intervention and control practices, adjusting for confounders. RESULTS The response rate was 43% (n=686). Nonrespondent analysis showed no difference between arms, although differences were seen by risk status and age. The overall difference in difference was 2.8%, favoring the intervention. The intervention performed better in 9 of 11 composites. The intervention performed significantly better in follow-up on test results (P=0.091) and patients' rating of the provider (P=0.091), whereas the control performed better in access to care (P=0.093). Both arms also had decreases, including 4 of 11 composites for the intervention, and 8 of 11 for the control. DISCUSSION Practices that targeted HVEs showed significantly more improvement in patient experience of care. However, contemporaneous trends may have affected results, leading to declines in patient experience in both arms.
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Affiliation(s)
- David A Dorr
- Oregon Health and Science University, Portland, OR
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Alexander P, Michaels L, Newsom RS. Intraocular pressure is not the only important postoperative variable following vitrectomy. Eye (Lond) 2016; 30:768. [PMID: 26846594 DOI: 10.1038/eye.2016.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- P Alexander
- Department of Ophthalmology, University Hospital Southampton, Southampton, UK
| | - L Michaels
- Department of Ophthalmology, University Hospital Southampton, Southampton, UK
| | - R S Newsom
- Department of Ophthalmology, University Hospital Southampton, Southampton, UK
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Campbell-Voytal K, Daly JM, Nagykaldi ZJ, Aspy CB, Dolor RJ, Fagnan LJ, Levy BT, Palac HL, Michaels L, Patterson VB, Kano M, Smith PD, Sussman AL, Williams R, Sterling P, O'Beirne M, Neale AV. Team Science Approach to Developing Consensus on Research Good Practices for Practice-Based Research Networks: A Case Study. Clin Transl Sci 2015; 8:632-7. [PMID: 26602516 DOI: 10.1111/cts.12363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Using peer learning strategies, seven experienced PBRNs working in collaborative teams articulated procedures for PBRN Research Good Practices (PRGPs). The PRGPs is a PBRN-specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings. This paper describes the team science processes which culminated in the PRGPs. Skilled facilitators used team science strategies and methods from the Technology of Participation (ToP®), and the Consensus Workshop Method to support teams to codify diverse research expertise in practice-based research. The participatory nature of "sense-making" moved through identifiable stages. Lessons learned include (1) team input into the scope of the final outcome proved vital to project relevance; (2) PBRNs with diverse domains of research expertise contributed broad knowledge on each topic; and (3) ToP® structured facilitation techniques were critical for establishing trust and clarifying the "sense-making" process.
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Affiliation(s)
- Kimberly Campbell-Voytal
- Department of Family Medicine and Public Health Sciences, Wayne State University (MetroNet Detroit Practice-based Research Network), Detroit, Michigan, USA
| | - Jeanette M Daly
- Department of Family Medicine, University of Iowa (Iowa Research Network [IRENE]), Iowa City, Iowa, USA
| | - Zsolt J Nagykaldi
- University of Oklahoma Health Sciences Center, Department of Family & Preventive Medicine (Oklahoma Physicians Resource/Research Network [OKPRN]), Oklahoma City, Oklahoma, USA
| | - Cheryl B Aspy
- University of Oklahoma Health Sciences Center, Department of Family & Preventive Medicine (Oklahoma Physicians Resource/Research Network [OKPRN]), Oklahoma City, Oklahoma, USA
| | - Rowena J Dolor
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center (Primary Care Research Consortium [PCRC]), Durham, North Carolina, USA
| | - Lyle J Fagnan
- Oregon Health & Science University (Oregon Rural Practice-based Research Network [ORPRN]), Portland, Oregon, USA
| | - Barcey T Levy
- Department of Family Medicine, Carver College of Medicine, and Department of Epidemiology, College of Public Health, University of Iowa, (Iowa Research Network [IRENE]), Iowa City, Iowa, USA
| | - Hannah L Palac
- Department of Family Medicine, University of Wisconsin-Madison (Wisconsin Research and Education Network [WREN]), Madison, Wisconsin, USA
| | - LeAnn Michaels
- Oregon Health & Science University (Oregon Rural Practice-based Research Network [ORPRN]), Portland, Oregon, USA
| | - V Beth Patterson
- Duke Clinical Research Institute (Primary Care Research Consortium [PCRC]), Durham, North Carolina, USA
| | - Miria Kano
- Department of Family and Community Medicine, University of New Mexico (Research Involving Outpatient Settings Network [RIOS Net]), Albuquerque, New Mexico, USA
| | - Paul D Smith
- Department of Family Medicine, University of Wisconsin-Madison (Wisconsin Research and Education Network [WREN]), Madison, Wisconsin, USA
| | - Andrew L Sussman
- Department of Family and Community Medicine, University of New Mexico (Research Involving Outpatient Settings Network [RIOS Net]), Albuquerque, New Mexico, USA
| | - Robert Williams
- Department of Family and Community Medicine, University of New Mexico (Research Involving Outpatient Settings Network [RIOS Net]), Albuquerque, New Mexico, USA
| | - Pamela Sterling
- Department of Family Medicine, University of Calgary, Alberta, Canada
| | - Maeve O'Beirne
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Alberta, Canada
| | - Anne Victoria Neale
- Department of Family Medicine and Public Health Sciences, Wayne State University (MetroNet Detroit Practice-based Research Network), Detroit, Michigan, USA
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Eden KB, Scariati P, Klein K, Watson L, Remiker M, Hribar M, Forro V, Michaels L, Nelson HD. Mammography Decision Aid Reduces Decisional Conflict for Women in Their Forties Considering Screening. J Womens Health (Larchmt) 2015; 24:1013-20. [PMID: 26360918 DOI: 10.1089/jwh.2015.5256] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical guidelines recommend a personalized approach to mammography screening for women in their forties; however, methods to do so are lacking. An evidence-based mammography screening decision aid was developed as an electronic mobile application and evaluated in a before-after study. METHODS The decision aid (Mammopad) included modules on breast cancer, mammography, risk assessment, and priority setting about screening. Women aged 40-49 years who were patients of rural primary care clinics, had no major risk factors for breast cancer, and no mammography during the previous year were invited to use the decision aid. Twenty women participated in pretesting of the decision aid and 75 additional women completed the before-after study. The primary outcome was decisional conflict measured before and after using Mammopad. Secondary outcomes included decision self-efficacy and intention to begin or continue mammography screening. Differences comparing measures before versus after use were determined using Wilcoxon signed rank tests. RESULTS After using Mammopad, women reported reduced decisional conflict based on mean Decisional Conflict Scale scores overall (46.33 versus 8.33; Z = -7.225; p < 0.001) and on all subscales (p < 0.001). Women also reported increased mean Decision Self-Efficacy Scale scores (79.67 versus 95.73; Z = 6.816, p < 0.001). Although 19% of women changed their screening intentions, this was not statistically significant. CONCLUSIONS Women reported less conflict about their decisions for mammography screening, and felt more confident to make decisions after using Mammopad. This approach may help guide women through the decision making process to determine personalized screening choices that are appropriate for them.
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Affiliation(s)
- Karen B Eden
- 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon
| | | | - Krystal Klein
- 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon
| | - Lindsey Watson
- 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon
| | - Mark Remiker
- 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon
| | - Michelle Hribar
- 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon
| | - Vanessa Forro
- 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon
| | - LeAnn Michaels
- 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon
| | - Heidi D Nelson
- 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon.,4 Providence Cancer Center , Providence Health and Services, Portland, Oregon
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Dolor RJ, Campbell-Voytal K, Daly J, Nagykaldi ZJ, O'Beirne M, Sterling P, Fagnan LJ, Levy B, Michaels L, Louks HA, Smith P, Aspy CB, Patterson VB, Kano M, Sussman AL, Williams R, Neale AV. Practice-based Research Network Research Good Practices (PRGPs): Summary of Recommendations. Clin Transl Sci 2015; 8:638-46. [PMID: 26296309 DOI: 10.1111/cts.12317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Practice-based research networks (PBRNs) conduct research in community settings, which poses quality control challenges to the integrity of research, such as study implementation and data collection. A foundation for improving research processes within PBRNs is needed to ensure research integrity. METHODS Network directors and coordinators from seven U.S.-based PBRNs worked with a professional team facilitator during semiannual in-person meetings and monthly conference calls to produce content for a compendium of recommended research practices specific to the context of PBRNs. Participants were assigned to contribute content congruent with their expertise. Feedback on the draft document was obtained from attendees at the preconference workshop at the annual PBRN meeting in 2013. A revised document was circulated to additional PBRN peers prior to finalization. RESULTS The PBRN Research Good Practices (PRGPs) document is organized into four chapters: (1) Building PBRN Infrastructure; (2) Study Development and Implementation; (3) Data Management, and (4) Dissemination Policies. Each chapter contains an introduction, detailed procedures for each section, and example resources with information links. CONCLUSION The PRGPs is a PBRN-specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings.
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Affiliation(s)
- Rowena J Dolor
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Kimberly Campbell-Voytal
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jeanette Daly
- Department of Family Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Zsolt J Nagykaldi
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Maeve O'Beirne
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Pamela Sterling
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lyle J Fagnan
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Barcey Levy
- Department of Family Medicine, University of Iowa, Iowa City, Iowa, USA
| | - LeAnn Michaels
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Hannah A Louks
- Department of Family Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paul Smith
- Department of Family Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Cheryl B Aspy
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - V Beth Patterson
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Miria Kano
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Andrew L Sussman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Robert Williams
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Anne Victoria Neale
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
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Michaels L, Alexander P, Newsom R. Macular pseudohaemorrhage secondary to Allen Dot artefact. Case Reports 2015; 2015:bcr-2014-207980. [DOI: 10.1136/bcr-2014-207980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Zia ZU, Sadaqat HA, Tahir MHN, Sadia B, Bushman BS, Hole D, Michaels L, Malik W. Estimation of genetic diversity using SSR markers in sunflower. RUSS J GENET+ 2014. [DOI: 10.1134/s1022795414050147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zia ZU, Sadaqat HA, Tahir MHN, Sadia B, Bushman BS, Hole D, Michaels L, Malik W. Estimation of genetic diversity using SSR markers in sunflower. Genetika 2014; 50:570-580. [PMID: 25715473 DOI: 10.7868/s0016675814050142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Microsatellites or simple sequence repeats (SSRs) were used for the estimation of genetic diversity among a group of 40 sunflower lines developed at the research area of Department of Plant Breeding and Genetics, University of Agriculture, Faisalabad. Total numbers of alleles amplified by 22 polymorphic primers were 135 with an average of 6.13 alleles per locus, suggesting that SSR is a powerful technique for assessment of genetic diversity at molecular level. The expected heterozygosity (PIC) ranged from 0.17 to 0.89. The highest PIC value was observed at the locus C1779. The genetic distances ranged from 9 to 37%. The highest genetic distance was observed between the lines L50 and V3. Genetic distances were low showing lesser amount of genetic diversity among the sunflower lines.
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Ko CW, Riffle S, Michaels L, Morris C, Holub J, Shapiro JA, Ciol MA, Kimmey MB, Seeff LC, Lieberman D. Serious complications within 30 days of screening and surveillance colonoscopy are uncommon. Clin Gastroenterol Hepatol 2010; 8:166-73. [PMID: 19850154 PMCID: PMC2821994 DOI: 10.1016/j.cgh.2009.10.007] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 10/06/2009] [Accepted: 10/10/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The risk of serious complications after colonoscopy has important implications for the overall benefits of colorectal cancer screening programs. We evaluated the incidence of serious complications within 30 days after screening or surveillance colonoscopies in diverse clinical settings and sought to identify potential risk factors for complications. METHODS Patients age 40 and over undergoing colonoscopy for screening, surveillance, or evaluation based an abnormal result from another screening test were enrolled through the National Endoscopic Database (CORI). Patients completed a standardized telephone interview approximately 7 and 30 days after their colonoscopy. We estimated the incidence of serious complications within 30 days of colonoscopy and identified risk factors associated with complications using logistic regression analyses. RESULTS We enrolled 21,375 patients. Gastrointestinal bleeding requiring hospitalization occurred in 34 patients (incidence 1.59/1000 exams; 95% confidence interval [CI], 1.10-2.22). Perforations occurred in 4 patients (0.19/1000 exams; 95% CI, 0.05-0.48), diverticulitis requiring hospitalization in 5 patients (0.23/1000 exams; 95% CI, 0.08-0.54), and postpolypectomy syndrome in 2 patients (0.09/1000 exams; 95% CI, 0.02-0.30). The overall incidence of complications directly related to colonoscopy was 2.01 per 1000 exams (95% CI, 1.46-2.71). Two of the 4 perforations occurred without biopsy or polypectomy. The risk of complications increased with preprocedure warfarin use and performance of polypectomy with cautery. CONCLUSIONS Complications after screening or surveillance colonoscopy are uncommon. Risk factors for complications include warfarin use and polypectomy with cautery.
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Affiliation(s)
| | | | | | | | | | - Jean A. Shapiro
- the Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Laura C. Seeff
- the Centers for Disease Control and Prevention, Atlanta, Georgia
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Michaels L, Soucek S, Linthicum F. The intravestibular source of the vestibular aqueduct: Its structure and pathology in Ménière's disease. Acta Otolaryngol 2009; 129:592-601. [PMID: 18720071 DOI: 10.1080/00016480802342416] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION We describe a thin, highly vascular layer of mineralized cartilage, which surrounds most of the endolymphatic duct. In the normal ear this may act in helping to control the chemical composition of endolymph. In Ménière's disease (MD) there is a marked apoptotic change among the mineralized cartilage cells of this layer, which seems to be associated also with the deposition of a pathological substance in the walls of many blood vessels. This may lead to serious chemical change in the nearby endolymph and so provoke the symptoms of MD. OBJECTIVES Endolymphatic hydrops is found in all cases of MD, but is not specific for that condition. We sought a cellular change in the vicinity of the saccule that might be more specific than the lesion of endolymphatic hydrops and thus lead to a more successful management of the disease. MATERIALS AND METHODS We examined stained step sections of 33 autopsy temporal bones from 20 cases of MD, particularly in the region of the vestibule, and compared the changes with those found in a similar region of 65 temporal bones taken from randomly selected cases of non-Ménière conditions. RESULTS In all temporal bones there was a well-demarcated region of the posterior vestibule, which formed a skeletal arch around the opening of the tunnel of the vestibular aqueduct into which the endolymphatic duct entered from the vestibule. This 'vestibular arch' was composed mainly of blood vessels and mineralized chondrocytes. The inner skeletal layer surrounding the course of most of the endolymphatic duct in the tunnel of the vestibular aqueduct was composed of the same tissue and was in fact continuous with the vestibular arch. In the non-Ménière temporal bones the mineralized chondrocytes were congregated around normal thin-walled blood vessels and small numbers of them seemed to be undergoing apoptosis in this vicinity. In all of the MD temporal bones, except five in which the vestibular arch was either absent or atrophic, we found pronounced changes of apoptosis among the mineralized cartilage cells and these were associated with proliferative changes in blood vessels in which a bluish-staining translucent deposit, possibly mineralization of the vascular wall, was prominent.
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Upile T, Patel N, Jerjes W, Singh N, Sandison A, Michaels L. Advances in the understanding of chondrodermatitis nodularis chronica helices: the perichondrial vasculitis theory. Clin Otolaryngol 2009; 34:147-50. [DOI: 10.1111/j.1749-4486.2008.01851.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lieberman D, Moravec M, Holub J, Michaels L, Eisen G. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology 2008; 135:1100-5. [PMID: 18691580 PMCID: PMC2581902 DOI: 10.1053/j.gastro.2008.06.083] [Citation(s) in RCA: 310] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 06/17/2008] [Accepted: 06/26/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Colorectal cancer screening with diagnostic imaging can detect polyps. The management of patients whose largest polyp is less than 10 mm is uncertain. The primary aim of this study was to determine rates of advanced histology in patients undergoing colorectal cancer screening whose largest polyp is 9 mm or less. METHODS Subjects include all asymptomatic adults receiving colonoscopy for screening during 2005 from 17 practice sites, which provide both colonoscopy and pathology reports to the Clinical Outcomes Research Initiative repository. Patients were classified by size of largest polyp. Advanced histology was defined as an adenoma with villous or serrated histology, high-grade dysplasia, or an invasive cancer. Risk factors for advanced histology were determined using Pearson chi(2) and Fisher exact tests. RESULTS Among 13,992 asymptomatic patients who had screening colonoscopy, 6360 patients (45%) had polyps, with complete histology available in 5977 (94%) patients. The proportion with advanced histology was 1.7% in the 1- to 5-mm group, 6.6% in the 6- to 9-mm group, 30.6% in the greater than 10-mm group, and 72.1% in the tumor group. Distal location was associated with advanced histology in the 6- to 9-mm group (P = .04) and in the greater than 10-mm group (P = .002). CONCLUSIONS One in 15 asymptomatic patients whose largest polyp is 6 to 9 mm will have advanced histology and would undergo surveillance at 3 years based on current guidelines. Because histology is necessary for this decision, most of these patients should be offered colonoscopy. Further study should determine whether patients whose largest polyp is 1-5 mm can be safely followed without polypectomy.
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Affiliation(s)
- David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon 97239, USA.
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Bibas AG, Xenellis J, Michaels L, Anagnostopoulou S, Ferekidis E, Wright A. Temporal bone study of development of the organ of Corti: correlation between auditory function and anatomical structure. J Laryngol Otol 2007; 122:336-42. [PMID: 17367561 DOI: 10.1017/s0022215107006548] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To study the development of the organ of Corti in the human cochlea, and to correlate our findings with the onset of auditory function. MATERIAL AND METHODS Step sections of 81 human fetal temporal bones were studied, from eight weeks of gestation to full term. RESULTS By the end of the 10th week, the tectorial membrane primordium could be traced even in the most apical turns. Individual hair cells became identifiable at the basal turn at 14 weeks. At the same time, a small but well formed oval space was observed between the inner and outer hair cells in the basal turn. This does not correspond to the tunnel of Corti, as is erroneously quoted in the literature, as the individual pillar cells develop at later stages. Between 14 and 15 weeks, Hensen's cells were recognised for the first time. Individual pillar cells were identifiable at 17 weeks and the tunnel of Corti opened at 20 weeks. By 25 weeks, the cochlea had reached its adult size, but continued to develop until full term. DISCUSSION AND CONCLUSIONS A temporal coincidence of different developmental events is responsible for early fetal audition at 20 weeks, including growth of pillar cells, opening of the tunnel of Corti and regression of Kollicker's organ, with the subsequent formation of the inner spiral sulcus and then separation of the tectorial membrane. The fine structures of the organ of Corti continue to develop well after the 25th week, and this may well alter the mechanical properties of the vibrating parts of the cochlea, which may in turn account for the frequency shift observed in preterm infants. These changes will have to be taken into account in the development of prenatal hearing screening tests.
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Affiliation(s)
- A G Bibas
- UCL Ear Institute, Royal Free & University College London Medical School, London, UK.
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Declau F, Spaendonck MV, Timmermans JP, Michaels L, Liang J, Qiu JP, Van de Heyning P. Prevalence of histologic otosclerosis: an unbiased temporal bone study in Caucasians. Adv Otorhinolaryngol 2007; 65:6-16. [PMID: 17245017 DOI: 10.1159/000098663] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND 'Histologic otosclerosis' refers to a disease process without clinical symptoms or manifestations that can only be discovered by sectioning of the temporal bone at autopsy. 'Clinical otosclerosis' concerns the presence of otosclerosis at a site where it causes conductive hearing loss by interfering with the motion of the stapes or of the round window membrane. Various authors have studied the prevalence of histologic otosclerosis on laboratory collections of temporal bones. Some 12-15% of the temporal bones with histologic otosclerosis have demonstrated stapedial fixation. Using these figures for calculating the prevalence of clinical otosclerosis gives an extrapolated clinical prevalence of 0.99-1.2%. This does not correlate well with the clinical data on otosclerotic families from which a clinical prevalence of 0.3% has been estimated. OBJECTIVE To study the prevalence of histologic otosclerosis in an unselected series of temporal bones. STUDY DESIGN During a 1-year period, 118 consecutive pairs of temporal bones of deceased patients at a tertiary center were collected to determine the prevalence of otosclerosis. Although histology remains the gold standard for evaluation of otosclerosis, the gross observation of temporal bone slices combined with microradiography was used to screen for otosclerotic lesions more rapidly and with a lower cost-benefit ratio. The temporal bones with suspected otosclerosis shown with these techniques were further analyzed by conventional histology. RESULTS 2.5% of the 236 temporal bones (or 3.4% of patients) studied demonstrated histologic otosclerosis. CONCLUSIONS Although the prevalence of 2.5% is much lower than previously published figures on histologic otosclerosis, the extrapolated data (extrapolated clinical prevalence = 0.30-0.38%) correlate well with clinical studies of otosclerotic families. The previous studies based on laboratory collections were likely biased by the presence of hearing loss or other otological diseases.
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Affiliation(s)
- F Declau
- Department of Otorhinolaryngology, Head and Neck Surgery and Communication Disorders, University of Antwerp, Antwerp, Belgium
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Upile T, Jerjes W, Howard D, Michaels L, Hopper C, Wright A. Elastic scattering spectroscopy in the head & neck. Clin Otolaryngol 2006. [DOI: 10.1111/j.1365-2273.2006.01341_14.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Upile T, Michaels L, Jerjes W, Howard D, Hopper C, Wright A. Epidermal hyperplasia of the tympanic membrane and deep external ear canal: novel histo-pathological features, embryological and clinical correlates. Clin Otolaryngol 2006. [DOI: 10.1111/j.1365-2273.2006.01341_10.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chik Z, Johnston A, Tucker AT, Chew SL, Michaels L, Alam CAS. Pharmacokinetics of a new testosterone transdermal delivery system, TDS-testosterone in healthy males. Br J Clin Pharmacol 2006; 61:275-9. [PMID: 16487220 PMCID: PMC1885014 DOI: 10.1111/j.1365-2125.2005.02542.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS The Transdermal Delivery System (TDS) is a liquid formulation that can be applied to the skin via a metered pump spray to deliver drug to the systemic circulation. The aims of this study were to assess the ability of the TDS preparation to deliver testosterone systemically, and to characterize the pharmacokinetic profiles of the hormone in healthy males. METHODS An open label, comparative, randomized placebo controlled study involving three treatments and three periods with a minimum of a 1 week washout period was conducted. Twelve healthy males received 50 mg TDS-testosterone, TDS-placebo, and 50 mg of a commercially available topical testosterone preparation (Androgel, 1% topical testosterone gel). RESULTS The mean AUC(0,12 h) was higher following application of TDS-testosterone (61.8 ng ml-1 h), compared with Androgel (57.7 ng ml-1 h) and TDS-placebo (50.7 ng ml-1 h. The mean Cmax (0,12 h) was similar for TDS-testosterone (6.6 ng ml-1) and Androgel (6.5 ng ml-1) and these values were higher than those for TDS-placebo (5.7 ng ml-1). Analysis of variance showed that the 90% confidence intervals on the relative difference of the ratio for the AUC(0,12 h) and the Cmax (0,12 h) between TDS-testosterone and Androgel, were contained within the bioequivalence limit (80, 125%) (Cmax 89.2, 112.3% and AUC 93.5, 120.5%). Serum testosterone concentrations were lower following TDS-Placebo and were not bioequivalent either to the gel or spray. CONCLUSIONS The TDS preparation was shown to deliver testosterone systemically to humans and the concentrations of the hormone in the 12 h following TDS administration were bioequivalent to an existing topical delivery gel.
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Affiliation(s)
- Z Chik
- Clinical Pharmacology, William Harvey Research Institute, Barts, and the Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK
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Abstract
OBJECTIVE To address questions about the etiology, behavior, optimal treatment, and prognosis of metastasizing pleomorphic adenoma (MPA), we undertook a review of the literature (1953-2005) and constructed a virtual series of all identified cases of MPA, metastatic lesions that are very occasionally identified in patients with a history of pleomorphic salivary adenoma and, on detailed pathological evaluation, found to exhibit all the histological hallmarks of the preceding benign lesions. DATA SOURCES A review of the English-language literature between 1953 and 2005 using MEDLINE, secondary references identified from bibliographies of pertinent articles, and a further case from one of our institutions. DATA SYNTHESIS A virtual case series was constructed and quantitatively analyzed. Forty-two patients with an average age of 33 years were identified. There were 20 male and 22 female patients. There was an overwhelming history of incomplete surgery for pleomorphic salivary adenoma. Most patients had locoregional recurrences before metastasis, and the mean presentation-to-metastasis latency was 16 years. Bone was the most common site for metastases (45%), followed by the head and neck (43%) and lung (36%). There was significant morbidity and mortality from distant disease, with 5-year disease-specific and disease-free survival of 58% and 50%, respectively. Developing distant lesions within 10 years of the primary tumor and presence of metastases in multiple sites were independent predictors of survival on Cox regression analysis. Metastasectomy conferred significant survival advantage over nonoperative treatment (log-rank analysis, P<.02). Chemotherapy and radiotherapy were of limited value. CONCLUSIONS Meticulous surgery is crucial in preventing MPA. Metastatic disease carries significant morbidity and mortality and should be treated surgically when feasible.
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Affiliation(s)
- S A R Nouraei
- Department of Otolaryngology-Head and Neck Surgery, Charing Cross Hospital, London, England.
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Bibas A, Hornigold R, Liang J, Michaels L, Anagnostopoulou S, Wright A. The development of the spiral ganglion in the human foetus. Folia Morphol (Warsz) 2006; 65:140-4. [PMID: 16773603] [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: 05/10/2023]
Abstract
The development of the spiral ganglion was studied in steps sections of 81 human temporal bones. By the 8th week, the spiral ganglion has already separated from the vestibular ganglion. At 13 weeks two distinct populations are observed that correspond to neuron and Schwann cells. At 15 weeks the spiral ganglion has increased its distance from the cochlear duct and is surrounded by mesenchyme near the scala tympani. At 14 weeks a gradual decrease in the nucleus-to-cell area ratio was observed in spiral ganglion neurons that may reflect a morphological adaptation to function. By the 23rd week the modiolus begins to ossify and the spiral ganglion is surrounded by bony trabeculae. The time course of spiral ganglion development follows that of the stria vascularis and organ of Corti, although maturation changes are still observed in the neuronal population even beyond 20 weeks.
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Affiliation(s)
- A Bibas
- Institute of Laryngology and Otology, Royal Free and University College London Medical School, England.
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Tucker AT, Chik Z, Michaels L, Kirby K, Seed MP, Johnston A, Alam CAS. Study of a combined percutaneous local anaesthetic and the TDS system for venepuncture. Anaesthesia 2006; 61:123-6. [PMID: 16430563 DOI: 10.1111/j.1365-2044.2005.04432.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transdermal Delivery System (TDS) is a liquid formulation which can be applied to the skin via a metered pump spray to deliver drug across skin. This placebo controlled, double blind trial compared anaesthetic properties of two TDS systems (TDS alpha and TDS beta) with placebo. The active and placebo treatments were applied to the dorsum of the hands, bilaterally and simultaneously for 5 min on 100 healthy volunteers. Following cannulation, pain perception was measured using the verbal rating score (VRS) and visual analogue score (VAS). Lidocaine plasma levels were assessed at 0 and 2 h. The VRS and VAS results show that TDS beta significantly decreased pain score compared to placebo (p < 0.02). Blood lidocaine at 2 h post application was also higher for TDS beta than for TDS alpha, suggesting that a 5 min application of TDS beta was effective in delivering local anaesthetic and accelerating the onset of skin anaesthesia prior to venous cannulation in adults.
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Affiliation(s)
- A T Tucker
- The Ernest Cooke Clinical Microvascular Unit 3-Anaesthetics, St. Bartholomew's Hospital, London EC1A 7BE, UK.
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Abstract
HYPOTHESIS To highlight the clinical and histologic features of ossicular fixation produced by bone dust during mastoid surgery. BACKGROUND Bone dust deposition in the middle ear may occur during temporal bone surgery, but the ossicular fixation that may result from it remains underreported. METHODS A case is reported of delayed conductive hearing loss after saccus decompression surgery resulting from ossicular fixation by bone dust deposition. RESULTS Six months after the initial surgery, the patient experienced a 45 dB conductive hearing loss. The findings on second-look tympanotomy were stapes fixation and round window niche occlusion by newly formed tissue. Histologic examination of the latter showed fibrosis and new bone formation in reaction to particles of bone dust. New bone formation is a frequent concomitant of fibrosis in the middle ear and is probably not a growth from the bone dust. CONCLUSION The use of high-speed drilling of bone in temporal bone surgery carries the risk of bone dust particle deposition in the middle ear. Measures are discussed that can be used to prevent this complication.
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Crawford FC, Vanderploeg RD, Freeman MJ, Singh S, Waisman M, Michaels L, Abdullah L, Warden D, Lipsky R, Salazar A, Mullan MJ. APOE genotype influences acquisition and recall following traumatic brain injury. Neurology 2002; 58:1115-8. [PMID: 11940706 DOI: 10.1212/wnl.58.7.1115] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
APOE has been demonstrated to influence traumatic brain injury (TBI) outcome. The relationship between APOE genotype and memory following TBI was examined in 110 participants in the Defense and Veterans' Head Injury Program. Memory performance was worse in those who had an APOE epsilon 4 allele (n = 30) than those who did not (n = 80), whereas genotype groups did not differ on demographic or injury variables or on measures of executive functioning. These data support a specific role for the APOE protein in memory outcome following TBI, and suggest an APOE isoform-specific effect on neuronal repair processes.
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Affiliation(s)
- F C Crawford
- Roskamp Institute, University of South Florida, Tampa 33613, USA.
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Abstract
AIMS This study investigated the development of the fallopian canal with particular reference to the mode of ossification and dehiscences, sites of incomplete closure around the facial nerve. BACKGROUND The precise sequence of events surrounding ossification of the tissues around the facial nerve is uncertain. Incomplete ossification results in dehiscence of the adult structure, which places the nerve at increased risk of damage from disease processes in the middle ear and iatrogenic trauma during otologic surgery. METHODS Twenty-four temporal bones from 12-to 36-week human fetuses were resected. Eight temporal bones from 22-to 36-week fetuses were microsliced to produce 1.5-mm horizontal sections and radiographed. Sixteen temporal bones from 12-to 35-week fetuses were serially microtomed to produce 7-microm slices, which were stained with hematoxylin and eosin. Quantitative and qualitative analyses of these sections were performed to document patterns of closure of the primitive canal and dehiscence formation. RESULTS The tympanic part of the primitive fallopian canal, the facial sulcus, developed anteroposteriorly from the geniculate fossa to enclose the facial nerve. The mesenchyme that formed the facial sulcus underwent endochondral ossification, while the bone which capped or closed the sulcus developed in membrane. In the tympanic segment, permanent congenital dehiscences were elliptical and about 1 mm in length. CONCLUSIONS This study clarifies the mode of development of the fallopian canal, with particular reference to dehiscences, and provides a scientific basis for otologic practice.
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Affiliation(s)
- G Barnes
- Division of Anatomy and Center for Neuroscience Research, Guy's, King's and St. Thomas' School of Biomedical Sciences, King's College London, London SE1 9RT, U.K
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Declau F, Van Spaendonck M, Timmermans JP, Michaels L, Liang J, Qiu JP, Van de Heyning P. Prevalence of otosclerosis in an unselected series of temporal bones. Otol Neurotol 2001; 22:596-602. [PMID: 11568664 DOI: 10.1097/00129492-200109000-00006] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Histologic otosclerosis is a disease process without clinical symptoms or manifestations that can be discovered only by sectioning of the temporal bone at autopsy. Clinical otosclerosis is otosclerosis at a site where it causes conductive hearing loss by interfering with the motion of the stapes or of the round window membrane. Various authors have studied the prevalence of histologic otosclerosis on laboratory collections of temporal bones. Some 12% to 15% of temporal bones with histologic otosclerosis have demonstrated stapedial fixation. Using these figures for calculating the prevalence of clinical otosclerosis gives an extrapolated clinical prevalence of 0.99% to 1.2%. This does not correlate well with the clinical data on otosclerotic families, from which a clinical prevalence of 0.3% has been estimated. OBJECTIVE To study the prevalence of histologic otosclerosis in an unselected series of temporal bones. STUDY DESIGN During a 1-year period, 118 consecutive pairs of temporal bones of deceased patients at a tertiary care center were collected to determine the prevalence of otosclerosis. Although histology remains the gold standard for evaluation of otosclerosis, the gross observation of temporal bone slices combined with microradiography was used to screen for otosclerotic lesions more rapidly and with a lower cost/benefit ratio. The temporal bones, which were suspected of having otosclerosis with these techniques, were further analyzed by conventional histology. RESULTS 2.5% of the 236 temporal bones (or 3.4% of patients) studied demonstrated histologic otosclerosis. CONCLUSIONS Although the prevalence of 2.5% is much lower than previously published figures on histologic otosclerosis, the extrapolated data (extrapolated clinical prevalence = 0.30% to 0.38%) correlate well with clinical studies of otosclerotic families. The previous studies based on laboratory collections were likely biased by hearing loss or other otologic diseases.
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Affiliation(s)
- F Declau
- Department of Otorhinolaryngology, Head and Neck Surgery and Communication Disorders, University of Antwerp, Belgium
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Michaels L. The eighteenth-century origins of angina pectoris: predisposing causes, recognition and aftermath. Med Hist Suppl 2001:1-219. [PMID: 12035770 PMCID: PMC2531046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Abstract
Although expansion of bony walls occurs in allergic fungal disease of the nose and paranasal sinuses by increased mucus secretion and fungal growth, the latter is apparently confined to the lumen and does not invade the tissues. Nevertheless, spread of the disease process from paranasal sinuses to orbit, cheek and intracranial cavity is well described. An imaging and histopathological study was carried out in 16 cases to determine how the disease originates and spreads. The infection starts in the nasal cavity, the lumen of a sinus or in a seromucinous gland or duct. A thin vascular zone of intense allergic inflammation surrounds the infected mucin. Erosion of bone takes place focally, probably by substances produced by the inflammatory tissue, allowing intromission by the thin vascular layer together with its underlying fungus-containing mucus and so extension of the disease process through the eroded bone.
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Affiliation(s)
- L Michaels
- The Royal National, Throat, Nose and Ear Hospital, London, UK
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Gale N, Kambic V, Michaels L, Cardesa A, Hellquist H, Zidar N, Poljak M. The Ljubljana classification: a practical strategy for the diagnosis of laryngeal precancerous lesions. Adv Anat Pathol 2000; 7:240-51. [PMID: 10907809 DOI: 10.1097/00125480-200007040-00006] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is no internationally accepted classification of epithelial hyperplastic laryngeal lesions (EHLL). The majority of current classifications follow criteria similar to those commonly used for cervical epithelial lesions. However, the different etiology of laryngeal cancer and its particular clinical and histologic features necessitate a grading system more appropriate to this region. The Ljubljana classification of EHLL was devised in 1971 to cater to this requirement. Detailed criteria for histologic grading in this classification were formulated by a working group on EHLL of the European Society of Pathology in 1999. The system recognizes four grades: simple and abnormal hyperplasia are benign categories; atypical hyperplasia ("risky" epithelium) is potentially malignant, and carcinoma in situ actually malignant. The main features by which the proposed grading system differs from other classifications are: 1. the distinction between benign and potentially malignant lesions; 2. the positive separation of carcinoma in situ from atypical hyperplasia; 3. the lack of prognostic significance for any surface keratin layer. The eventual outcome of EHLL patients so graded justifies the proposal for separating the lesions into a benign group, showing malignant transformation in only 0.9% of cases, from a potentially malignant group showing malignant transformation in 11% of cases. For diagnostically difficult cases, supplementary techniques such as those using morphometry, immunohistochemical and molecular biology are advised to improve the accuracy of diagnosis and predictions of their biological behavior.
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Affiliation(s)
- N Gale
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Slovenia.
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Graham JM, Phelps PD, Michaels L. Congenital malformations of the ear and cochlear implantation in children: review and temporal bone report of common cavity. J Laryngol Otol Suppl 2000; 25:1-14. [PMID: 10824232 DOI: 10.1258/0022215001904842] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this review is to analyze aspects of congenital malformation of the ear in relation to cochlear implantation in children. Having briefly described the in utero development of the ear and the classification of types of external, middle and inner ear malformation, five practical aspects of these malformations are discussed. It seems likely that the combination of bilateral profound sensorineural deafness with bilateral microtia severe enough to make a surgical approach to the cochlea difficult will be extremely uncommon. No such cases have been reported, although Klippel-Feil deformity seems the syndrome most likely to produce this set of circumstances. Abnormalities in the intratympanic course of the facial nerve have been associated with cochlear malformation, emphasizing the benefit of intra-operative facial nerve monitoring, and a technique suggested for safely avoiding an abnormally placed nerve. Fistulae of cerebrospinal fluid (CSF) and perilymph can complicate surgery and are relatively common in common cavity and Mondini malformations. Strategies for facilitating surgery in the presence of 'gushers', for measuring the pressure of a gusher and for placement of the cochlear implant electrode array are reviewed, with reports of fluctuating levels of electric current when implants lie in dysplastic cochleas. The relationship of implant performance to VIIIth nerve tissue in malformed cochleas is discussed, with a description of the histological findings in a common cavity cochlea. Techniques for identifying the absence of the cochlear nerve are reviewed. Stimulation of the facial nerve by cochlear implants has been described in cases of congenital malformation of the labyrinth but is relatively uncommon. Case reports of the benefit received by implanted children with congenital cochlear malformation have appeared since 1988. Most cases reported have not yet been followed for long enough to establish a clear picture of the outcome following cochlear implantation in such children; no centre has yet built up a large series of cases, but there have been two multicentre postal surveys. It seems likely that in cochlear malformation the range of potential outcomes in terms of hearing threshold and the development of speech perception and production will be similar to the range found in implanted children without cochlear dysplasia. However there is, as yet, no clear picture of the mean level of performance within this range.
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Affiliation(s)
- J M Graham
- UCL/Nuffield Cochlear Implant Programme, Royal National Throat, Nose and Ear Hospital, London, UK
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Abstract
The development of the stria vascularis in the human cochlea was studied in step sections of 81 human foetal temporal bones. The stria vascularis primordium can be identified as a ridge of epithelial cells on the lateral wall of the cochlear duct. The first signs of differentiation appear at the 11th week, but it is not until the 17th-18th week that the typical trilaminar structure is observed. The appearance of similar cells with notched nuclei in both marginal and mesenchymal layers at this stage suggests the possibility that some of the intermediate cells may be of epithelial origin. By the 21st week, the overall appearance resembles that of the adult structure. This occurs 1 week after the opening of the tunnel of Corti, and possibly marks the onset of cochlear function.
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Affiliation(s)
- A Bibas
- Institute of Laryngology and Otology, Royal Free and University College London Medical School, London, UK
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Affiliation(s)
- H Hellquist
- Department of Pathology, University Hospital, Linkoping, Sweden
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Gill H, Michaels L, Phelps PD, Reardon W. Histopathological findings suggest the diagnosis in an atypical case of Pendred syndrome. Clin Otolaryngol Allied Sci 1999; 24:523-6. [PMID: 10607000 DOI: 10.1046/j.1365-2273.1999.00308.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Radiological malformation of the labyrinth, specifically dilatation of the vestibular aqueduct, has been clearly established as a feature in the majority of patients with Pendred syndrome. Mutations of the Pendred syndrome (PDN) gene have been identified in this autosomal recessive form of deafness. There is no direct correlation between the nature of the underlying mutation and the clinical features of deafness, thyroid dysfunction and cochlear malformation. We report a family, the proband of which was thought to deafness secondary to congenital hypothyroidism. At autopsy, histopathological examination of this patient revealed a dilated vestibular aqueduct. Subsequent work on the family has confirmed the diagnosis of Pendred syndrome in the proband and her affected sister.
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Affiliation(s)
- H Gill
- Department of Clinical Genetics, Institute, Child Health, London, UK
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Michaels L. Ljubljana classification of epithelial hyperplastic laryngeal lesions. Histopathology 1999; 35:181. [PMID: 10460665 DOI: 10.1046/j.1365-2559.1999.0744a.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Michaels L, Lee K, Manuja SL, Soucek SO. Family with low-grade neuroendocrine carcinoma of salivary glands, severe sensorineural hearing loss, and enamel hypoplasia. Am J Med Genet 1999; 83:183-6. [PMID: 10096593] [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: 02/11/2023]
Abstract
Four sibs in a family on the Isle of Man, two brothers and two sisters ranging in age from 33 to 45 years, presented with low-grade malignant tumors of the submandibular gland in three cases and of the nasal cavities and maxillary sinuses in one. The neoplasms were all of the same histological type, apparently hitherto undescribed, showing well-differentiated neoplastic ducts, surrounded by neoplastic myoepithelial cells, together with sheets of epithelial cells expressing neuroendocrine markers by immunohistochemistry. Cervical neck node metastases have developed in all four cases. In the sib with a primary sinonasal neoplasm, widespread bloodstream metastases also became manifest and a single such metastasis in his brother. All four sibs have severe enamel hypoplasia and the same lesion is present in 5 of their 11 children. In the two male patients, severe sensorineural hearing loss has developed in adult life, unilateral in the left ear in one brother, bilateral in the other. In the brother with bilateral sensorineural hearing loss, magnetic resonance imaging revealed a vestibular schwannoma on the left side, which is currently under treatment. The inherited hearing loss is thought to be unilateral in this case also.
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Affiliation(s)
- L Michaels
- Department of Histopathology, UCL Medical School, and Royal National Throat, Nose and Ear Hospital, Royal Free Hospital Trust, London, United Kingdom.
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Michaels L, Lee K, Manuja S, Soucek S. Family with low-grade neuroendocrine carcinoma of salivary glands, severe sensorineural hearing loss, and enamel hypoplasia. ACTA ACUST UNITED AC 1999. [DOI: 10.1002/(sici)1096-8628(19990319)83:3<183::aid-ajmg7>3.0.co;2-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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