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Doyle R, Craft P, Turner M, Paterson C. Identifying the unmet supportive care needs of individuals affected by testicular cancer: a systematic review. J Cancer Surviv 2024; 18:263-287. [PMID: 35781623 PMCID: PMC10960773 DOI: 10.1007/s11764-022-01219-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/19/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To critically appraise studies to identify experiences of unmet supportive care needs of individuals affected by testicular cancer. METHODS A registered priori systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. CINAHL, PsycINFO, and MEDLINE were searched for quantitative, qualitative, and mixed methods studies using a wide range of search terms. All articles were double screened according to a pre-determined eligibility criterion. Reference lists of the final included studies were checked for further eligible studies. The review process was managed using Covidence systematic review software. Data from the studies were extracted, methodological quality appraisal conducted, and a narrative synthesis conducted. RESULTS Of the 72 papers identified, 36 studies were included. In descending order of frequency of need, psychological needs were identified in 26/36, physical needs 18/36, interpersonal/intimacy needs 19/36, health system/information needs 11/36, cognitive needs 9/36, social needs 7/36, and of equal frequencies counts of 4/36 for family, practical, and patient-clinician information needs. Only one study explored spiritual needs and no daily living needs were identified. CONCLUSIONS The experience of needs varied in terms of frequency and distress which were commonly influenced by the age of the individual across the cancer care continuum persisting after 1-year post-treatment. IMPLICATIONS FOR CANCER SURVIVORS When caring for individuals affected by testicular cancer, clinicians are encouraged to take a holistic lens to cancer care, particularly to explore issue or concerns that young men affected by testicular cancer might be embarrassed or reticent to discuss.
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Affiliation(s)
- R Doyle
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra, Bruce, ACT, 2601, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, ACT, Australia
| | - P Craft
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, ACT, Australia
- School of Medicine, Australian National University, Canberra, ACT, Australia
| | - M Turner
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra, Bruce, ACT, 2601, Australia
| | - C Paterson
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra, Bruce, ACT, 2601, Australia.
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, ACT, Australia.
- Robert Gordon University, Aberdeen, Scotland, UK.
- ACT, Canberra Health Services, SYNERGY Nursing & Midwifery Research Centre, ACT Health Directorate, Canberra Hospital, Level 3, Building 6, GPO Box 825, Canberra, 2601, Australia.
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Nechaeva T, Verra L, Pucek J, Ranc L, Bergamaschi M, Zevi Della Porta G, Muggli P, Agnello R, Ahdida CC, Amoedo C, Andrebe Y, Apsimon O, Apsimon R, Arnesano JM, Bencini V, Blanchard P, Burrows PN, Buttenschön B, Caldwell A, Chung M, Cooke DA, Davut C, Demeter G, Dexter AC, Doebert S, Farmer J, Fasoli A, Fonseca R, Furno I, Granados E, Granetzny M, Graubner T, Grulke O, Gschwendtner E, Guran E, Henderson J, Kedves MÁ, Kim SY, Kraus F, Krupa M, Lefevre T, Liang L, Liu S, Lopes N, Lotov K, Martinez Calderon M, Mazzoni S, Moon K, Morales Guzmán PI, Moreira M, Okhotnikov N, Pakuza C, Pannell F, Pardons A, Pepitone K, Poimenidou E, Pukhov A, Rey S, Rossel R, Saberi H, Schmitz O, Senes E, Silva F, Silva L, Spear B, Stollberg C, Sublet A, Swain C, Topaloudis A, Torrado N, Turner M, Velotti F, Verzilov V, Vieira J, Welsch C, Wendt M, Wing M, Wolfenden J, Woolley B, Xia G, Yarygova V, Zepp M. Hosing of a Long Relativistic Particle Bunch in Plasma. Phys Rev Lett 2024; 132:075001. [PMID: 38427892 DOI: 10.1103/physrevlett.132.075001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/16/2024] [Indexed: 03/03/2024]
Abstract
Experimental results show that hosing of a long particle bunch in plasma can be induced by wakefields driven by a short, misaligned preceding bunch. Hosing develops in the plane of misalignment, self-modulation in the perpendicular plane, at frequencies close to the plasma electron frequency, and are reproducible. Development of hosing depends on misalignment direction, its growth on misalignment extent and on proton bunch charge. Results have the main characteristics of a theoretical model, are relevant to other plasma-based accelerators and represent the first characterization of hosing.
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Affiliation(s)
- T Nechaeva
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - L Verra
- CERN, 1211 Geneva 23, Switzerland
| | - J Pucek
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - L Ranc
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - M Bergamaschi
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - G Zevi Della Porta
- Max Planck Institute for Physics, 80805 Munich, Germany
- CERN, 1211 Geneva 23, Switzerland
| | - P Muggli
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - R Agnello
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | | | - C Amoedo
- CERN, 1211 Geneva 23, Switzerland
| | - Y Andrebe
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - O Apsimon
- University of Manchester M13 9PL, Manchester M13 9PL, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - R Apsimon
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | | | - V Bencini
- CERN, 1211 Geneva 23, Switzerland
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | - P Blanchard
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - P N Burrows
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | - B Buttenschön
- Max Planck Institute for Plasma Physics, 17491 Greifswald, Germany
| | - A Caldwell
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - M Chung
- UNIST, Ulsan 44919, Republic of Korea
| | | | - C Davut
- University of Manchester M13 9PL, Manchester M13 9PL, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - G Demeter
- Wigner Research Centre for Physics, 1121 Budapest, Hungary
| | - A C Dexter
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | | | - J Farmer
- Max Planck Institute for Physics, 80805 Munich, Germany
| | - A Fasoli
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - R Fonseca
- ISCTE - Instituto Universitéario de Lisboa, 1049-001 Lisbon, Portugal
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - I Furno
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | | | - M Granetzny
- University of Wisconsin, Madison, Wisconsin 53706, USA
| | - T Graubner
- Philipps-Universität Marburg, 35032 Marburg, Germany
| | - O Grulke
- Max Planck Institute for Plasma Physics, 17491 Greifswald, Germany
- Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | | | - E Guran
- CERN, 1211 Geneva 23, Switzerland
| | - J Henderson
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- STFC/ASTeC, Daresbury Laboratory, Warrington WA4 4AD, United Kingdom
| | - M Á Kedves
- Wigner Research Centre for Physics, 1121 Budapest, Hungary
| | - S-Y Kim
- CERN, 1211 Geneva 23, Switzerland
- UNIST, Ulsan 44919, Republic of Korea
| | - F Kraus
- Philipps-Universität Marburg, 35032 Marburg, Germany
| | - M Krupa
- CERN, 1211 Geneva 23, Switzerland
| | | | - L Liang
- University of Manchester M13 9PL, Manchester M13 9PL, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - S Liu
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - N Lopes
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - K Lotov
- Budker Institute of Nuclear Physics SB RAS, 630090 Novosibirsk, Russia
- Novosibirsk State University, 630090 Novosibirsk, Russia
| | | | | | - K Moon
- UNIST, Ulsan 44919, Republic of Korea
| | | | - M Moreira
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - N Okhotnikov
- Budker Institute of Nuclear Physics SB RAS, 630090 Novosibirsk, Russia
- Novosibirsk State University, 630090 Novosibirsk, Russia
| | - C Pakuza
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | | | | | - K Pepitone
- Angstrom Laboratory, Department of Physics and Astronomy, 752 37 Uppsala, Sweden
| | | | - A Pukhov
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
- Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - S Rey
- CERN, 1211 Geneva 23, Switzerland
| | - R Rossel
- CERN, 1211 Geneva 23, Switzerland
| | - H Saberi
- University of Manchester M13 9PL, Manchester M13 9PL, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - O Schmitz
- University of Wisconsin, Madison, Wisconsin 53706, USA
| | - E Senes
- CERN, 1211 Geneva 23, Switzerland
| | - F Silva
- INESC-ID, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - L Silva
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - B Spear
- John Adams Institute, Oxford University, Oxford OX1 3RH, United Kingdom
| | - C Stollberg
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), 1015 Lausanne, Switzerland
| | - A Sublet
- CERN, 1211 Geneva 23, Switzerland
| | - C Swain
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | | | - N Torrado
- CERN, 1211 Geneva 23, Switzerland
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - M Turner
- CERN, 1211 Geneva 23, Switzerland
| | | | - V Verzilov
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - J Vieira
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
| | - C Welsch
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | - M Wendt
- CERN, 1211 Geneva 23, Switzerland
| | - M Wing
- UCL, London WC1 6BT, United Kingdom
| | - J Wolfenden
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
- University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | | | - G Xia
- University of Manchester M13 9PL, Manchester M13 9PL, United Kingdom
- Cockcroft Institute, Warrington WA4 4AD, United Kingdom
| | - V Yarygova
- Budker Institute of Nuclear Physics SB RAS, 630090 Novosibirsk, Russia
- Novosibirsk State University, 630090 Novosibirsk, Russia
| | - M Zepp
- University of Wisconsin, Madison, Wisconsin 53706, USA
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Degraeuwe E, Persijn L, Nuytinck L, Allegaert K, De Taeye L, Gasthuys E, Christiaens D, Karamaria S, Raes A, Turner M, Vande Walle J. The development of the Belgian paediatric clinical trial network. Acta Clin Belg 2024; 79:34-45. [PMID: 38054741 DOI: 10.1080/17843286.2023.2283664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023]
Abstract
Paediatric clinical trials are critical to ensure that medications prescribed to children are safe and effective. However, evidence-based dosing and labelling of such medications remain limited, and most clinical trials in paediatrics fail. Factors for lack of trial completion include performance at site level (limited patient recruitment, limited site staff experience and lack of infrastructure), the sponsor team (limited paediatric specific expertise in design, uncertainties on robustness of biomarkers or outcome variables) as well as regulatory and administrative burdens. As a result of the growing demand for site support, the Belgian Paediatric Clinical Research Network (BPCRN) established in 2009 has been relaunched in 2018 to improve paediatric clinical trials, with the support of innovative-medicines-initiative 2 (IMI2) pan-European network conect4children (c4c) and the transatlantic network I-ACT for Children (US).This paper highlights the formation of the BPCRN and the practical insights it offers for advancing paediatric clinical trials through national networks. A national network can improve trial quality, safety and efficiency, provide clinical research expertise, identify suitable sites, and help with troubleshooting of common trial issues. The BPCRN's centralized approach has advanced paediatric clinical trials by streamlining communication and standardizing trial conduct. Challenges and opportunities have arisen, including a relaunch in 2018, orphan medicine trials, and network sustainability. Collaboration between network activities, government support, site-level improvements, efficient communication, and interaction with industry are key to achieve lasting transformation in paediatric medicine research.
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Affiliation(s)
- E Degraeuwe
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health sciences (UGENT), Ghent University, Ghent, Belgium
- Departement of Pediatrics, Ghent University Hospital (UZGENT), Ghent, Belgium
| | - L Persijn
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health sciences (UGENT), Ghent University, Ghent, Belgium
- Departement of Pediatrics, Ghent University Hospital (UZGENT), Ghent, Belgium
| | - L Nuytinck
- Departement of Pediatrics, Ghent University Hospital (UZGENT), Ghent, Belgium
| | - K Allegaert
- department of development and regeneration, and department of pharmaceutical and pharmacological sciences, (KU Leuven), University of Leuven, Leuven, Belgium
| | - L De Taeye
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health sciences (UGENT), Ghent University, Ghent, Belgium
| | - E Gasthuys
- Laboratory of Medical Biochemistry and Clinical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - D Christiaens
- Departement of Pediatrics, Ghent University Hospital (UZGENT), Ghent, Belgium
| | - S Karamaria
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health sciences (UGENT), Ghent University, Ghent, Belgium
| | - A Raes
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health sciences (UGENT), Ghent University, Ghent, Belgium
- Departement of Pediatrics, Ghent University Hospital (UZGENT), Ghent, Belgium
- Heidelberg Uniklinik, European Rare Kidney Disease Reference Network (ERKNET), Heidelberg, Germany
| | - M Turner
- Departement of Neonatology and Pediatrics, University of Liverpool, Liverpool, UK
| | - J Vande Walle
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health sciences (UGENT), Ghent University, Ghent, Belgium
- Departement of Pediatrics, Ghent University Hospital (UZGENT), Ghent, Belgium
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Haenel E, Elash CA, Garner K, Turner M, Kern S. Flexible approaches to eCOA administration in clinical trials: The site perspective. Contemp Clin Trials Commun 2024; 37:101241. [PMID: 38174210 PMCID: PMC10758701 DOI: 10.1016/j.conctc.2023.101241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
The Critical Path Institute convened the Support Flexible Approaches to PRO Data Collection project as part of the eCOA: Getting Better Together Initiative which was instigated to identify and address common challenges and drive positive change with eCOA implementation in clinical trials. The project aimed to identify clinical trial stakeholders' concerns related to electronic PRO (ePRO) implementation and propose areas of improvement via simplification and flexibility. One workstream focused on patient-/site-centric approaches for simplification and surveyed representatives of clinical sites and site monitors for their perspectives. A semi-structured questionnaire was developed and distributed via snowball sampling to site professionals and clinical research associates (CRAs) that had ePRO experience who had been identified via representative groups or sponsor-led site networks. Responses were received from various site roles across a range of global regions; the largest contribution was from the United States. Topics raised included helpdesk capabilities, technical concerns, device types, and user interfaces among others and are discussed further in this paper. The feedback derived from the questionnaire provided the basis for concrete ideas that sponsors should consider incorporating into protocol design for participant visits, technology use, devices, and methods of back-up data collection.
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Affiliation(s)
| | | | | | | | | | - Electronic Clinical Outcome Assessment (eCOA) Consortium and the Patient-Reported Outcome (PRO) Consortium
- Kayentis SAS, Meylan, France
- YPrime, Malvern, PA, USA
- Signant Health, Blue Bell, PA, USA
- GlaxoSmithKline, Collegeville, PA, USA
- Critical Path Institute, Tucson, AZ, USA
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Paterson C, Mckie A, Turner M, Kaak V. Barriers and facilitators associated with the implementation of surgical safety checklists: A qualitative systematic review. J Adv Nurs 2024; 80:465-483. [PMID: 37675871 DOI: 10.1111/jan.15841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
AIM Despite the documented benefits of the World Health Organisation Patient Safety Checklist compliance rates with implementation continue to cause risk to patient safety. This qualitative systematic review aimed to explore the reported factors that impact compliance and implementation processes related to surgical safety checklists in perioperative settings. DESIGN A qualitative systematic review. METHODS A systematic review using the Joanna Briggs Institute (JBI) approach to synthesize qualitative studies was conducted and reported according to PRISMA guidelines. Electronic databases were expansively searched using keywords and subject headings. Articles were assessed using a pre-selected eligibility criterion. Data extraction and quality appraisal was undertaken for all included studies and a meta-aggregation performed. DATA SOURCES The CINAHL, Medline and Scopus databases were searched in August 2022 and the search was repeated in June 2023. RESULTS 34 studies were included. Following the synthesis of the findings there were multiple interrelating barriers to checklist compliance that impacted implementation. There were more barriers than enablers reported in existing studies. Enablers included effective leadership, education and training, timely use of audit and feedback, local champions, and the option for local modifications to the surgical checklist. Further research should focus on targeted interventions that improve observed compliance rates to optimize patient safety. CONCLUSION This qualitative systematic review identified multiple key factors that influenced the uptake of the Surgical Safety Checklist in operating theatres. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Surgeon participation, hierarchical culture, complacency, and duplication of existing safety processes were identified which impacted the use and completion of the checklist.
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Affiliation(s)
- Catherine Paterson
- Faculty of Health, University of Canberra, Bruce ACT, Australia
- Caring Futures Institute, Flinders University, Australia
- Central Adelaide Local Health Network, Adelaide
- Robert Gordon University, Aberdeen, Scotland, UK
| | - A Mckie
- Faculty of Health, University of Canberra, Bruce ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce ACT, Australia
| | - V Kaak
- Faculty of Health, University of Canberra, Bruce ACT, Australia
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Sack DE, Brantley M, Ratliff M, Mathieson S, Turner M, Pettit AC, Sterling TR, Rebeiro PF. Misclassification of Loss to Care Among Persons With Human Immunodeficiency Virus: Improved Capture of Silent Transfers Through Surveillance Linkage Using Statewide Mandatorily Reported Laboratory Measures. Clin Infect Dis 2024; 78:118-121. [PMID: 37555632 PMCID: PMC10821811 DOI: 10.1093/cid/ciad461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023] Open
Abstract
Human Immunodeficiency Virus (HIV)-positive individuals lost to follow-up from particular clinics may not be lost to care (LTC). After linking Vanderbilt's Comprehensive Care Clinic cohort to Tennessee's statewide HIV surveillance database, LTC decreased from 48.4% to 35.0% at 10 years. Routine surveillance linkage by domestic HIV clinics would improve LTC and retention measure accuracy.
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Affiliation(s)
- Daniel E Sack
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Meredith Brantley
- Division of HIV/STDs/Viral Hepatitis, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Melanie Ratliff
- Division of HIV/STDs/Viral Hepatitis, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Samantha Mathieson
- Division of HIV/STDs/Viral Hepatitis, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - April C Pettit
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Brown LL, Perkins JM, Shepherd BE, Ramasamy S, Wilkins M, Osman A, Turner M, Link T, Edgerton R, Suiter SV, Pettit AC. Piloting Safety and Stabilization: A Multi-component Trauma Intervention to Improve HIV Viral Suppression, Retention in Care, and Post-traumatic Stress Disorder in a Southern United States HIV Service Organization. AIDS Behav 2024; 28:174-185. [PMID: 37751108 PMCID: PMC10868717 DOI: 10.1007/s10461-023-04174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 09/27/2023]
Abstract
In this observational study, we assessed the extent to which a community-created pilot intervention, providing trauma-informed care for persons with HIV (PWH), affected HIV care retention and viral suppression among PWH attending an HIV Services Organization in the Southern US. PWH with trauma exposure and/or trauma symptoms (N = 166) were offered a screening and referral to treatment (SBIRT) session. Per self-selection, 30 opted-out, 29 received SBIRT-Only, 25 received SBIRT-only but reported receiving other behavioral health care elsewhere, and 82 participated in the Safety and Stabilization (S&S) Intervention. Estimates from multivariable logistic regression analyses indicated S&S Intervention participants had increased retention in HIV care (adjusted odds ratio [aOR] 5.46, 95% CI 1.70-17.50) and viral suppression (aOR 17.74, 95% CI 1.83-172), compared to opt-out participants. Some evidence suggested that PTSD symptoms decreased for intervention participants. A randomized controlled trial is needed to confirm findings.
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Affiliation(s)
- Leslie Lauren Brown
- Psychiatry and Behavioral Sciences, Meharry Medical College, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37203, USA.
- Infectious Disease Division, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Jessica M Perkins
- Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Bryan E Shepherd
- Infectious Disease Division, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shobana Ramasamy
- Infectious Disease Division, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Megan Wilkins
- Infectious Disease Clinic, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Megan Turner
- Infectious Disease Division, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Ryan Edgerton
- Department of Family & Community Medicine, Meharry Medical College, Nashville, TN, USA
| | - Sarah V Suiter
- Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - April C Pettit
- Infectious Disease Division, Vanderbilt University School of Medicine, Nashville, TN, USA
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Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [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] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Paterson C, Kavanagh PS, Bacon R, Turner M, Moore M, Barratt M, Chau M. To understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer: a systematic review of qualitative studies. J Cancer Surviv 2023:10.1007/s11764-023-01508-9. [PMID: 38151586 DOI: 10.1007/s11764-023-01508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE This study aimed to understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer. METHODS A qualitative systematic review has been reported according to PRISMA guidelines. A comprehensive search was conducted across multiple databases (APA PsycINFO, CINAHL, and Medline) and citation searches. Studies were screened according to pre-determined inclusion and exclusion criteria. Methodological quality was evaluated. Findings were extracted in relation to the context of interest of experiences, needs, and preferences of supportive care. Each finding was accompanied by a qualitative verbatim illustration representing the participant's voice. RESULTS 4449 publications were screened, and 44 studies were included. Cancer populations represented in the included studies included lymphoma, leukaemia, brain cancer, sarcomas, and neuroblastoma. Two overarching synthesised findings were identified as (1) coping, caring relationships, communication, and impact of the clinical environment, and (2) experiences of isolation, fear of the unknown, restricted information, and changing self. Children and adolescents articulated that cancer care would be enhanced by developing a sense of control over their body and healthcare, being involved in communication and shared decision-making, and ensuring the clinical environment is age-appropriate. Many experienced a sense of disconnection from the rest of the world (including peers, school, and experiences of prejudice and bullying), and a lack of tailored support and information were identified as key unmet care needs that require further intervention. CONCLUSIONS Children and adolescent who are diagnosed with cancer are a unique and understudied group in oncological survivorship research, with the slowest progress in improvement of care over time. This review will facilitate the development of future interventions and promote the importance of tailored support for children and adolescents at all stages of the cancer journey. IMPLICATIONS FOR CANCER SURVIVORS Children and adolescents continue to experience a range of difficulties despite routine contact with cancer healthcare professionals. Children and adolescents should be carefully assessed about their individual circumstances and preferences for support given the clear implications from this review that "one size" does not fit all.
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Affiliation(s)
- C Paterson
- Caring Futures Institute, Flinders University, Adelaide, Australia.
- Central Adelaide Local Health Network, Adelaide, Australia.
- Robert Gordon University, Aberdeen, Scotland, UK.
- Faculty of Health, University of Canberra, Bruce, ACT, Australia.
| | - P S Kavanagh
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - R Bacon
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - M Moore
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - M Barratt
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - M Chau
- South Australia Medical Imaging, Flinders Medical Centre, Adelaide, Australia
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Paterson C, Turner M, Hooper ME, Ladbrook E, Macauley L, McKie A. Identifying experiences of supportive care of children and young people affected by kidney failure: A qualitative systematic review. J Ren Care 2023. [PMID: 38116998 DOI: 10.1111/jorc.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 11/03/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Children and young people affected by kidney failure experience complexities in their care. Little is known about the unique needs of this young patient population group living with a long-term condition. OBJECTIVE A meta-aggregation of all qualitative studies was conducted to identify experiences of supportive care among children and young people living with kidney failure. METHODS A systematic review of qualitative studies was conducted following the Joanna Briggs Institute meta-aggregation method. This review has been reported according to the PRISMA statement guidelines. Six electronic databases (CINAHL, Cochrane Library, MEDLINE, Proquest, PsycINFO, and Scopus) were comprehensively searched by an expert systematic review librarian using keywords and subject headings, from inception to September 2022. All studies were accessed using a predetermined inclusion and exclusion criteria. Methodological quality assessment and data extraction performed. Qualitative findings accompanied by illustrative quotes from included studies were extracted and grouped into categories which created the overall synthesised findings. RESULTS A total of 34 studies were included in this review representing a total of 613 children and young people affected by kidney failure. There was a total of 190 findings which created 13 categories representing experiences of supportive care. The meta-aggregation developed five synthesised findings namely: 'physical needs', 'information and technology', 'treatment and healthcare', 'social needs' and 'psychological impacts'. CONCLUSION This systematic review identified that children and young people affected by kidney failure can experience a range of unmet supportive care needs in routine clinical services. Kidney failure impacted children and young people's self-identify, social and peer networks, introduced daily practical needs because of inherent physical and psychological burden due to the failure and associated treatments. Despite improvements in the medical management of kidney failure in children and young people, further attention is needed to optimise supported self-management in this young patient group.
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Affiliation(s)
- C Paterson
- Caring Futures Institute, Flinders University, Adelaide, Australia
- Central Adelaide Local Health Network, Adelaide, Australia
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Robert Gordon University, Aberdeen, UK
| | - M Turner
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - M-E Hooper
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - E Ladbrook
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | | | - A McKie
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
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Paterson C, Armitage L, Turner M. Current Landscape of Ecological Momentary Assessment (Real-Time Data) Methodology in Cancer Research: A Systematic Review. Semin Oncol Nurs 2023; 39:151514. [PMID: 37865555 DOI: 10.1016/j.soncn.2023.151514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To critically synthesize and describe the use and methods of ecological momentary assessment (EMA) in cancer research. DATA SOURCES A systematic review was conducted and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guideline. Electronic databases (APA PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE, Scopus, and Web of Science Core Collection) were searched using a variety of keywords and subject headings by an expert systematic review librarian. All publications were double screened by two reviewers using predetermined exclusion and inclusion criteria throughout the full review process. The review used Covidence Systematic Review Software. Methodological quality assessment and data extraction were performed. A narrative synthesis was conducted to examine the aim for EMA, the characteristics of the study samples, the EMA sampling procedures, EMA completion rates, outcome measures, and any implications of findings for survivorship care. CONCLUSION A total of 42 EMA studies in cancer were included. Most studies used an electronic mobile device to capture EMA data apart from several that used paper diaries. Existing studies were found to have significant heterogeneity in methods and widely varying approaches to design and self-report measurements. While EMA in cancer research holds significant promise to advance cancer care research into the future by increasing ecological validity and reducing retrospective bias and can capture the unique idiographic within-person change over time, in real-time, further research is needed to develop standardized EMA self-report questionnaires. IMPLICATIONS FOR NURSING PRACTICE This is the first comprehensive systematic review to describe the use and methods of EMA in cancer research. There is significant heterogeneity in methods and widely varying approaches to design and self-report measurements in EMA cancer research. People affected by cancer found taking part in EMA studies reported benefit from the experience. However, researchers must engage with cancer survivors in the development and co-design of future EMA questionnaires to ensure relevant and acceptability of EMA data collection protocols.
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Affiliation(s)
- C Paterson
- Caring Futures Institute, Flinders University, Australia; Central Adelaide Local Health Network, Adelaide; Robert Gordon University, Aberdeen, Scotland, UK; Faculty of Health, University of Canberra, Bruce, ACT, Australia.
| | - L Armitage
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
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Berk M, Köhler-Forsberg O, Turner M, Penninx BWJH, Wrobel A, Firth J, Loughman A, Reavley NJ, McGrath JJ, Momen NC, Plana-Ripoll O, O'Neil A, Siskind D, Williams LJ, Carvalho AF, Schmaal L, Walker AJ, Dean O, Walder K, Berk L, Dodd S, Yung AR, Marx W. Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management. World Psychiatry 2023; 22:366-387. [PMID: 37713568 PMCID: PMC10503929 DOI: 10.1002/wps.21110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.
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Affiliation(s)
- Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Megan Turner
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anna Wrobel
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Amy Loughman
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - John J McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, QLD, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - Natalie C Momen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Dan Siskind
- Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Andre F Carvalho
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lianne Schmaal
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Adam J Walker
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Olivia Dean
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Ken Walder
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lesley Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Seetal Dodd
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Alison R Yung
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Wolfgang Marx
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
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Hussain M, Chau S, Turner M, Paterson C. Scan-Associated Distress in People Affected by Cancer: A Qualitative Systematic Review. Semin Oncol Nurs 2023; 39:151502. [PMID: 37735038 DOI: 10.1016/j.soncn.2023.151502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/26/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE The term "scanxiety" has been coined to describe the anxiety commonly associated with individuals undergoing cancer-related imaging. Despite the prevalence and severity of scanxiety across various clinical and demographic populations, there remains a significant lack of qualitative insights from existing studies that effectively capture patients' experiences of scanxiety in their own words. Therefore, this review addresses the following research question: What are the experiences of scanxiety distress among people affected by cancer across the cancer care continuum? DATA SOURCES Following the PRISMA methodology, a meta-aggregation of qualitative studies was performed, encompassing patients of all age groups who had been diagnosed with cancer or were indicated for a cancer-related scan. Of the 556 articles screened, 15 were deemed eligible for inclusion in the analysis. CONCLUSION The three overarching themes of 1) experience of "scan-itis," 2) experience of "patient-clinician support," and 3) development of self-management strategies reveal the complex and interconnected factors that influence scanxiety in individuals undergoing cancer-related imaging. These findings emphasized distress experienced by patients during the waiting period for scan results, the act of viewing the results, and even the delivery of "bad" news. Consequently, patients expressed a strong desire for increased information, communication, and empathy from attending healthcare providers. Patients also report a myriad of self-coping strategies to manage their scanxiety well before, during, and after their scan appointment. IMPLICATIONS FOR NURSING PRACTICE The study highlights the need for targeted interventions for those undergoing cancer-related scans, including increased awareness and education for health professionals regarding scanxiety.
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Affiliation(s)
- M Hussain
- Faculty of Health, University of Canberra, Bruce ACT, Australia
| | - S Chau
- Caring Futures Institute, Flinders University, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce ACT, Australia
| | - C Paterson
- Faculty of Health, University of Canberra, Bruce ACT, Australia; Caring Futures Institute, Flinders University, Australia; Central Adelaide Local Health Network, Adelaide; Robert Gordon University, Aberdeen, Scotland, UK; Flinders Medical Centre, Adelaide, Australia.
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Amorim G, Jaworski J, Cordeiro-Santos M, Kritski AL, Figueiredo MC, Turner M, Andrade BB, Velez Edwards DR, Santos AR, Rolla VC, Sterling TR, Haas DW. Pharmacogenetics of tuberculosis treatment toxicity and effectiveness in a large Brazilian cohort. medRxiv 2023:2023.08.30.23294860. [PMID: 37693472 PMCID: PMC10491388 DOI: 10.1101/2023.08.30.23294860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Genetic polymorphisms have been associated with risk of anti-tuberculosis treatment toxicity. We characterized associations with adverse events and treatment failure/recurrence among adults treated for tuberculosis in Brazil. Methods Participants were followed in Regional Prospective Observational Research in Tuberculosis (RePORT)-Brazil. We included persons with culture-confirmed drug-susceptible pulmonary tuberculosis who started treatment between 2015-2019, and who were evaluable for pharmacogenetics. Treatment included 2 months of isoniazid, rifampin or rifabutin, pyrazinamide, and ethambutol, then 4 months of isoniazid and rifampin or rifabutin, with 24 month follow-up. Analyses included 43 polymorphisms in 20 genes related to anti-tuberculosis drug hepatotoxicity or pharmacokinetics. Whole exome sequencing was done in a case-control toxicity subset. Results Among 903 participants in multivariable genetic association analyses, NAT2 slow acetylator status was associated with increased risk of treatment-related grade 2 or greater adverse events, including hepatotoxicity. Treatment failure/recurrence was more likely among NAT2 rapid acetylators, but not statistically significant at the 5% level. A GSTM1 polymorphism (rs412543) was associated with increased risk of treatment-related adverse events, including hepatotoxicity. SLCO1B1 polymorphisms were associated with increased risk of treatment- related hepatoxicity and treatment failure/recurrence. Polymorphisms in NR1/2 were associated with decreased risk of adverse events and increased risk of failure/recurrence. In whole exome sequencing, hepatotoxicity was associated with a polymorphism in VTI1A , and the genes METTL17 and PRSS57 , but none achieved genome-wide significance. Conclusions In a clinical cohort representing three regions of Brazil, NAT2 acetylator status was associated with risk for treatment-related adverse events. Additional significant polymorphisms merit investigation in larger study populations.
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Jackson N, Turner M, Paterson C. What are the holistic care impacts among individuals living through the COVID-19 pandemic in residential or community care settings? An integrative systematic review. Int J Older People Nurs 2023; 18:e12557. [PMID: 37365716 DOI: 10.1111/opn.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION To critically synthesise evidence in relation to the holistic care impacts (physical, psychological, social, spiritual, and environmental well-being) among individuals living in residential aged care facilities (RACFs) with restrictions during the COVID-19 pandemic. METHODS An integrative systematic review followed a pre-registered protocol and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guidelines. Electronic databases were searched from inception to June 2022. Qualitative, quantitative, and mixed methods studies were included. All articles were double screened according to a pre-determined eligibility criterion. The review process was managed using Covidence systematic review software. Data from the studies were extracted, methodological quality appraisal conducted, and a narrative synthesis conducted. RESULTS 18 studies were included. The impact of restrictive practices and periods of lockdown impacted older people on all levels of individual quality-of-life. With or without COVID-19, residents experienced functional decline and many experienced malnutrition, increased incontinence, increased pain, and poorer general health and significant psychological distress. Depression increased with reduced social contact, as did anxiety and loneliness. Some residents spoke of suicidal ideation. CONCLUSION It is highly plausible that further outbreaks may prompt knee-jerk reactions from public health departments and governing bodies to continue to restrict and lockdown facilities. Public health COVID-19 outbreak policy for aged care across the globe will need to consider the benefits verses risk debate given the findings uncovered in this review. These findings showed that it is vital that policy considers quality-of-life domains not solely survival rates.
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Affiliation(s)
- N Jackson
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - C Paterson
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Australian Capital Territory, Australia
- Robert Gordon University, Aberdeen, UK
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Paterson C, Roberts C, Li J, Chapman M, Strickland K, Johnston N, Law E, Bacon R, Turner M, Mohanty I, Pranavan G, Toohey K. What are the experiences of supportive care in people affected by brain cancer and their informal caregivers: A qualitative systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01401-5. [PMID: 37256499 DOI: 10.1007/s11764-023-01401-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE To critically synthesise qualitative research to understand experiences of supportive care in people affected by brain cancer and their informal caregivers. METHODS A qualitative systematic review was conducted according to the Joanna Briggs methodology and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. Electronic databases were searched by an expert systematic review librarian for all qualitative studies irrespective of research design. All publications were double screened by two reviewers using a pre-determined exclusion and inclusion criteria. The review was managed using Covidence systematic review software. Methodological quality assessment and data extraction were performed. Qualitative findings accompanied by illustrative quotes from included studies were extracted and grouped into categories, which created the overall synthesised findings. RESULTS A total of 33 studies were included which represented a total sample of 671 participants inclusive of 303 patients and 368 informal caregivers. There was a total of 220 individual findings included in this review, which were synthesised into two findings (1) caregivers and patients perceived supports which would have been helpful and (2) caregiver and patient experiences of unmet supportive care needs. CONCLUSION This review highlighted the suffering and distress caused by brain cancer and associated treatments. Both patients and their informal caregivers experienced disconnect from themselves in renegotiating roles, and a profound sense of loneliness as the physical deterioration of the disease progressed. Both patients and informal caregivers reported similar unmet needs within the current service provision for brain cancer. However, what is apparent is that current cancer services are provided solely for patients, with little or no consideration to the support needs of both the patient and their informal caregiver. Service re-design is needed to improve care coordination with individualised informational support, implementation of holistic needs assessments for both the patients and their caregivers, better community support provision, improved opportunities for emotional care with early referral for palliative care services. IMPLICATIONS FOR CANCER SURVIVORS It is recommended that members of the multidisciplinary brain cancer team reflect on these findings to target holistic needs assessments and develop shared self-management care plans for both the patient and the informal caregiver.
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Affiliation(s)
- C Paterson
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia.
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia.
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia.
- Canberra Health Services and ACT Health, Garran, Canberra, Australia.
- Robert Gordon University, Aberdeen, Scotland, UK.
| | - C Roberts
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - J Li
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - M Chapman
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- Department of Palliative Care, Canberra Health Services, Garran, Canberra, Australia
- School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - K Strickland
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, WA, Australia
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, AUT, Auckland, New Zealand
| | - N Johnston
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - E Law
- Icon Cancer Centre, Canberra, Australia
| | - R Bacon
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
| | - I Mohanty
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - G Pranavan
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - K Toohey
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
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Turner M, Craighead F, MacKenzie JD, Aujayeb A. Day Case Local Anaesthetic Thoracoscopy: Experience from 2 District General Hospitals in the United Kingdom. Med Sci (Basel) 2023; 11:medsci11010023. [PMID: 36976531 PMCID: PMC10056019 DOI: 10.3390/medsci11010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Local anaesthetic thoracoscopy (LAT) can be a vital procedure for diagnosis of unexplained pleural effusions. Traditionally, poudrage for pleurodesis and insertion of a large bore drain necessitated admission. There has been a shift towards performing LAT as a day case procedure with indwelling pleural catheter (IPC) insertion. This was advocated during the COVID pandemic by the British Thoracic Society (BTS). To determine the feasibility of such pathways, continuous evaluations are required. Methods: All day case LAT procedures with IPC insertion, performed in theatre, were identified at two large district general hospitals (Northumbria HealthCare in the North East of England and Victoria Hospital, NHS Fife, in Scotland). Rapid pleurodesis with talc was not performed due to local staffing problems. All patients had their LAT in theatre under conscious sedation with a rigid scope. Demographics, clinical, radiological and histopathological characteristics and outcomes were collected. Results: 79 patients underwent day case LAT. The lung did not deflate, meaning biopsies were not enabled, in four of the patients. The mean age was 72 years (standard deviation 13). Fifty-five patients were male and twenty-four were female. The main diagnoses were lung cancers, mesotheliomas and fibrinous pleuritis with an overall diagnostic sensitivity of 93%. Other diagnoses were breast, tonsillar, unknown primary cancers and lymphomas. Seventy-three IPCs were simultaneously placed and, due to normal macroscopic appearances in two patients, two large bore drains were placed and removed within one hour of LAT termination. Sixty-six (88%) patients were discharged on the same day. Seven patients required admission: one for treatment of surgical emphysema, four because they lived alone, one for pain control and one for control of a cardiac arrythmia. Within 30 days, there were five IPC site infections with two resultant empyemas (9%), with no associated mortality. Two patients developed pneumonia requiring admission and one patient required admission for pain management. The median number of days for which the IPCs remained in situ was 78.5 days (IQR 95). The median length of stay (LoS) was 0 days (IQR 0). No patients required further interventions for pleural fluid management. Conclusions: Day case LAT with IPC insertion is feasible with this current set up, with a median stay of 0 days, and should be widely adopted. The health economics of preventing admission are considerable, as our previous analysis showed a median length of stay of 3.96 days, although we are not comparing matched cohorts.
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Affiliation(s)
- Megan Turner
- Respiratory Trainee, Victoria Hospital, Hayfield Rd, Kirkcaldy KY2 5AH, UK
| | - Felicity Craighead
- Respiratory Trainee, Victoria Hospital, Hayfield Rd, Kirkcaldy KY2 5AH, UK
| | | | - Avinash Aujayeb
- Respiratory Consultant, Department of Respiratory Medicine, Northumbria Healthcare NHS Trust, Northumbria Way, Cramlington NE23 6NZ, UK
- Correspondence:
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Miller M, Boulanger M, Guo M, Turner M, Olson S, Eaton C, Hsu M, Feliciano J. PPD01.02 Identifying Physical, Social, Emotional, and Medical Needs of Lung Cancer Survivors with Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.018] [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: 01/30/2023]
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Ridolfi F, Peetluk L, Amorim G, Turner M, Figueiredo M, Cordeiro-Santos M, Cavalcante S, Kritski A, Durovni B, Andrade B, Sterling TR, Rolla V. Tuberculosis Treatment Outcomes in Brazil: Different Predictors for Each Type of Unsuccessful Outcome. Clin Infect Dis 2023; 76:e930-e937. [PMID: 35788646 PMCID: PMC10169436 DOI: 10.1093/cid/ciac541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Successful tuberculosis (TB) treatment is necessary for disease control. The World Health Organization (WHO) has a target TB treatment success rate of ≥90%. We assessed whether the different types of unfavorable TB treatment outcome had different predictors. METHODS Using data from Regional Prospective Observational Research for Tuberculosis-Brazil, we evaluated biological and behavioral factors associated with each component of unsuccessful TB outcomes, recently updated by WHO (death, loss to follow-up [LTFU], and treatment failure). We included culture-confirmed, drug-susceptible, pulmonary TB participants receiving standard treatment in 2015-2019. Multinomial logistic regression models with inverse probability weighting were used to evaluate the distinct determinants of each unsuccessful outcome. RESULTS Of 915 participants included, 727 (79%) were successfully treated, 118 (13%) were LTFU, 44 (5%) had treatment failure, and 26 (3%) died. LTFU was associated with current drug-use (adjusted odds ratio [aOR] = 5.3; 95% confidence interval [CI], 3.0-9.4), current tobacco use (aOR = 2.9; 95% CI, 1.7-4.9), and being a person with HIV (PWH) (aOR = 2.0; 95% CI, 1.1-3.5). Treatment failure was associated with PWH (aOR = 2.7; 95% CI, 1.2-6.2) and having diabetes (aOR = 2.2; 95% CI, 1.1-4.4). Death was associated with anemia (aOR = 5.3; 95% CI, 1.4-19.7), diabetes (aOR = 3.1; 95% CI, 1.4-6.7), and PWH (aOR = 3.9; 95% CI, 1.3-11.4). Direct observed therapy was protective for treatment failure (aOR = 0.5; 95% CI, .3-.9) and death (aOR = 0.5; 95% CI, .2-1.0). CONCLUSIONS The treatment success rate was below the WHO target. Behavioral factors were most associated with LTFU, whereas clinical comorbidities were correlated with treatment failure and death. Because determinants of unsuccessful outcomes are distinct, different intervention strategies may be needed to improve TB outcomes.
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Affiliation(s)
- Felipe Ridolfi
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fiocruz, Rio de Janeiro, Brazil
| | - Lauren Peetluk
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Gustavo Amorim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Marina Figueiredo
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Marcelo Cordeiro-Santos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT), Manaus, Brazil
- Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | - Solange Cavalcante
- Clínica de Família Rinaldo Delamare, Rocinha, Rio de Janeiro, Brazil
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Rio de Janeiro, Brazil
| | - Afrânio Kritski
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Rio de Janeiro, Brazil
| | - Betina Durovni
- Centro de Estudos Estratégicos, Fiocruz, Rio de Janeiro, Brazil
| | - Bruno Andrade
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
- Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
- Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Valeria Rolla
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fiocruz, Rio de Janeiro, Brazil
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21
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Pellegrino RA, Rebeiro PF, Turner M, Davidson A, Best N, Shaffernocker C, Kheshti A, Kelly S, Raffanti S, Sterling TR, Castilho JL. Sex and Race Disparities in Mortality and Years of Potential Life Lost Among People With HIV: A 21-Year Observational Cohort Study. Open Forum Infect Dis 2022; 10:ofac678. [PMID: 36726547 PMCID: PMC9879712 DOI: 10.1093/ofid/ofac678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background Since the availability of antiretroviral therapy, mortality rates among people with HIV (PWH) have decreased; however, this does not quantify premature deaths among PWH, and disparities persist. Methods We examined all-cause and premature mortality among PWH receiving care at the Vanderbilt Comprehensive Care Clinic from January 1998 to December 2018. Mortality rates were compared by demographic and clinical factors, and adjusted incidence rate ratios (aIRRs) were calculated using multivariable Poisson regression. For individuals who died, age-adjusted years of potential life lost (aYPLL) per total person-years living with HIV were calculated from US sex-specific life tables, and sex and race differences were examined using multivariable linear regression. Results Among 6531 individuals (51% non-Hispanic [NH] White race, 40% NH Black race, 21% cis-gender women, 78% cis-gender men) included, 956 (14.6%) died. In adjusted analysis, PWH alive in the most recent calendar era (2014-2018) had decreased risk of mortality compared with those in the earliest calendar era (1998-2003; aIRR, 0.22; 95% CI, 0.17-0.29), and women had increased risk of death compared with men (aIRR, 1.31; 95% CI, 1.12-1.54). Of those who died, Black women had the highest aYPLL (aIRR, 592.5; 95% CI, 588.4-596.6), followed by Black men (aIRR, 470.7; 95% CI, 468.4-472.9), White women (aIRR, 411.5; 95% CI, 405.6-417.4), then White men (aIRR, 308.6; 95% CI, 308.0-309.2). In adjusted models, higher YPLL remained associated with NH Black race and cis-gender women, regardless of HIV risk factor. Conclusions Despite marked improvement over time, sex disparities in mortality as well as sex and race disparities in YPLL remained among PWH in this cohort.
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Affiliation(s)
- Rachael A Pellegrino
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Noelle Best
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chandler Shaffernocker
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Asghar Kheshti
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sean Kelly
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen Raffanti
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica L Castilho
- Correspondence: Jessica L. Castilho, MD, MPH, Vanderbilt University Medical Center, A2200 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232 ()
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Vernon I, Owen J, Aylett-Bullock J, Cuesta-Lazaro C, Frawley J, Quera-Bofarull A, Sedgewick A, Shi D, Truong H, Turner M, Walker J, Caulfield T, Fong K, Krauss F. Bayesian emulation and history matching of JUNE. Philos Trans A Math Phys Eng Sci 2022; 380:20220039. [PMID: 35965471 PMCID: PMC9376712 DOI: 10.1098/rsta.2022.0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/07/2022] [Indexed: 05/21/2023]
Abstract
We analyze JUNE: a detailed model of COVID-19 transmission with high spatial and demographic resolution, developed as part of the RAMP initiative. JUNE requires substantial computational resources to evaluate, making model calibration and general uncertainty analysis extremely challenging. We describe and employ the uncertainty quantification approaches of Bayes linear emulation and history matching to mimic JUNE and to perform a global parameter search, hence identifying regions of parameter space that produce acceptable matches to observed data, and demonstrating the capability of such methods. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
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Affiliation(s)
- I. Vernon
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J. Owen
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J. Aylett-Bullock
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - C. Cuesta-Lazaro
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - J. Frawley
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - A. Quera-Bofarull
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - A. Sedgewick
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Centre for Extragalactic Astronomy, Durham University, Durham DH13LE, UK
| | - D. Shi
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - H. Truong
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - M. Turner
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - J. Walker
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - T. Caulfield
- Department of Computer Science, Durham University, Durham DH13LE, UK
| | - K. Fong
- Department of Science, Technology, Engineering and Public Policy, University College London, London WC1E6BT, UK
- Department of Anaesthesia, University College London Hospital, London NW12BU, UK
| | - F. Krauss
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
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Vernon I, Owen J, Aylett-Bullock J, Cuesta-Lazaro C, Frawley J, Quera-Bofarull A, Sedgewick A, Shi D, Truong H, Turner M, Walker J, Caulfield T, Fong K, Krauss F. Bayesian emulation and history matching of JUNE. Philos Trans A Math Phys Eng Sci 2022; 380:20210039. [PMID: 35965471 DOI: 10.1098/rsta.2021.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/06/2021] [Indexed: 05/21/2023]
Abstract
We analyze JUNE: a detailed model of COVID-19 transmission with high spatial and demographic resolution, developed as part of the RAMP initiative. JUNE requires substantial computational resources to evaluate, making model calibration and general uncertainty analysis extremely challenging. We describe and employ the uncertainty quantification approaches of Bayes linear emulation and history matching to mimic JUNE and to perform a global parameter search, hence identifying regions of parameter space that produce acceptable matches to observed data, and demonstrating the capability of such methods. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
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Affiliation(s)
- I Vernon
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J Owen
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Department of Mathematical Sciences, Durham University, Durham DH13LE, UK
| | - J Aylett-Bullock
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - C Cuesta-Lazaro
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - J Frawley
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - A Quera-Bofarull
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - A Sedgewick
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Centre for Extragalactic Astronomy, Durham University, Durham DH13LE, UK
| | - D Shi
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Computational Cosmology, Durham University, Durham DH13LE, UK
| | - H Truong
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - M Turner
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Advanced Research Computing, Durham University, Durham DH13LE, UK
| | - J Walker
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
| | - T Caulfield
- Department of Computer Science, Durham University, Durham DH13LE, UK
| | - K Fong
- Department of Science, Technology, Engineering and Public Policy, University College London, London WC1E6BT, UK
- Department of Anaesthesia, University College London Hospital, London NW12BU, UK
| | - F Krauss
- Institute for Data Science, Durham University, Durham DH13LE, UK
- Institute for Particle Physics Phenomenology, Durham University, Durham DH13LE, UK
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Schember CO, Scott SE, Jenkins CA, Rebeiro PF, Turner M, Furukawa SS, Bofill C, Yan Z, Jackson GP, Pettit AC. Electronic Patient Portal Access, Retention in Care, and Viral Suppression Among People Living With HIV in Southeastern United States: Observational Study. JMIR Med Inform 2022; 10:e34712. [PMID: 35877160 PMCID: PMC9361138 DOI: 10.2196/34712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Approximately 1.1 million people living with HIV live in the United States, and the incidence is highest in Southeastern United States. Electronic patient portal prevalence is increasing and can improve engagement in primary medical care. Retention in care and viral suppression-measures of engagement in HIV care-are associated with decreased HIV transmission, morbidity, and mortality. OBJECTIVE We aimed to determine if patient portal access among people living with HIV was associated with retention and viral suppression. METHODS We conducted an observational cohort study among people living with HIV in care at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee) from 2011-2016. Individual access was defined as patient portal account registration at any point in the year prior. Retention was defined as ≥2 kept appointments or HIV lab measurements ≥3 months apart within a 12-month period. Viral suppression was defined as the last viral load in the calendar year <200 copies/mL. We calculated adjusted prevalence ratios (aPRs) and 95% CIs using modified Poisson regression with generalized estimating equations to estimate the association of portal access with retention and viral suppression. RESULTS We included 4237 people living with HIV contributing 16,951 person-years of follow-up (median 5, IQR 3-5 person-years). The median age was 43 (IQR 33-50) years. Of the 4237 people living with HIV, 78.1% (n=4237) were male, 40.8% (n=1727) were Black non-Hispanic, and 56.5% (n=2395) had access. Access was independently associated with retention (aPR 1.13, 95% CI 1.10-1.17) and viral suppression (aPR 1.18, 95% CI 1.14-1.22). CONCLUSIONS In this population, patient portal access was associated with retention and viral suppression. Future prospective studies should assess the impact of increasing portal access among people living with HIV on these HIV outcomes.
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Affiliation(s)
- Cassandra Oliver Schember
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah E Scott
- Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Cathy A Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Peter F Rebeiro
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sally S Furukawa
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carmen Bofill
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Zhou Yan
- Department of Health Information Technology Web Development, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Gretchen P Jackson
- Departments of Surgery, Pediatrics and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - April C Pettit
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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Tingle SJ, Thompson ER, Bates L, Connelly C, Colenutt S, Turner M, Ugail H, Hodgetts R, Thomson BM, Sheerin N, Wilson C. O030 Image-analysis algorithm to determine quality of cold perfusion in kidney transplantation. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.030] [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: 11/06/2022]
Abstract
Abstract
Introduction
Surgeon assessment of visual ‘quality of perfusion’ (QOP) influences kidney discard and predicts transplant outcome. However, this assessment is subjective and bias-prone.
We aimed to design an application utilising a smartphone camera to make this assessment objective and enhance decision making.
Methods
The QOP in photographs of backbench kidneys was graded from 1 (ideal) to 5 (very poor) by three independent surgeons. A training cohort was used to develop an image-analysis algorithm, which was validated in a separate cohort.
Results
Analysing surgeon scores of 174 kidney images revealed that inter-rater agreement was good for kidneys displaying the best (rated 1) and worst (rated 4 or 5) QOP. However, for intermediate scores inter-rater agreement was poor. Inter-rater agreement between surgeons decreased as they graded more images; as surgeons fatigued, their ability to classify images worsened. A training cohort (n=174 kidneys) was used for algorithm development. First, small regions within each image were mapped within the CEILAB colour-space, where well-perfused and poorly perfused areas show clear separation. To generate a score for each kidney these regions are compared with ideally flushed kidney tissue. Testing our algorithm (validation cohort - n=29 kidneys) revealed strong correlation between image-analysis QOP score and surgeon assessment, r=0.789 (0.587–0.899), P<0.001.
Conclusion
Surgeon inter-rater agreement on kidney QOP is low for kidneys with borderline QOP and worsens with fatigue. We provide a QOP score utilising an image-analysis algorithm, which correlates with surgeon scoring. With additional images and training this could provide an objective, numerical, point-of-care assessment of organ quality.
Take-home message
Current visual assessment of transplant organ quality is subjective and bias-prone. This body of work attempts to create a point-of-care image-analysis application to provide an objective numeric organ quality score.
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Affiliation(s)
- SJ Tingle
- NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation at Cambridge and Newcastle Universities , Newcastle upon Tyne, NE1 7RU
- Translational and Clinical Research Institute, Newcastle University , NE2 4HH
| | - ER Thompson
- NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation at Cambridge and Newcastle Universities , Newcastle upon Tyne, NE1 7RU
- Translational and Clinical Research Institute, Newcastle University , NE2 4HH
| | - L Bates
- NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation at Cambridge and Newcastle Universities , Newcastle upon Tyne, NE1 7RU
- Translational and Clinical Research Institute, Newcastle University , NE2 4HH
| | - C Connelly
- NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation at Cambridge and Newcastle Universities , Newcastle upon Tyne, NE1 7RU
- Translational and Clinical Research Institute, Newcastle University , NE2 4HH
| | - S Colenutt
- NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation at Cambridge and Newcastle Universities , Newcastle upon Tyne, NE1 7RU
- Translational and Clinical Research Institute, Newcastle University , NE2 4HH
| | - M Turner
- Translational and Clinical Research Institute, Newcastle University , NE2 4HH
| | - H Ugail
- Department of Engineering and Informatics IRC, University of Bradford , BD7 1DP
- Aedstem Ltd , Yorkshire, Yorkshire, YO42 2QE
| | - R Hodgetts
- Department of Engineering and Informatics IRC, University of Bradford , BD7 1DP
- Aedstem Ltd , Yorkshire, Yorkshire, YO42 2QE
| | - BM Thomson
- Department of Engineering and Informatics IRC, University of Bradford , BD7 1DP
- Aedstem Ltd , Yorkshire, Yorkshire, YO42 2QE
| | - N Sheerin
- Translational and Clinical Research Institute, Newcastle University , NE2 4HH
| | - C Wilson
- NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation at Cambridge and Newcastle Universities , Newcastle upon Tyne, NE1 7RU
- Translational and Clinical Research Institute, Newcastle University , NE2 4HH
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26
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Helme D, Turner M. P.109 Separating elective and emergency streams - the benefit of centralisation of maternity services at Aneurin Bevan University Health Board (ABUHB). Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103405] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gilbert E, Turner M, de Viggiani N, Selman L. Developing a typology of models of palliative care delivery in prisons in high-income countries: protocol for a scoping review with narrative synthesis. BMJ Open 2022; 12:e060886. [PMID: 35487724 PMCID: PMC9058786 DOI: 10.1136/bmjopen-2022-060886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION A combination of punitive sentencing practices within ageing populations, compounded by the health challenges faced by people in prison, means that dedicated palliative care provision within prisons is a pressing requirement. However, evidence about exactly how quality palliative and end-of-life care is delivered in this environment remains sparse.This review aims to develop a typology of models of palliative and end-of-life care delivery within prisons in high-income countries to inform service development and policy. METHODS AND ANALYSIS We will conduct a scoping review of published studies and grey literature, following the Arksey and O'Malley framework. We will report data on models of palliative and end-of-life care delivery in prisons in high-income countries. Searches will be undertaken in Medline, EMBASE, CINAHL, Social Sciences Citation Index and PsyINFO for all study types, published from 1 January 2000 to December 2021, and reference lists from key reviews and studies will be screened for additional references. We will also screen grey literature from within other high-income countries using a targeted search strategy. For published reports of original research, study quality and risk of bias will be assessed independently by two reviewers using the Mixed Methods Appraisal Tool. A narrative synthesis of the data will be undertaken, integrating the results of the quality assessment. ETHICS AND DISSEMINATION Approval by research ethics committee is not required since the review only includes published and publicly accessible data. We will publish our findings in a peer-reviewed journal as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidance. PROTOCOL REGISTRATION The final protocol was registered with the Research Registry on 26 November 2021 (www.researchregistry.com).Unique ID number: reviewregistry1260.
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Affiliation(s)
- Emma Gilbert
- Palliative and End of Life Care Research Group, Bristol Medical School, University of Bristol, Bristol, UK
| | - M Turner
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Nick de Viggiani
- School of Health and Social Wellbeing, University of the West of England Bristol, Bristol, UK
| | - Lucy Selman
- Palliative and End of Life Care Research Group, Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
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Young LM, Moylan S, John T, Turner M, Opie R, Hockey M, Saunders D, Bruscella C, Jacka F, Teychenne M, Rosenbaum S, Banker K, Mahoney S, Tembo M, Lai J, Mundell N, McKeon G, Yucel M, Speight J, Absetz P, Versace V, Chatterton ML, Berk M, Manger S, Mohebbi M, Morgan M, Chapman A, Bennett C, O’Shea M, Rocks T, Leach S, O’Neil A. Evaluating telehealth lifestyle therapy versus telehealth psychotherapy for reducing depression in adults with COVID-19 related distress: the curbing anxiety and depression using lifestyle medicine (CALM) randomised non-inferiority trial protocol. BMC Psychiatry 2022; 22:219. [PMID: 35346115 PMCID: PMC8958477 DOI: 10.1186/s12888-022-03840-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There is increasing recognition of the substantial burden of mental health disorders at an individual and population level, including consequent demand on mental health services. Lifestyle-based mental healthcare offers an additional approach to existing services with potential to help alleviate system burden. Despite the latest Royal Australian New Zealand College of Psychiatrists guidelines recommending that lifestyle is a 'first-line', 'non-negotiable' treatment for mood disorders, few such programs exist within clinical practice. Additionally, there are limited data to determine whether lifestyle approaches are equivalent to established treatments. Using an individually randomised group treatment design, we aim to address this gap by evaluating an integrated lifestyle program (CALM) compared to an established therapy (psychotherapy), both delivered via telehealth. It is hypothesised that the CALM program will not be inferior to psychotherapy with respect to depressive symptoms at 8 weeks. METHODS The study is being conducted in partnership with Barwon Health's Mental Health, Drugs & Alcohol Service (Geelong, Victoria), from which 184 participants from its service and surrounding regions are being recruited. Eligible participants with elevated psychological distress are being randomised to CALM or psychotherapy. Each takes a trans-diagnostic approach, and comprises four weekly (weeks 1-4) and two fortnightly (weeks 6 and 8) 90-min, group-based sessions delivered via Zoom (digital video conferencing platform). CALM focuses on enhancing knowledge, behavioural skills and support for improving dietary and physical activity behaviours, delivered by an Accredited Exercise Physiologist and Accredited Practising Dietitian. Psychotherapy uses cognitive behavioural therapy (CBT) delivered by a Psychologist or Clinical Psychologist, and Provisional Psychologist. Data collection occurs at baseline and 8 weeks. The primary outcome is depressive symptoms (assessed via the Patient Health Questionnaire-9) at 8 weeks. Societal and healthcare costs will be estimated to determine the cost-effectiveness of the CALM program. A process evaluation will determine its reach, adoption, implementation and maintenance. DISCUSSION If the CALM program is non-inferior to psychotherapy, this study will provide the first evidence to support lifestyle-based mental healthcare as an additional care model to support individuals experiencing psychological distress. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12621000387820 , Registered 8 April 2021.
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Affiliation(s)
- Lauren M. Young
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Steve Moylan
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia ,grid.414257.10000 0004 0540 0062Barwon Health, Geelong, Australia
| | - Tayla John
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia ,grid.414257.10000 0004 0540 0062Barwon Health, Geelong, Australia
| | - Megan Turner
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Rachelle Opie
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Meghan Hockey
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Dean Saunders
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Courtney Bruscella
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Felice Jacka
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Megan Teychenne
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Simon Rosenbaum
- grid.1005.40000 0004 4902 0432University of New South Wales, Sydney, Australia
| | - Khyati Banker
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Sophie Mahoney
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Monica Tembo
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Jerry Lai
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia ,grid.474047.4Intersect Australia, Sydney, Australia
| | - Niamh Mundell
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | - Grace McKeon
- grid.1005.40000 0004 4902 0432University of New South Wales, Sydney, Australia
| | - Murat Yucel
- grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - Jane Speight
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia ,Diabetes Victoria, Melbourne, Australia
| | - Pilvikki Absetz
- grid.502801.e0000 0001 2314 6254Tampere University, Tampere, Finland
| | - Vincent Versace
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | | | - Michael Berk
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia ,grid.414257.10000 0004 0540 0062Barwon Health, Geelong, Australia
| | - Sam Manger
- grid.1011.10000 0004 0474 1797James Cook University, Townsville, Australia
| | | | - Mark Morgan
- grid.1033.10000 0004 0405 3820Bond University, Gold Coast, Australia
| | - Anna Chapman
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | | | - Melissa O’Shea
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | - Tetyana Rocks
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | | | - Adrienne O’Neil
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
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Bhatta M, Bian A, Norwood J, Shepherd BE, Ransby I, Nelson J, Turner M, Sterling TR, Castilho JL. Low rates of contraception use in women with HIV. Open Forum Infect Dis 2022; 9:ofac113. [PMID: 35392458 PMCID: PMC8982767 DOI: 10.1093/ofid/ofac113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Women with human immunodeficiency virus (WWH) have low rates of hormonal or long-acting contraceptive use. Few studies have described contraception use among WWH over time. Methods We examined contraception (including all forms of hormonal contraception, intrauterine devices, and bilateral tubal ligations) use among cisgender women aged 18–45 years in care at Vanderbilt’s human immunodeficiency virus (HIV) clinic in Nashville, Tennessee, from 1998 through 2018. Weighted annual prevalence estimates of contraception use were described. Cox proportional hazards models examined factors associated with incident contraception use and pregnancy. Results Of the 737 women included, median age at clinic entry was 31 years; average follow-up was 4.1 years. At clinic entry, 47 (6%) women were on contraception and 164 (22%) were pregnant. The median annual percentage of time on any contraception use among nonpregnant women was 31.7% and remained stable throughout the study period. Younger age was associated with increased risk of pregnancy and contraceptive use. Psychiatric comorbidity decreased likelihood of contraception (adjusted hazard ratio [aHR], 0.52 [95% CI {confidence interval}, .29–.93]) and increased likelihood of pregnancy (aHR, 1.77 [95% CI, .97–3.25]). While not associated with contraceptive use, more recent year of clinic entry was associated with higher pregnancy risk. Race, substance use, CD4 cell count, HIV RNA, smoking, and antiretroviral therapy were not associated with contraception use nor pregnancy. Conclusions Most WWH did not use contraception at baseline nor during follow-up. Likelihood of pregnancy increased with recent clinic entry while contraception use remained stable over time. Continued efforts to ensure access to effective contraception options are needed in HIV clinics.
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Affiliation(s)
- Manasa Bhatta
- School of Medicine, Vanderbilt University, Nashville, TN, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jamison Norwood
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Imani Ransby
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Nelson
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Megan Turner
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy R Sterling
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica L Castilho
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
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Tuthill E, Bowes L, Kennelly M, Turner M. 146 Virtual role-play: A useful tool for undergraduate obstetrics and gynaecology teaching during a pandemic. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.223] [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: 11/24/2022]
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Pellegrino R, Rebeiro PF, Turner M, Davidson A, Best N, Shaffernocker C, Sterling T, Castilho JL. 53. Sex and Race Disparities in Premature Mortality among People with HIV: A 21-Year Observational Cohort Study. Open Forum Infect Dis 2021. [PMCID: PMC8643894 DOI: 10.1093/ofid/ofab466.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Since the availability of antiretroviral therapy, mortality rates among people with HIV (PWH) have decreased; however, this trend may fail to quantify premature deaths among PWH. We assessed trends and disparities in all-cause and premature mortality by sex, HIV risk factor, and race, among PWH receiving care at the Vanderbilt Comprehensive Care Clinic from January 1998 – December 2018.
Methods
We examined mortality trends across calendar eras using person-time from clinic entry to date of death or December 31, 2018. We compared mortality rates by demographic and clinical factors and calculated adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) using multivariable Poisson regression. For individuals who died, years of potential life lost (YPLL) were obtained from the expected years of life remaining by referencing US sex-specific period life tables at age and year of death; age-adjusted YPLL (aYPLL) rates were also calculated. We examined patient factors associated with YPLL using multivariable linear regression.
Results
Among the 6,531 individuals (51% non-Hispanic [NH] White race, 40% NH Black race, 21% female) included, 956 (14.6%) died. Mortality rates dramatically decreased during the study period (Figure). After adjusting for calendar era, age, injection drug use, hepatitis C virus (HCV), year of HIV diagnosis, history of AIDS-defining illness, CD4 cell count, and HIV RNA at clinic entry, only female sex (aIRR=1.32, 95% CI: 1.13–1.55 vs. males) but not NH Black race (aIRR=1.02, 95% CI: 0.88–1.17 vs. NH White race) was associated with increased mortality. In contrast, aYPLL per 1,000-person years was significantly higher for both female and NH Black PWH (Table 1). In adjusted models including CD4 cell count, HIV RNA, HCV, and year of clinic entry, higher YPLL remained associated with NH Black race, female sex regardless of HIV risk factor, and younger age at HIV diagnosis (Table 2).
Conclusion
Despite marked improvement over time, sex disparities in mortality as well as sex and race disparities in YPLL remained among PWH in care in this cohort. YPLL is a useful measure for examining persistent gaps in longevity and premature mortality among PWH.
Disclosures
Peter F. Rebeiro, PhD, MHS, Gilead (Other Financial or Material Support, Single Honorarium for an Expert Panel)
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Affiliation(s)
| | | | - Megan Turner
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Noelle Best
- Vanderbilt University Medical Center, Nashville, Tennessee
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Erber A, Ewing V, Turner M, Molla M, Murbe G, Davey G, Lang T. Set-up of GoLBeT, a pragmatic clinical trial of podoconiosis management in a low-resource setting. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.023] [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: 11/12/2022] Open
Abstract
Abstract
Clinical trials are often perceived as being expensive, difficult and beyond the capacity of academic groups and healthcare workers in low-resource settings. However, in order to improve healthcare coverage, the WHO World Health Report 2013 stated that all countries need to become generators as well as recipients of data. This study is a methodological examination of the steps and processes involved in setting up the Gojjam Lymphoedema Best Practice Trial (GoLBeT; ISRCTN67805210), a highly pragmatic clinical trial conducted in northern Ethiopia. Challenges to the trial and strategies used to deal with them were explored, together with reasons for delays. A qualitative approach using the Global Health Research Process Map as a framework was used to analyse emails and reports from the period between trial inception and recruitment. This analysis was complemented by interviews with key informants from the operational team and a group discussion. This study showed that the key areas of difficulty in setting up and planning this trial were: the study design (definition and measurement of the study endpoint, and assuring statistical power); recruitment and appropriate training of staff; planning for data quality; and gaining regulatory approvals. Collaboration was essential to successfully setting up the trial. Other important aspects were a team and process perspective, staff training, community engagement, and data quality e.g., through data management. Lessons learnt from this trial might guide in planning pragmatic trials in settings where research is not common, allowing researchers to anticipate challenges and address them through trial design, planning and operational delivery. We also hope that this example might encourage similar pragmatic studies to be undertaken. Such studies are rarely undertaken or locally led, but are an accessible and efficient way to drive improved outcomes in public health.
Key messages
Pragmatic clinical trials are essential to drive improved outcomes in public health in low-resource settings, but are perceived as challenging to set up and initiate. Our analysis of the Gojjam Lymphoedema Best Practice Trial found that factors for a successful set-up were collaborations, a team perspective, staff training, community engagement and data management.
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Affiliation(s)
- A Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Centre for Tropical Medicine and Global Health, NDM, University of Oxford, Oxford, UK
| | - V Ewing
- Centre for Tropical Medicine and Global Health, NDM, University of Oxford, Oxford, UK
| | - M Turner
- Office for National Statistics, Duffryn, Newport, UK
| | - M Molla
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - G Murbe
- Centre for Global Health Research, BSMS, University of Sussex, Brighton, UK
| | - G Davey
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Health Research, BSMS, University of Sussex, Brighton, UK
| | - T Lang
- Centre for Tropical Medicine and Global Health, NDM, University of Oxford, Oxford, UK
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Ali S, Nanda A, Turner M, Swales C. 725 Experience of Implementing Diversity Teaching into University of Oxford. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Medical education should equip students with the necessary skills to support the diverse population they treat and work with and be confident to act as an ally for patients and colleagues. We found there to be a gap for a diversity module in the curriculum at Oxford University.
Method
We created a diversity training session for over 300 medical students aiming to;
The course consisted of a series of talks conducted by a senior lecturer on diversity, doctors, patients, and students, followed by small-group case-based teaching facilitated by a final-year medical student and a junior doctor. All facilitators underwent training by a senior lecturer on diversity. The cases encouraged students to reflect on their own personal biases and enact how they would confront discrimination on the wards. Students completed a survey before and after the session, rating self-confidence on six key learning points.
Results
91.4% students agreed the session was useful to their medical training. There was a significant increase in students who felt confident implementing all learning points: defining key terms (post-session: 95.4%, pre-session: 82.3%); understanding health inequalities (post-session: 93%, pre-session: 54.6%); awareness of personal bias (post-session: 87.9%, pre-session: 70%); partaking in allyship (post-session: 95%, pre-session: 89.5%); and being an active bystander (post-session: 91.4%, pre-session: 45.9%). 79.3% felt confident to challenge acts of discrimination (33.6% pre-session).
Conclusions
This session educates and empowers students to challenge acts of discrimination. We recommend the implementation of similar sessions at all medical schools.
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Affiliation(s)
- S Ali
- University of Oxford, Oxford, United Kingdom
| | - A Nanda
- University of Oxford Clinical Graduate School, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - M Turner
- St George's, University of London Medical School, London, United Kingdom
- Diversity in Medicine and Health Group, London, United Kingdom
| | - C Swales
- Clinical Studies, University of Oxford Medical School, Oxford, United Kingdom
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Leonard MA, Cindi Z, Bradford Y, Bourgi K, Koethe J, Turner M, Norwood J, Woodward B, Erdem H, Basham R, Baker P, Rebeiro PF, Sterling TR, Hulgan T, Daar ES, Gulick R, Riddler SA, Sinxadi P, Ritchie MD, Haas DW. Efavirenz Pharmacogenetics and Weight Gain Following Switch to Integrase Inhibitor-Containing Regimens. Clin Infect Dis 2021; 73:e2153-e2163. [PMID: 32829410 PMCID: PMC8492125 DOI: 10.1093/cid/ciaa1219] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/14/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Unwanted weight gain affects some people living with human immunodeficiency virus (HIV) who are prescribed integrase strand transfer inhibitors (INSTIs). Mechanisms and risk factors are incompletely understood. METHODS We utilized 2 cohorts to study pharmacogenetics of weight gain following switch from efavirenz- to INSTI-based regimens. In an observational cohort, we studied weight gain at 48 weeks following switch from efavirenz- to INSTI-based regimens among patients who had been virologically suppressed for at least 2 years at a clinic in the United States. Associations were characterized with CYP2B6 and UGT1A1 genotypes that affect efavirenz and INSTI metabolism, respectively. In a clinical trials cohort, we studied weight gain at 48 weeks among treatment-naive participants who were randomized to receive efavirenz-containing regimens in AIDS Clinical Trials Group studies A5095, A5142, and A5202 and did not receive INSTIs. RESULTS In the observational cohort (n = 61), CYP2B6 slow metabolizers had greater weight gain after switch (P = .01). This was seen following switch to elvitegravir or raltegravir, but not dolutegravir. UGT1A1 genotype was not associated with weight gain. In the clinical trials cohort (n = 462), CYP2B6 slow metabolizers had lesser weight gain at week 48 among participants receiving efavirenz with tenofovir disoproxil fumarate (P = .001), but not those receiving efavirenz with abacavir (P = .65). Findings were consistent when stratified by race/ethnicity and by sex. CONCLUSIONS Among patients who switched from efavirenz- to INSTI-based therapy, CYP2B6 genotype was associated with weight gain, possibly reflecting withdrawal of the inhibitory effect of higher efavirenz concentrations on weight gain. The difference by concomitant nucleoside analogue is unexplained.
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Affiliation(s)
| | - Zinhle Cindi
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Yuki Bradford
- Department of Genetics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kassem Bourgi
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John Koethe
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Megan Turner
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jamison Norwood
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Rebecca Basham
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paxton Baker
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Todd Hulgan
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric S Daar
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Roy Gulick
- Weill Cornell Medicine, New York, New York, USA
| | | | - Phumla Sinxadi
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marylyn D Ritchie
- Department of Genetics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David W Haas
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Meharry Medical College, Nashville, Tennessee, USA
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Jørgensen JS, Ametova E, Burca G, Fardell G, Papoutsellis E, Pasca E, Thielemans K, Turner M, Warr R, Lionheart WRB, Withers PJ. Core Imaging Library - Part I: a versatile Python framework for tomographic imaging. Philos Trans A Math Phys Eng Sci 2021; 379:20200192. [PMID: 34218673 PMCID: PMC8255949 DOI: 10.1098/rsta.2020.0192] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We present the Core Imaging Library (CIL), an open-source Python framework for tomographic imaging with particular emphasis on reconstruction of challenging datasets. Conventional filtered back-projection reconstruction tends to be insufficient for highly noisy, incomplete, non-standard or multi-channel data arising for example in dynamic, spectral and in situ tomography. CIL provides an extensive modular optimization framework for prototyping reconstruction methods including sparsity and total variation regularization, as well as tools for loading, preprocessing and visualizing tomographic data. The capabilities of CIL are demonstrated on a synchrotron example dataset and three challenging cases spanning golden-ratio neutron tomography, cone-beam X-ray laminography and positron emission tomography. This article is part of the theme issue 'Synergistic tomographic image reconstruction: part 2'.
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Affiliation(s)
- J. S. Jørgensen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
- Department of Mathematics, The University of Manchester, Manchester, UK
| | - E. Ametova
- Laboratory for Applications of Synchrotron Radiation, Karlsruhe Institute of Technology, Karlsruhe, Germany
- Henry Royce Institute, Department of Materials, The University of Manchester, Manchester, UK
| | - G. Burca
- ISIS Neutron and Muon Source, STFC, UKRI, Rutherford Appleton Laboratory, Didcot, UK
- Department of Mathematics, The University of Manchester, Manchester, UK
| | - G. Fardell
- Scientific Computing Department, STFC, UKRI, Rutherford Appleton Laboratory, Didcot, UK
| | - E. Papoutsellis
- Scientific Computing Department, STFC, UKRI, Rutherford Appleton Laboratory, Didcot, UK
- Henry Royce Institute, Department of Materials, The University of Manchester, Manchester, UK
| | - E. Pasca
- Scientific Computing Department, STFC, UKRI, Rutherford Appleton Laboratory, Didcot, UK
| | - K. Thielemans
- Institute of Nuclear Medicine and Centre for Medical Image Computing, University College London, London, UK
| | - M. Turner
- Research IT Services, The University of Manchester, Manchester, UK
| | - R. Warr
- Henry Royce Institute, Department of Materials, The University of Manchester, Manchester, UK
| | | | - P. J. Withers
- Henry Royce Institute, Department of Materials, The University of Manchester, Manchester, UK
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Jørgensen JS, Ametova E, Burca G, Fardell G, Papoutsellis E, Pasca E, Thielemans K, Turner M, Warr R, Lionheart WRB, Withers PJ. Core Imaging Library - Part I: a versatile Python framework for tomographic imaging. Philos Trans A Math Phys Eng Sci 2021. [PMID: 34218673 DOI: 10.5281/zenodo.4744394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We present the Core Imaging Library (CIL), an open-source Python framework for tomographic imaging with particular emphasis on reconstruction of challenging datasets. Conventional filtered back-projection reconstruction tends to be insufficient for highly noisy, incomplete, non-standard or multi-channel data arising for example in dynamic, spectral and in situ tomography. CIL provides an extensive modular optimization framework for prototyping reconstruction methods including sparsity and total variation regularization, as well as tools for loading, preprocessing and visualizing tomographic data. The capabilities of CIL are demonstrated on a synchrotron example dataset and three challenging cases spanning golden-ratio neutron tomography, cone-beam X-ray laminography and positron emission tomography. This article is part of the theme issue 'Synergistic tomographic image reconstruction: part 2'.
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Affiliation(s)
- J S Jørgensen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
- Department of Mathematics, The University of Manchester, Manchester, UK
| | - E Ametova
- Laboratory for Applications of Synchrotron Radiation, Karlsruhe Institute of Technology, Karlsruhe, Germany
- Henry Royce Institute, Department of Materials, The University of Manchester, Manchester, UK
| | - G Burca
- ISIS Neutron and Muon Source, STFC, UKRI, Rutherford Appleton Laboratory, Didcot, UK
- Department of Mathematics, The University of Manchester, Manchester, UK
| | - G Fardell
- Scientific Computing Department, STFC, UKRI, Rutherford Appleton Laboratory, Didcot, UK
| | - E Papoutsellis
- Scientific Computing Department, STFC, UKRI, Rutherford Appleton Laboratory, Didcot, UK
- Henry Royce Institute, Department of Materials, The University of Manchester, Manchester, UK
| | - E Pasca
- Scientific Computing Department, STFC, UKRI, Rutherford Appleton Laboratory, Didcot, UK
| | - K Thielemans
- Institute of Nuclear Medicine and Centre for Medical Image Computing, University College London, London, UK
| | - M Turner
- Research IT Services, The University of Manchester, Manchester, UK
| | - R Warr
- Henry Royce Institute, Department of Materials, The University of Manchester, Manchester, UK
| | - W R B Lionheart
- Department of Mathematics, The University of Manchester, Manchester, UK
| | - P J Withers
- Henry Royce Institute, Department of Materials, The University of Manchester, Manchester, UK
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Konger R, Derr-Yellin E, Zhou H, Turner M. 103 The contact hypersensitivity defect in mice lacking epidermal Pparg requires signaling through TNFR1, TNFR2, and tryptophan hydroxylase 1. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Freischlag K, Olivere L, Turner M, Adam M, Mantyh C, Migaly J. Does Fragmentation of Care in Locally Advanced Rectal Cancer Increase Patient Mortality? J Gastrointest Surg 2021; 25:1287-1296. [PMID: 32754789 DOI: 10.1007/s11605-020-04760-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/19/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate health care fragmentation in patients with stage II and III rectal cancers. BACKGROUND Fragmentation of care among multiple hospitals may worsen outcomes for cancer patients. METHODS National Cancer Database was queried for adult patients who underwent radiation and surgery for locally advanced (stage II-III) rectal adenocarcinoma from 2006 to 2015. Fragmented care was defined as receiving radiation at a different hospital from surgery. Descriptive statistics characterized patients, and survival probability was plotted using the Kaplan-Meier method and a Cox proportional hazards model. RESULTS A total of 37,081 patients underwent surgery and radiation for stage II-III rectal cancer from 2006 to 2015 (24,102 integrated care vs. 12,979 fragmented care). Patients who received fragmented care (hazard ratio [HR] 1.105; 95% CI 1.045-1.169) had a higher risk of mortality. Patients who received at least surgery (HR 0.84; 95% CI 0.77-0.92) at academic hospitals had a lower risk of mortality. Academic hospitals had a higher proportion of patients with fragmented care (38.0 vs. comprehensive community 32.8% vs. community 33.8%, p < 0.001). Within academic hospitals, fragmented care portended worse survival (integrated academic 80.0% vs. fragmented academic 76.7%, p = 0.0002). Fragmented care at academic hospitals had increased survival over integrated care at community hospitals (fragmented academic 76.7 vs. integrated community 72.2%, p = 0.00039). CONCLUSIONS In patients with stage II-III rectal cancer, patients who have integrated care at academic hospitals or at least surgery at academic centers had better survival. All efforts should be made to reduce care fragmentation and surgery at academic centers should be prioritized.
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Affiliation(s)
- Kyle Freischlag
- Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
| | - L Olivere
- Duke University School of Medicine, Durham, NC, USA
| | - M Turner
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - M Adam
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - C Mantyh
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - J Migaly
- Duke University Medical Center, Surgery, Durham, NC, USA
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Batsch F, Muggli P, Agnello R, Ahdida CC, Amoedo Goncalves MC, Andrebe Y, Apsimon O, Apsimon R, Bachmann AM, Baistrukov MA, Blanchard P, Braunmüller F, Burrows PN, Buttenschön B, Caldwell A, Chappell J, Chevallay E, Chung M, Cooke DA, Damerau H, Davut C, Demeter G, Deubner HL, Doebert S, Farmer J, Fasoli A, Fedosseev VN, Fiorito R, Fonseca RA, Friebel F, Furno I, Garolfi L, Gessner S, Gorgisyan I, Gorn AA, Granados E, Granetzny M, Graubner T, Grulke O, Gschwendtner E, Hafych V, Helm A, Henderson JR, Hüther M, Kargapolov IY, Kim SY, Kraus F, Krupa M, Lefevre T, Liang L, Liu S, Lopes N, Lotov KV, Martyanov M, Mazzoni S, Medina Godoy D, Minakov VA, Moody JT, Moon K, Morales Guzmán PI, Moreira M, Nechaeva T, Nowak E, Pakuza C, Panuganti H, Pardons A, Perera A, Pucek J, Pukhov A, Ramjiawan RL, Rey S, Rieger K, Schmitz O, Senes E, Silva LO, Speroni R, Spitsyn RI, Stollberg C, Sublet A, Topaloudis A, Torrado N, Tuev PV, Turner M, Velotti F, Verra L, Verzilov VA, Vieira J, Vincke H, Welsch CP, Wendt M, Wing M, Wiwattananon P, Wolfenden J, Woolley B, Xia G, Zepp M, Zevi Della Porta G. Transition between Instability and Seeded Self-Modulation of a Relativistic Particle Bunch in Plasma. Phys Rev Lett 2021; 126:164802. [PMID: 33961468 DOI: 10.1103/physrevlett.126.164802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/18/2021] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
We use a relativistic ionization front to provide various initial transverse wakefield amplitudes for the self-modulation of a long proton bunch in plasma. We show experimentally that, with sufficient initial amplitude [≥(4.1±0.4) MV/m], the phase of the modulation along the bunch is reproducible from event to event, with 3%-7% (of 2π) rms variations all along the bunch. The phase is not reproducible for lower initial amplitudes. We observe the transition between these two regimes. Phase reproducibility is essential for deterministic external injection of particles to be accelerated.
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Affiliation(s)
- F Batsch
- Max Planck Institute for Physics, Munich, Germany
| | - P Muggli
- Max Planck Institute for Physics, Munich, Germany
| | - R Agnello
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | | | - Y Andrebe
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | - O Apsimon
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - R Apsimon
- Cockcroft Institute, Daresbury, United Kingdom
- Lancaster University, Lancaster, United Kingdom
| | - A-M Bachmann
- Max Planck Institute for Physics, Munich, Germany
| | - M A Baistrukov
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - P Blanchard
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | - P N Burrows
- John Adams Institute, Oxford University, Oxford, United Kingdom
| | - B Buttenschön
- Max Planck Institute for Plasma Physics, Greifswald, Germany
| | - A Caldwell
- Max Planck Institute for Physics, Munich, Germany
| | - J Chappell
- University College London, London, United Kingdom
| | | | - M Chung
- Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - D A Cooke
- University College London, London, United Kingdom
| | | | - C Davut
- Cockcroft Institute, Daresbury, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - G Demeter
- Wigner Research Center for Physics, Budapest, Hungary
| | - H L Deubner
- Philipps-Universität Marburg, Marburg, Germany
| | | | - J Farmer
- Max Planck Institute for Physics, Munich, Germany
- CERN, Geneva, Switzerland
| | - A Fasoli
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | - R Fiorito
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - R A Fonseca
- ISCTE-Instituto Universitéario de Lisboa, Portugal
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | | | - I Furno
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | - S Gessner
- CERN, Geneva, Switzerland
- SLAC National Accelerator Laboratory, Menlo Park, California, USA
| | | | - A A Gorn
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | | | - M Granetzny
- University of Wisconsin, Madison, Wisconsin, USA
| | - T Graubner
- Philipps-Universität Marburg, Marburg, Germany
| | - O Grulke
- Max Planck Institute for Plasma Physics, Greifswald, Germany
- Technical University of Denmark, Lyngby, Denmark
| | | | - V Hafych
- Max Planck Institute for Physics, Munich, Germany
| | - A Helm
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - J R Henderson
- Cockcroft Institute, Daresbury, United Kingdom
- Accelerator Science and Technology Centre, ASTeC, STFC Daresbury Laboratory, Warrington, United Kingdom
| | - M Hüther
- Max Planck Institute for Physics, Munich, Germany
| | - I Yu Kargapolov
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - S-Y Kim
- Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - F Kraus
- Philipps-Universität Marburg, Marburg, Germany
| | | | | | - L Liang
- Cockcroft Institute, Daresbury, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - S Liu
- TRIUMF, Vancouver, Canada
| | - N Lopes
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - K V Lotov
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - M Martyanov
- Max Planck Institute for Physics, Munich, Germany
| | | | | | - V A Minakov
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - J T Moody
- Max Planck Institute for Physics, Munich, Germany
| | - K Moon
- Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | | | - M Moreira
- CERN, Geneva, Switzerland
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - T Nechaeva
- Max Planck Institute for Physics, Munich, Germany
| | | | - C Pakuza
- John Adams Institute, Oxford University, Oxford, United Kingdom
| | | | | | - A Perera
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - J Pucek
- Max Planck Institute for Physics, Munich, Germany
| | - A Pukhov
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - R L Ramjiawan
- CERN, Geneva, Switzerland
- John Adams Institute, Oxford University, Oxford, United Kingdom
| | - S Rey
- CERN, Geneva, Switzerland
| | - K Rieger
- Max Planck Institute for Physics, Munich, Germany
| | - O Schmitz
- University of Wisconsin, Madison, Wisconsin, USA
| | - E Senes
- CERN, Geneva, Switzerland
- John Adams Institute, Oxford University, Oxford, United Kingdom
| | - L O Silva
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | | | - R I Spitsyn
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - C Stollberg
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | | | - N Torrado
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - P V Tuev
- Novosibirsk State University, Novosibirsk, Russia
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - M Turner
- CERN, Geneva, Switzerland
- Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | | | - L Verra
- Max Planck Institute for Physics, Munich, Germany
- CERN, Geneva, Switzerland
- Technical University Munich, Munich, Germany
| | | | - J Vieira
- GoLP/Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | | | - C P Welsch
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | | | - M Wing
- University College London, London, United Kingdom
| | | | - J Wolfenden
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | | | - G Xia
- Cockcroft Institute, Daresbury, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - M Zepp
- University of Wisconsin, Madison, Wisconsin, USA
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Hsu M, Murray J, Zhang J, Barasa D, Turner M, Forde P, Ettinger D, Lam V, Marrone K, Levy B, Hann C, Brahmer J, Feliciano J, Naidoo J. MA07.05 Survivors from Anti-PD-(L)1 Immunotherapy in NSCLC: Clinical Features, Survival Outcomes and Long-term Toxicities. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.186] [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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Bourgi K, Rebeiro PF, Turner M, Castilho JL, Hulgan T, Raffanti SP, Koethe JR, Sterling TR. Greater Weight Gain in Treatment-naive Persons Starting Dolutegravir-based Antiretroviral Therapy. Clin Infect Dis 2021; 70:1267-1274. [PMID: 31100116 DOI: 10.1093/cid/ciz407] [Citation(s) in RCA: 188] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/15/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Recent studies have reported weight gain in virologically suppressed persons living with human immunodeficiency virus (PLWH) switched from older antiretroviral therapy (ART) to newer integrase strand transfer inhibitor (INSTI)-based regimens. In this study, we investigated whether weight gain differs among treatment-naive PLWH starting INSTI-based regimens compared to other ART regimens. METHODS Adult, treatment-naive PLWH in the Vanderbilt Comprehensive Care Clinic cohort initiating INSTI-, protease inhibitor (PI)-, and nonnucleoside reverse transcriptase inhibitor (NNRTI)-based ART between January 2007 and June 2016 were included. We used multivariable linear mixed-effects models to generate marginal predictions of weights over time, adjusting for baseline clinical and demographic characteristics. We used restricted cubic splines to relax linearity assumptions and bootstrapping to generate 95% confidence intervals. RESULTS Among 1152 ART-naive PLWH, 351 initiated INSTI-based regimens (135 dolutegravir, 153 elvitegravir, and 63 raltegravir), 86% were male, and 49% were white. At ART initiation, median age was 35 years, body mass index was 25.1 kg/m2, and CD4+ T-cell count was 318 cells/μL. Virologic suppression at 18 months was similar between different ART classes. At all examined study time points, weight gain was highest among PLWH starting dolutegravir. At 18 months, PLWH on dolutegravir gained 6.0 kg, compared to 2.6 kg for NNRTIs (P < .05), and 0.5 kg for elvitegravir (P < .05). PLWH starting dolutegravir also gained more weight at 18 months compared to raltegravir (3.4 kg) and PIs (4.1 kg), though these differences were not statistically significant. CONCLUSIONS Treatment-naive PLWH starting dolutegravir-based regimens gained significantly more weight at 18 months than those starting NNRTI-based and elvitegravir-based regimens.
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Affiliation(s)
- Kassem Bourgi
- Vanderbilt University Medical Center, Nashville, Tennessee.,Indiana University School of Medicine, Indianapolis
| | | | - Megan Turner
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Todd Hulgan
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - John R Koethe
- Vanderbilt University Medical Center, Nashville, Tennessee
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Pickering KA, Gilroy K, Cassidy JW, Fey SK, Najumudeen AK, Zeiger LB, Vincent DF, Gay DM, Johansson J, Fordham RP, Miller B, Clark W, Hedley A, Unal EB, Kiel C, McGhee E, Machesky LM, Nixon C, Johnsson AE, Bain M, Strathdee D, van Hoof SR, Medema JP, Anderson KI, Brachmann SM, Stucke VM, Malliri A, Drysdale M, Turner M, Serrano L, Myant K, Campbell AD, Sansom OJ. A RAC-GEF network critical for early intestinal tumourigenesis. Nat Commun 2021; 12:56. [PMID: 33397922 PMCID: PMC7782582 DOI: 10.1038/s41467-020-20255-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/17/2020] [Indexed: 01/29/2023] Open
Abstract
RAC1 activity is critical for intestinal homeostasis, and is required for hyperproliferation driven by loss of the tumour suppressor gene Apc in the murine intestine. To avoid the impact of direct targeting upon homeostasis, we reasoned that indirect targeting of RAC1 via RAC-GEFs might be effective. Transcriptional profiling of Apc deficient intestinal tissue identified Vav3 and Tiam1 as key targets. Deletion of these indicated that while TIAM1 deficiency could suppress Apc-driven hyperproliferation, it had no impact upon tumourigenesis, while VAV3 deficiency had no effect. Intriguingly, deletion of either gene resulted in upregulation of Vav2, with subsequent targeting of all three (Vav2-/- Vav3-/- Tiam1-/-), profoundly suppressing hyperproliferation, tumourigenesis and RAC1 activity, without impacting normal homeostasis. Critically, the observed RAC-GEF dependency was negated by oncogenic KRAS mutation. Together, these data demonstrate that while targeting RAC-GEF molecules may have therapeutic impact at early stages, this benefit may be lost in late stage disease.
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Affiliation(s)
- K A Pickering
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - K Gilroy
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - J W Cassidy
- CRUK Cambridge Institute, University of Cambridge, Robinson Way, Cambridge, CB2 ORE, UK
| | - S K Fey
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow, G61 1QH, UK
| | - A K Najumudeen
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - L B Zeiger
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow, G61 1QH, UK
| | - D F Vincent
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - D M Gay
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - J Johansson
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - R P Fordham
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - B Miller
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - W Clark
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - A Hedley
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - E B Unal
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRC), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08003, Barcelona, Spain
- Institute for Theoretical Biology, Humboldt Universität zu Berlin, Berlin, Germany
| | - C Kiel
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRC), Barcelona, Spain
| | - E McGhee
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - L M Machesky
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow, G61 1QH, UK
| | - C Nixon
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - A E Johnsson
- The Babraham Institute, Babraham Hall, Babraham, Cambridge, CB22 3AT, UK
| | - M Bain
- IBAHCM and School of Veterinary Medicine, 464 Bearsden Road, Bearsden, Glasgow, G61 1QH, UK
| | - D Strathdee
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK
| | - S R van Hoof
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine (CEMM) and Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
- Oncode Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - J P Medema
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine (CEMM) and Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
- Oncode Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - K I Anderson
- The Francis Crick Institute, Mill Hill Laboratory, London, NW7 1AA, UK
| | - S M Brachmann
- Novartis Institutes for BioMedical Research, Klybeckstrasse, 141, 4002, Basel, Switzerland
| | - V M Stucke
- Novartis Institutes for BioMedical Research, Klybeckstrasse, 141, 4002, Basel, Switzerland
| | - A Malliri
- CRUK Manchester Institute, 553 Wilmslow Road, Manchester, M20 4BX, UK
| | - M Drysdale
- Broad Institute, 415 Main St, Cambridge, MA, 02142, United States
| | - M Turner
- The Babraham Institute, Babraham Hall, Babraham, Cambridge, CB22 3AT, UK
| | - L Serrano
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRC), Barcelona, Spain
| | - K Myant
- Edinburgh Research Centre, The Institute of Genetics and Molecular Medicine, Crewe Road South, Edinburgh, EH4 2XR, UK.
| | - A D Campbell
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK.
| | - O J Sansom
- CRUK Beatson Institute, Garscube Estate, Switchback Road, Glasgow, G61 1BD, UK.
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Glasgow, G61 1QH, UK.
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Braunmüller F, Nechaeva T, Adli E, Agnello R, Aladi M, Andrebe Y, Apsimon O, Apsimon R, Bachmann AM, Baistrukov MA, Batsch F, Bergamaschi M, Blanchard P, Burrows PN, Buttenschön B, Caldwell A, Chappell J, Chevallay E, Chung M, Cooke DA, Damerau H, Davut C, Demeter G, Deubner LH, Dexter A, Djotyan GP, Doebert S, Farmer J, Fasoli A, Fedosseev VN, Fiorito R, Fonseca RA, Friebel F, Furno I, Garolfi L, Gessner S, Goddard B, Gorgisyan I, Gorn AA, Granados E, Granetzny M, Grulke O, Gschwendtner E, Hafych V, Hartin A, Helm A, Henderson JR, Howling A, Hüther M, Jacquier R, Jolly S, Kargapolov IY, Kedves MÁ, Keeble F, Kelisani MD, Kim SY, Kraus F, Krupa M, Lefevre T, Li Y, Liang L, Liu S, Lopes N, Lotov KV, Martyanov M, Mazzoni S, Medina Godoy D, Minakov VA, Moody JT, Morales Guzmán PI, Moreira M, Muggli P, Panuganti H, Pardons A, Peña Asmus F, Perera A, Petrenko A, Pucek J, Pukhov A, Ráczkevi B, Ramjiawan RL, Rey S, Ruhl H, Saberi H, Schmitz O, Senes E, Sherwood P, Silva LO, Spitsyn RI, Tuev PV, Turner M, Velotti F, Verra L, Verzilov VA, Vieira J, Welsch CP, Williamson B, Wing M, Wolfenden J, Woolley B, Xia G, Zepp M, Zevi Della Porta G. Proton Bunch Self-Modulation in Plasma with Density Gradient. Phys Rev Lett 2020; 125:264801. [PMID: 33449727 DOI: 10.1103/physrevlett.125.264801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
We study experimentally the effect of linear plasma density gradients on the self-modulation of a 400 GeV proton bunch. Results show that a positive or negative gradient increases or decreases the number of microbunches and the relative charge per microbunch observed after 10 m of plasma. The measured modulation frequency also increases or decreases. With the largest positive gradient we observe two frequencies in the modulation power spectrum. Results are consistent with changes in wakefields' phase velocity due to plasma density gradients adding to the slow wakefields' phase velocity during self-modulation growth predicted by linear theory.
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Affiliation(s)
| | - T Nechaeva
- Belarusian State University, Minsk, Belarus
| | - E Adli
- University of Oslo, Oslo, Norway
| | - R Agnello
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | - M Aladi
- Wigner Research Center for Physics, Budapest, Hungary
| | - Y Andrebe
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | - O Apsimon
- Cockcroft Institute, Daresbury, United Kingdom
- Lancaster University, Lancaster, United Kingdom
| | - R Apsimon
- Cockcroft Institute, Daresbury, United Kingdom
- Lancaster University, Lancaster, United Kingdom
| | - A-M Bachmann
- Max Planck Institute for Physics, Munich, Germany
- CERN, Geneva, Switzerland
- Technical University Munich, Munich, Germany
| | - M A Baistrukov
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - F Batsch
- Max Planck Institute for Physics, Munich, Germany
- CERN, Geneva, Switzerland
- Technical University Munich, Munich, Germany
| | | | - P Blanchard
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | - P N Burrows
- John Adams Institute, Oxford University, Oxford, United Kingdom
| | - B Buttenschön
- Max Planck Institute for Plasma Physics, Greifswald, Germany
| | - A Caldwell
- Max Planck Institute for Physics, Munich, Germany
| | | | | | - M Chung
- UNIST, Ulsan, Republic of Korea
| | | | | | - C Davut
- Cockcroft Institute, Daresbury, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - G Demeter
- Wigner Research Center for Physics, Budapest, Hungary
| | - L H Deubner
- Philipps-Universität Marburg, Marburg, Germany
| | - A Dexter
- Cockcroft Institute, Daresbury, United Kingdom
- Lancaster University, Lancaster, United Kingdom
| | - G P Djotyan
- Wigner Research Center for Physics, Budapest, Hungary
| | | | - J Farmer
- Max Planck Institute for Physics, Munich, Germany
- CERN, Geneva, Switzerland
| | - A Fasoli
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | - R Fiorito
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - R A Fonseca
- ISCTE-Instituto Universitéario de Lisboa, Lisbon, Portugal
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | | | - I Furno
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | - S Gessner
- CERN, Geneva, Switzerland
- SLAC National Accelerator Laboratory, Menlo Park, California, USA
| | | | | | - A A Gorn
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | | | - M Granetzny
- University of Wisconsin, Madison, Wisconsin, USA
| | - O Grulke
- Max Planck Institute for Plasma Physics, Greifswald, Germany
- Technical University of Denmark, Lyngby, Denmark
| | | | - V Hafych
- Max Planck Institute for Physics, Munich, Germany
| | | | - A Helm
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - J R Henderson
- Cockcroft Institute, Daresbury, United Kingdom
- Accelerator Science and Technology Centre, ASTeC, STFC Daresbury Laboratory, Warrington, United Kingdom
| | - A Howling
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | - M Hüther
- Max Planck Institute for Physics, Munich, Germany
| | - R Jacquier
- Ecole Polytechnique Federale de Lausanne (EPFL), Swiss Plasma Center (SPC), Lausanne, Switzerland
| | | | - I Yu Kargapolov
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - M Á Kedves
- Wigner Research Center for Physics, Budapest, Hungary
| | | | | | - S-Y Kim
- UNIST, Ulsan, Republic of Korea
| | - F Kraus
- Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Y Li
- Cockcroft Institute, Daresbury, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - L Liang
- Cockcroft Institute, Daresbury, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - S Liu
- TRIUMF, Vancouver, Canada
| | - N Lopes
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - K V Lotov
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - M Martyanov
- Max Planck Institute for Physics, Munich, Germany
| | | | | | - V A Minakov
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - J T Moody
- Max Planck Institute for Physics, Munich, Germany
| | | | - M Moreira
- CERN, Geneva, Switzerland
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - P Muggli
- Max Planck Institute for Physics, Munich, Germany
| | | | | | - F Peña Asmus
- Max Planck Institute for Physics, Munich, Germany
- Technical University Munich, Munich, Germany
| | - A Perera
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - A Petrenko
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
| | - J Pucek
- Max Planck Institute for Physics, Munich, Germany
| | - A Pukhov
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - B Ráczkevi
- Wigner Research Center for Physics, Budapest, Hungary
| | - R L Ramjiawan
- CERN, Geneva, Switzerland
- John Adams Institute, Oxford University, Oxford, United Kingdom
| | - S Rey
- CERN, Geneva, Switzerland
| | - H Ruhl
- Ludwig-Maximilians-Universität, Munich, Germany
| | | | - O Schmitz
- University of Wisconsin, Madison, Wisconsin, USA
| | - E Senes
- CERN, Geneva, Switzerland
- John Adams Institute, Oxford University, Oxford, United Kingdom
| | | | - L O Silva
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - R I Spitsyn
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - P V Tuev
- Budker Institute of Nuclear Physics SB RAS, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | | | | | - L Verra
- Max Planck Institute for Physics, Munich, Germany
- CERN, Geneva, Switzerland
- Technical University Munich, Munich, Germany
| | | | - J Vieira
- GoLP/Instituto de Plasmas e Fusáo Nuclear, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - C P Welsch
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - B Williamson
- Cockcroft Institute, Daresbury, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - M Wing
- UCL, London, United Kingdom
| | - J Wolfenden
- Cockcroft Institute, Daresbury, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | | | - G Xia
- Cockcroft Institute, Daresbury, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - M Zepp
- University of Wisconsin, Madison, Wisconsin, USA
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Paterson C, Kozlovskaia M, Turner M, Strickland K, Roberts C, Ogilvie R, Pranavan G, Craft P. Identifying the supportive care needs of men and women affected by chemotherapy-induced alopecia? A systematic review. J Cancer Surviv 2020; 15:14-28. [PMID: 32683651 DOI: 10.1007/s11764-020-00907-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To systematically evaluate evidence regarding the unmet supportive care needs of men and women affected by chemotherapy-induced alopecia (CIA) to inform clinical practice guidelines. METHODS We performed a review of CINAHL, MEDLINE, PsychINFO, Scopus, the Cochrane Library (CCRT and CDSR) controlled trial databases and clinicaltrials.gov from January 1990 to June 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Twenty-seven publications were selected for inclusion in this analysis. RESULTS Included reports used qualitative (ten) and quantitative (17) studies. Across these studies men and women reported the major impact that CIA had on their psychological well-being, quality of life and body image. Hair loss had a negative impact irrespective of gender, which resulted in feelings of vulnerability and visibility of being a "cancer patient". Men and women described negative feelings, often similar, related to CIA with a range of unmet supportive care needs. CONCLUSIONS Some patients are not well-prepared for alopecia due to a lack of information and resources to reduce the psychological burden associated with CIA. Hair loss will affect each patient and their family differently, therefore, intervention and support must be tailored at an individual level of need to optimise psychological and physical well-being and recovery. IMPLICATIONS FOR CANCER SURVIVORS People affected by CIA may experience a range of unmet supportive care needs, and oncology doctors and nurses are urged to use these findings in their everyday consultations to ensure effective, person-centred care and timely intervention to minimise the sequalae associated with CIA.
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Affiliation(s)
- C Paterson
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia.
- Australian Capital Territory (ACT) Health & Canberra Health Services, Canberra, Australia.
- SYNERGY Nursing & Midwifery, Research Centre, ACT Health Directorate, Canberra Hospital, Canberra, Australia.
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra, ACT, Australia.
- Robert Gordon University, Aberdeen, Scotland.
| | - M Kozlovskaia
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia
- SYNERGY Nursing & Midwifery, Research Centre, ACT Health Directorate, Canberra Hospital, Canberra, Australia
| | - M Turner
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia
| | - K Strickland
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia
- SYNERGY Nursing & Midwifery, Research Centre, ACT Health Directorate, Canberra Hospital, Canberra, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra, ACT, Australia
| | - C Roberts
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra, ACT, Australia
| | - R Ogilvie
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia
- Australian Capital Territory (ACT) Health & Canberra Health Services, Canberra, Australia
- SYNERGY Nursing & Midwifery, Research Centre, ACT Health Directorate, Canberra Hospital, Canberra, Australia
| | - G Pranavan
- Australian Capital Territory (ACT) Health & Canberra Health Services, Canberra, Australia
- Australian National University, Canberra, Australia
| | - P Craft
- Australian Capital Territory (ACT) Health & Canberra Health Services, Canberra, Australia
- Australian National University, Canberra, Australia
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Cooper R, Wilkie G, Samuel K, McMillan L, Vickers M, Turner M, Campbell J, Fraser A. Therapeutic EBV-specific T cell cytotoxicity against allogeneic LCLs in vitro directly correlates to intracellular IFNγ/TNFα expression in response to EBV peptide stimulation. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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46
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Hall T, Jenkins CA, Hulgan T, Furukawa S, Turner M, Pratap S, Sterling TR, Tabatabai M, Berthaud V. Hepatitis C Coinfection and Mortality in People Living with HIV in Middle Tennessee. AIDS Res Hum Retroviruses 2020; 36:193-199. [PMID: 31789047 PMCID: PMC7071089 DOI: 10.1089/aid.2019.0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
HIV and hepatitis C virus (HCV) coinfection is associated with poor health outcomes. This study was designed to assess risk factors for and mortality with coinfection before direct-acting antiviral treatment availability in a state with an evolving opioid epidemic. HCV infection was determined from review of the medical record at two clinics serving the majority of people living with HIV (PLWH) in care in Middle Tennessee from 2004 to 2013. Association of potential risk factors with HCV-positivity was assessed using logistic regression. Association of HCV-positivity with mortality was assessed with a Cox proportional hazards model, adjusting for selected covariates. A total of 3,501 patients were included: 24% female; 51% men who have sex with men; 47% white; 44% African American/black; median age of 38 at their first visit; median most recent CD4 count 502 cells/μL (301-716); and HIV viral load 47 copies/mL (39-605); followed for a median of 3.0 (1-5) years. Prevalence of HCV was 13%. Those with a history of injection drug use (IDU) demonstrated the highest odds of HCV-positivity [odds ratio 12.94; 95% confidence interval (CI) 9.39-17.83]. There were 305 deaths; median age at death was 47 years (40-53). HCV coinfection was associated with greater mortality (hazard ratio 1.61; 95% CI 1.20-2.17; p < .001). Among PLWH, HCV coinfection was associated with IDU and an independent predictor of mortality. These results affirm the importance of HCV coinfection and inform interventions targeting the continuum of HCV care, uptake of HCV treatment, and the impact of drug use in this population.
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Affiliation(s)
- Toni Hall
- Department of Medicine, Meharry Medical College, Nashville, Tennessee
| | - Cathy A Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Hulgan
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sally Furukawa
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Megan Turner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Siddharth Pratap
- Department of Bioinformatics, Meharry Medical College, Nashville, Tennessee
| | - Timothy R Sterling
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohammad Tabatabai
- Department of Biostatistics, Meharry Medical College, Nashville, Tennessee
| | - Vladimir Berthaud
- Department of Medicine, Meharry Medical College, Nashville, Tennessee
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Gschwendtner E, Turner M, Adli E, Ahuja A, Apsimon O, Apsimon R, Bachmann AM, Batsch F, Bracco C, Braunmüller F, Burger S, Burt G, Buttenschön B, Caldwell A, Chappell J, Chevallay E, Chung M, Cooke D, Damerau H, Deubner LH, Dexter A, Doebert S, Farmer J, Fedosseev VN, Fiorito R, Fonseca RA, Friebel F, Garolfi L, Gessner S, Goddard B, Gorgisyan I, Gorn AA, Granados E, Grulke O, Hartin A, Helm A, Henderson JR, Hüther M, Ibison M, Jolly S, Keeble F, Kelisani MD, Kim SY, Kraus F, Krupa M, Lefevre T, Li Y, Liu S, Lopes N, Lotov KV, Martyanov M, Mazzoni S, Minakov VA, Molendijk JC, Moody JT, Moreira M, Muggli P, Panuganti H, Pardons A, Peña Asmus F, Perera A, Petrenko A, Pukhov A, Rey S, Sherwood P, Silva LO, Sosedkin AP, Tuev PV, Velotti F, Verra L, Verzilov VA, Vieira J, Welsch CP, Wendt M, Williamson B, Wing M, Woolley B, Xia G. Correction to 'Proton-driven plasma wakefield acceleration in AWAKE'. Philos Trans A Math Phys Eng Sci 2020; 378:20190539. [PMID: 31865874 PMCID: PMC6939239 DOI: 10.1098/rsta.2019.0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Bertrand-Philippe M, Turner M, Cominos D, Tsikleas G. Extrapulmonary lymphangioleiomyomatosis of the uterus and pelvic lymph nodes: A case report. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Specht S, Scoto M, Childs A, Eglon G, Hastings L, Pysden K, Manning S, Jimenez C, Munot P, Brusa C, Turner M, Guglieri M, Manzur A, Muntoni F, Straub V, Marini-Bettolo C. P.212Mortality in patients with spinal muscular atrophy over the last 10 years: the UK experience. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Castilho JL, Turner M, Shepherd BE, Koethe JR, Furukawa SS, Bofill CE, Raffanti S, Sterling TR. CD4/CD8 Ratio and CD4 Nadir Predict Mortality Following Noncommunicable Disease Diagnosis in Adults Living with HIV. AIDS Res Hum Retroviruses 2019; 35:960-967. [PMID: 31407605 DOI: 10.1089/aid.2019.0064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/24/2022] Open
Abstract
Incidence of noncommunicable diseases (NCDs), including cardiovascular disease (CVD), cirrhosis, and non-AIDS-defining cancers (NADCs), have been associated with HIV viremia, CD4 cell counts, and CD4/CD8 ratio in persons living with HIV (PLWH). This study examined the importance of these markers to mortality risk following NCD diagnosis. We examined factors associated with mortality following incident CVD, cirrhosis, or NADCs in a clinical cohort of PLWH between 1998 and 2015. We calculated Kaplan-Meier estimates and used multivariable Cox proportional hazard models. We included 341 patients with NCDs (CVD = 169, cancer = 103, and cirrhosis = 67), of whom 129 died. Median age at NCD diagnosis was 49 years and median proportion of time before NCD with virologic suppression was 64%. Median survival after CVD was longer than for cancer or cirrhosis (11.6 years vs. 4.8 and 3.4 years, respectively; log rank test p < .001). In multivariable Cox proportional hazard models, higher CD4/CD8 ratio preceding NCD (adjusted hazard ratio [aHR] per 0.1 increase = 0.92 [95% confidence interval 0.85-0.99]) and higher CD4 nadir (aHR per 100 cells/μL = 0.84 [0.72-0.97]) were associated with decreased mortality risk. Neither CD4 cell count before NCD nor HIV viremia was statistically associated with mortality in adjusted models. When restricted to 116 patients with virologic suppression for ≥80% of time before NCD, only CD4 nadir was associated with mortality risk. Low CD4/CD8 ratio and CD4 nadir were associated with increased mortality risk after NCD, suggesting that prior immunosuppression or ongoing immune imbalance remain important for outcomes following serious NCDs.
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Affiliation(s)
- Jessica L. Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John R. Koethe
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sally S. Furukawa
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carmen E. Bofill
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen Raffanti
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Timothy R. Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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