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Sturman N, Tran M, Vasiliadis S. Rescuing the profession we love: general practice training sector recommendations for improving the attractiveness of general practice training. A qualitative analysis. Med J Aust 2024. [PMID: 38699842 DOI: 10.5694/mja2.52291] [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: 06/23/2023] [Accepted: 10/24/2023] [Indexed: 05/05/2024]
Abstract
OBJECTIVES To investigate the views of the general practice training sector about responding to recruitment challenges, with the aim of identifying effective initiatives and other solutions. STUDY DESIGN Qualitative study; focus group discussion of recommendations from a medical educator workshop. SETTING, PARTICIPANTS An initial online appreciative enquiry workshop for medical educators followed by focus group discussions by a broader selection of people involved in general practitioner training (Royal Australian College of General Practitioners fellows, supervisors, practice managers, medical educators, registrars). MAIN OUTCOME MEASURES Key overarching themes and major recommendations for increasing recruitment derived from focus group responses to workshop recommendations, based on qualitative descriptive analysis. RESULTS The 26 medical educators at the workshop made four major recommendations: increase the number of student and junior doctor clinical placements in general practice; increase exposure of students and junior doctors to general practitioner teachers and educators; improve general practitioner trainee pay and entitlements; and improve the integration of general practice and hospital patient care and professional relationships. Thirty-four semi-structured focus group participants broadly supported the recommendations, provided that supervisors and training practices were adequately compensated for the effects on workloads, income, and patient care. Two overarching themes infused participant responses: "rescuing the profession we love" (reflecting participants' passion for general practice and their sense of threat), and "no idea what general practitioners do" (perceptions of being misunderstood and misrepresented by hospital-based practitioners). CONCLUSIONS Clinicians, educators, and policy makers should work together to increase the number of high quality, adequately supported student and junior doctor placements in general practice, improve intra-professional relationships, and trial new models of general practitioner trainee payment and conditions.
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Sabour S, Bantle K, Bhatnagar A, Huang JY, Biggs A, Bodnar J, Dale JL, Gleason R, Klein L, Lasure M, Lee R, Nazarian E, Schneider E, Smith L, Snippes Vagnone P, Therrien M, Tran M, Valley A, Wang C, Young EL, Lutgring JD, Brown AC. Descriptive analysis of targeted carbapenemase genes and antibiotic susceptibility profiles among carbapenem-resistant Acinetobacter baumannii tested in the Antimicrobial Resistance Laboratory Network-United States, 2017-2020. Microbiol Spectr 2024; 12:e0282823. [PMID: 38174931 PMCID: PMC10845962 DOI: 10.1128/spectrum.02828-23] [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: 08/17/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
Acinetobacter baumannii is a Gram-negative bacillus that can cause severe and difficult-to-treat healthcare-associated infections. A. baumannii can harbor mobile genetic elements carrying genes that produce carbapenemase enzymes, further limiting therapeutic options for infections. In the United States, the Antimicrobial Resistance Laboratory Network (AR Lab Network) conducts sentinel surveillance of carbapenem-resistant Acinetobacter baumannii (CRAB). Participating clinical laboratories sent CRAB isolates to the AR Lab Network for characterization, including antimicrobial susceptibility testing and molecular detection of class A (Klebsiella pneumoniae carbapenemase), class B (Active-on-Imipenem, New Delhi metallo-β-lactamase, and Verona integron-encoded metallo-β-lactamase), and class D (Oxacillinase, blaOXA-23-like, blaOXA-24/40-like, blaOXA-48-like, and blaOXA-58-like) carbapenemase genes. During 2017‒2020, 6,026 CRAB isolates from 45 states were tested for targeted carbapenemase genes; 1% (64 of 5,481) of CRAB tested for targeted class A and class B genes were positive, but 83% (3,351 of 4,041) of CRAB tested for targeted class D genes were positive. The number of CRAB isolates carrying a class A or B gene increased from 2 of 312 (<1%) tested in 2017 to 26 of 1,708 (2%) tested in 2020. Eighty-three percent (2,355 of 2,846) of CRAB with at least one of the targeted carbapenemase genes and 54% (271 of 500) of CRAB without were categorized as extensively drug resistant; 95% (42 of 44) of isolates carrying more than one targeted gene had difficult-to-treat susceptibility profiles. CRAB isolates carrying targeted carbapenemase genes present an emerging public health threat in the United States, and their rapid detection is crucial to improving patient safety.IMPORTANCEThe Centers for Disease Control and Prevention has classified CRAB as an urgent public health threat. In this paper, we used a collection of >6,000 contemporary clinical isolates to evaluate the phenotypic and genotypic properties of CRAB detected in the United States. We describe the frequency of specific carbapenemase genes detected, antimicrobial susceptibility profiles, and the distribution of CRAB isolates categorized as multidrug resistant, extensively drug-resistant, or difficult to treat. We further discuss the proportion of isolates showing susceptibility to Food and Drug Administration-approved agents. Of note, 84% of CRAB tested harbored at least one class A, B, or D carbapenemase genes targeted for detection and 83% of these carbapenemase gene-positive CRAB were categorized as extensively drug resistant. Fifty-four percent of CRAB isolates without any of these carbapenemase genes detected were still extensively drug-resistant, indicating that infections caused by CRAB are highly resistant and pose a significant risk to patient safety regardless of the presence of one of these carbapenemase genes.
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Affiliation(s)
- Sarah Sabour
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katie Bantle
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amelia Bhatnagar
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y. Huang
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela Biggs
- Maryland Department of Health, Baltimore, Maryland, USA
| | | | | | - Rachel Gleason
- Tennessee Department of Health, Nashville, Tennessee, USA
| | - Liore Klein
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Megan Lasure
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Rachel Lee
- Texas Department of State Health Services, Austin, Texas, USA
| | | | - Emily Schneider
- Washington State Department of Health Public Health Laboratories, Shoreline, Washington, USA
| | - Lori Smith
- Utah Public Health Laboratory, Taylorsville, Utah, USA
| | | | | | - Michael Tran
- Washington State Department of Health Public Health Laboratories, Shoreline, Washington, USA
| | - Ann Valley
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Chun Wang
- Texas Department of State Health Services, Austin, Texas, USA
| | - Erin L. Young
- Utah Public Health Laboratory, Taylorsville, Utah, USA
| | - Joseph D. Lutgring
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C. Brown
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Tran M, Rhee J, Smith O. Improving feedback literacy in a primary care rotation. Med Teach 2024:1-3. [PMID: 38306963 DOI: 10.1080/0142159x.2024.2310591] [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] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
Primary care education is a unique clinical experience for medical students. It is community-based and provides an opportunity for students to learn consultation skills with multiple sources of workplace-based feedback. Meaningful and demonstrable utilisation of this feedback by students remains an educational challenge. We showcase achievable changes to educational tasks in an established curriculum, which aim to improve student feedback literacy and create a feedback loop which improves on previous provision of unidirectional, terminal feedback. The changes have been well-received, with student and educator engagement being positive. Students have demonstrated critical reflection on feedback, and development in consultation and clinical reasoning skills.
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Affiliation(s)
- Michael Tran
- School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Joel Rhee
- School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Oliver Smith
- School of Population Health, University of New South Wales, Kensington, NSW, Australia
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Magin P, Ralston A, Fielding A, Holliday E, Tran M, Tapley A, van Driel M, Ball J, Moad D, Mitchell B, Fisher K, FitzGerald K, Spike N, Turner R, Davey A. Prediction of general practice licensure/certification examination performance by a measure of 'questionable' activities in clinical practice: a retrospective cohort study. Postgrad Med J 2024:qgad147. [PMID: 38298001 DOI: 10.1093/postmj/qgad147] [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: 10/19/2023] [Revised: 11/26/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE 'Low-value' clinical care and medical services are 'questionable' activities, being more likely to cause harm than good or with disproportionately low benefit relative to cost. This study examined the predictive ability of the QUestionable In Training Clinical Activities Index (QUIT-CAI) for general practice (GP) registrars' (trainees') performance in Australian GP Fellowship examinations (licensure/certification examinations for independent GP). METHODS The study was nested in ReCEnT, an ongoing cohort study in which Australian GP registrars document their in-consultation clinical practice. Outcome factors in analyses were individual registrars' scores on the three Fellowship examinations ('AKT', 'KFP', and 'OSCE' examinations) and pass/fail rates during 2012-21. Analyses used univariable and multivariable regression (linear or logistic, as appropriate). The study factor in each analysis was 'QUIT-CAI score percentage'-the percentage of times a registrar performed a QUIT-CAI clinical activity when 'at risk' (i.e. when managing a problem where performing a QUIT-CAI activity was a plausible option). RESULTS A total of 1265, 1145, and 553 registrars sat Applied Knowledge Test, Key Features Problem, and Objective Structured Clinical Exam examinations, respectively. On multivariable analysis, higher QUIT-CAI score percentages (more questionable activities) were significantly associated with poorer Applied Knowledge Test scores (P = .001), poorer Key Features Problem scores (P = .003), and poorer Objective Structured Clinical Exam scores (P = .005). QUIT-CAI score percentages predicted Royal Australian College of General Practitioner exam failure [odds ratio 1.06 (95% CI 1.00, 1.12) per 1% increase in QUIT-CAI, P = .043]. CONCLUSION Performing questionable clinical activities predicted poorer performance in the summative Fellowship examinations, thereby validating these examinations as measures of actual clinical performance (by our measure of clinical performance, which is relevant for a licensure/certification examination).
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Affiliation(s)
- Parker Magin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- General Practice Training Research Department, Royal Australian College of General Practitioners, Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304, Australia
| | - Anna Ralston
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- General Practice Training Research Department, Royal Australian College of General Practitioners, Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304, Australia
| | - Alison Fielding
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- General Practice Training Research Department, Royal Australian College of General Practitioners, Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Michael Tran
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, High Street and Botany Road, Kensington, Sydney, NSW 2052, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- General Practice Training Research Department, Royal Australian College of General Practitioners, Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304, Australia
| | - Mieke van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Dominica Moad
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- General Practice Training Research Department, Royal Australian College of General Practitioners, Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304, Australia
| | - Ben Mitchell
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
| | - Katie Fisher
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- General Practice Training Research Department, Royal Australian College of General Practitioners, Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304, Australia
| | - Kristen FitzGerald
- General Practice Training Tasmania (GPTT), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000, Australia
- School of Medicine, University of Tasmania, Level 1, Medical Science 1, 17 Liverpool Street, Hobart, TAS 7000, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training (EVGPT), 15 Cato Street, Hawthorn, VIC 3122, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street, Carlton, VIC 3053, Australia
- School of Rural Health, Monash University, Faculty of Medicine, Nursing and Health Sciences. Building 20/26 Mercy Street, Bendigo, VIC 3550, Australia
| | - Rachel Turner
- General Practice Training Research Department, Royal Australian College of General Practitioners, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Andrew Davey
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- General Practice Training Research Department, Royal Australian College of General Practitioners, Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304, Australia
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Marshall KH, Riddiford-Harland DL, Meller AE, Kruger V, Kirsebom M, Tran M, Caplan GA, Naganathan V, Cullen J, Gonski P, Zwar N, O'Keeffe JA, Krysinska K, Rhee JJ. Feasibility and acceptability of facilitated advance care planning in outpatient clinics: A qualitative study of health-care professionals experience. Australas J Ageing 2024. [PMID: 38258915 DOI: 10.1111/ajag.13272] [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: 05/29/2023] [Revised: 10/15/2023] [Accepted: 11/24/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE This study sought to determine the feasibility and acceptability of a facilitated advance care planning (ACP) intervention implemented in outpatient clinics, as perceived by health-care professionals (HCPs). METHODS Data from seven focus groups (n = 27) and nine semi-structured interviews with HCPs recruited as part of a pragmatic, randomised controlled trial (RCT) were analysed using qualitative descriptive methodology. Components of the intervention included HCP education and training, tools to assist HCPs with patient selection, hardcopy information, and ACP documentation, and specialised nurse-facilitators to support HCPs to complete ACP conversations and documentation with patients and caregivers. RESULTS Health-care professionals working in tertiary outpatient clinics perceived the facilitated ACP intervention as feasible and acceptable. Health-care professionals reported a high level of satisfaction with key elements of the intervention, including the specialised education and training, screening and assessment procedures and ongoing support from the nurse-facilitators. Health-care professionals reported this training and support increased their confidence and ACP knowledge, leading to more frequent ACP discussions with patients and their families. Health-care professionals noted their ability to conduct ACP screening and assessment in clinic was impeded by large clinical caseloads and patient-related factors (e.g., dementia diagnoses, and emotional distress). Additional barriers to ACP implementation identified by HCPs included poor collaboration, constrained time and clinical space, undefined roles and standardised recording procedures for HCPs. CONCLUSIONS Facilitated ACP intervention in outpatient clinics is perceived by HCPs as feasible and acceptable. Addressing barriers and tailoring implementation strategies may improve the delivery of ACP as part of tertiary outpatient care.
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Affiliation(s)
- Kate H Marshall
- Faculty of Medicine & Health, UNSW Academic General Practice Network, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Anne E Meller
- Advance Care Planning Services, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Vanessa Kruger
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Marie Kirsebom
- Section of Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Michael Tran
- Faculty of Medicine & Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Gideon A Caplan
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Faculty of Medicine and Health, Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - John Cullen
- Faculty of Medicine and Health, Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Peter Gonski
- Southcare Aged and Extended Community Care, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Julie-Ann O'Keeffe
- Aged, Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Karolina Krysinska
- Centre for Primary Health Care and Equity, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Joel J Rhee
- Faculty of Medicine & Health, UNSW Academic General Practice Network, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine & Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Bhatnagar AS, Machado MJ, Patterson L, Anderson K, Abelman RL, Bateman A, Biggs A, Bumpus-White P, Craft B, Howard M, LaVoie SP, Lonsway D, Sabour S, Schneider A, Snippes-Vagnone P, Tran M, Torpey D, Valley A, Elkins CA, Karlsson M, Brown AC. Antimicrobial Resistance Laboratory Network's multisite evaluation of the ThermoFisher Sensititre GN7F broth microdilution panel for antimicrobial susceptibility testing. J Clin Microbiol 2023; 61:e0079923. [PMID: 37971271 PMCID: PMC10729754 DOI: 10.1128/jcm.00799-23] [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: 06/22/2023] [Accepted: 09/25/2023] [Indexed: 11/19/2023] Open
Abstract
In 2017, the Centers for Disease Control and Prevention (CDC) established the Antimicrobial Resistance Laboratory Network to improve domestic detection of multidrug-resistant organisms. CDC and four laboratories evaluated a commercial broth microdilution panel. Antimicrobial susceptibility testing using the Sensititre GN7F (ThermoFisher Scientific, Lenexa, KS) was evaluated by testing 100 CDC and Food and Drug Administration AR Isolate Bank isolates [40 Enterobacterales (ENT), 30 Pseudomonas aeruginosa (PSA), and 30 Acinetobacter baumannii (ACB)]. We assessed multiple amounts of transfer volume (TV) between the inoculum and tubed 11-mL cation-adjusted Mueller-Hinton broth: 1 µL [tribe Proteeae (P-tribe) only] and 10, 30, and 50 µL, resulting in respective CFU per milliter of 1 × 104, 1 × 105, 3 × 105, and 5 × 105. Four TV combinations were analyzed: standard (STD) [1 µL (P-tribe) and 10 µL], enhanced standard (E-STD) [1 µL (P-tribe) and 30 µL], 30 µL, and 50 µL. Essential agreement (EA), categorical agreement, major error (ME), and very major error (VME) were analyzed by organism then TVs. For ENT, the average EA across laboratories was <90% for 7 of 15 β-lactams using STD and E-STD TVs. As TVs increased, EA increased (>90%), and VMEs decreased. For PSA, EA improved as TVs increased; however, MEs also increased. For ACB, increased TVs provided slight EA improvements; all TVs yielded multiple VMEs and MEs. For ENT and ACB, Minimum inhibitory concentrations (MICs) trended downward using a 1 or 10 µL TV; there were no obvious MIC trends by TV for PSA. The public health and clinical consequences of missing resistance warrant increased TV of 30 µL for the GN7F, particularly for P-tribe, despite being considered "off-label" use.
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Affiliation(s)
- Amelia S. Bhatnagar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - María-José Machado
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Logan Patterson
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Karen Anderson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Allen Bateman
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Angela Biggs
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Porscha Bumpus-White
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Goldbelt C6, LLC, Chesapeake, Virginia, USA
| | - Bradley Craft
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | | | - Stephen P. LaVoie
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David Lonsway
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Sabour
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Michael Tran
- Washington State Department of Health, Shoreline, Washington, USA
| | - David Torpey
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Ann Valley
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Christopher A. Elkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Goldbelt C6, LLC, Chesapeake, Virginia, USA
| | - Allison C. Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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7
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McFarland MS, Tran M, Ourth HL, Morreale AP. Evaluation of Patient Experience with Veterans Affairs Clinical Pharmacist Practitioners Providing Comprehensive Medication Management. J Pharm Pract 2023; 36:1356-1361. [PMID: 35924640 DOI: 10.1177/08971900221117892] [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] [Indexed: 11/15/2022]
Abstract
Patient experience is considered an important dimension of health care quality and thus is included as part of the quadruple aim of health care. The VHA Clinical Pharmacist Practitioner (CPP) operates as an advanced practice provider (APP) providing comprehensive medication management (CMM) with authority to initiate, discontinue or modify medication under a scope of practice (SOP). The VHA CPP practices in many different outpatient clinical areas to include but not limited to primary care, mental health, pain management, cardiology, substance use disorder and anticoagulation. While literature regarding the ability of the VHA CPP to increase access and quality of care is well published, very little information exist regarding patient experience with the VHA CPP. We sought to report the patient experience with VHA CPP as measured electronically over 1 year by Veterans. Patient experience surveys were electronically sent to randomly selected Veterans via email to evaluate a recent outpatient healthcare encounter at a VA medical center or outpatient clinic with a CPP with scoring on a Likert scale of 1-5 with 5 being optimal. A total of 743 Veteran surveys were completed for a response rate of 20%. For individual domains of patient experience based on respondent scores of 4 or 5, ease and simplicity were rated at 94.4%, quality 91.9%, employee helpfulness 94.9%, satisfaction 95.0% and confidence/trust 91.9%. Results demonstrate that Veterans' experience with the CPP in every patient care experience domain was positive with scores ranging from the low to high 90th percentile.
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Affiliation(s)
- Michael S McFarland
- U.S. Department of Veterans Affairs, Clinical Pharmacy Practice Office, Washington, D.C, USA
| | - Michael Tran
- U.S. Department of Veterans Affairs, Clinical Pharmacy Practice Office, Washington, D.C, USA
| | - Heather L Ourth
- U.S. Department of Veterans Affairs, Clinical Pharmacy Practice Office, Washington, D.C, USA
| | - Anthony P Morreale
- U.S. Department of Veterans Affairs, Clinical Pharmacy Practice Office, Washington, D.C, USA
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8
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Miller DR, Reisman JI, McDannold SE, Kleinberg F, Gillespie C, Zogas A, Ndiwane N, Ourth HL, Morreale AP, Tran M, McCullough MB. Clinical pharmacist practitioners on primary care teams play an important role in caring for complex patients with diabetes. Am J Health Syst Pharm 2023; 80:1637-1649. [PMID: 37566141 DOI: 10.1093/ajhp/zxad176] [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: 08/07/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE To evaluate whether clinical pharmacist practitioners (CPPs) are being utilized to care for patients with complex medication regimens and multiple chronic illnesses, we compared the clinical complexity of diabetes patients referred to CPPs in team primary care and those in care by other team providers (OTPs). METHODS In this cross-sectional comparison of patients with diabetes in the US Department of Veterans Affairs (VA) healthcare system in the 2017-2019 period, patient complexity was based on clinical factors likely to indicate need for more time and resources in medication and disease state management. These factors include insulin prescriptions; use of 3 or more other diabetes medication classes; use of 6 or more other medication classes; 5 or more vascular complications; metabolic complications; 8 or more other complex chronic conditions; chronic kidney disease stage 3b or higher; glycated hemoglobin level of ≥10%; and medication regime nonadherence. RESULTS Patients with diabetes referred to one of 110 CPPs for care (n = 12,728) scored substantially higher (P < 0.001) than patients with diabetes in care with one of 544 OTPs (n = 81,183) on every complexity measure, even after adjustment for age, sex, race, and marital status. Based on composite summary scores, the likelihood of complexity was 3.42 (interquartile range, 3.25-3.60) times higher for those in ongoing CPP care (ie, those with 2 or more visits) versus OTP care. Patients in CPP care also were, on average, younger, more obese, and had more prior outpatient visits and hospital stays. CONCLUSION The greater complexity of patients with diabetes seen by CPPs in primary care suggests that CPPs are providing valuable services in comprehensive medication and disease management of complex patients.
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Affiliation(s)
- Donald R Miller
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, MA, USA
| | - Joel I Reisman
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Sarah E McDannold
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Felicia Kleinberg
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Chris Gillespie
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Anna Zogas
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Ndindam Ndiwane
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Heather L Ourth
- Pharmacy Benefits Management Services, National Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC, USA
| | - Anthony P Morreale
- Pharmacy Benefits Management Services, National Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC, USA
| | - Michael Tran
- Pharmacy Benefits Management Services, National Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC, USA
| | - Megan B McCullough
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- Zuckerberg School of Health Sciences, Department of Public Health, University of Massachusetts, Lowell, MA, USA
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Ralston A, Fielding A, Holliday E, Ball J, Tapley A, van Driel M, Davey A, Turner R, Moad D, FitzGerald K, Spike N, Mitchell B, Tran M, Fisher K, Magin P. 'Low-value' clinical care in general practice: a cross-sectional analysis of low-value care in early-career GPs' practice. Int J Qual Health Care 2023; 35:0. [PMID: 37757860 DOI: 10.1093/intqhc/mzad081] [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: 04/17/2023] [Revised: 07/11/2023] [Accepted: 09/27/2023] [Indexed: 09/29/2023] Open
Abstract
Nonevidence-based and 'low-value' clinical care and medical services are 'questionable' clinical activities that are more likely to cause harm than good or whose benefit is disproportionately low compared with their cost. This study sought to establish general practitioner (GP), patient, practice, and in-consultation associations of an index of key nonevidence-based or low-value 'questionable' clinical practices. The study was nested in the Registrar Clinical Encounters in Training study-an ongoing (from 2010) cohort study in which Australian GP registrars (specialist GP trainees) record details of their in-consultation clinical and educational practice 6-monthly. The outcome factor in analyses, performed on Registrar Clinical Encounters in Training data from 2010 to 2020, was the score on the QUestionable In-Training Clinical Activities Index (QUIT-CAI), which incorporates recommendations of the Australian Choosing Wisely campaign. A cross-sectional analysis used negative binomial regression (with the model including an offset for the number of times the registrar was at risk of performing a questionable activity) to establish associations of QUIT-CAI scores. A total of 3206 individual registrars (response rate 89.9%) recorded 406 812 problems/diagnoses where they were at risk of performing a questionable activity. Of these problems/diagnoses, 15 560 (3.8%) involved questionable activities being performed. In multivariable analyses, higher QUIT-CAI scores (more questionable activities) were significantly associated with earlier registrar training terms: incidence rate ratios (IRRs) of 0.91 [95% confidence interval (CI) 0.87, 0.95] and 0.85 (95% CI 0.80, 0.90) for Term 2 and Term 3, respectively, compared to Term 1. Other significant associations of higher scores included the patient being new to the registrar (IRR 1.27; 95% CI 1.12, 1.45), the patient being of non-English-speaking background (IRR 1.24; 95% CI 1.04, 1.47), the practice being in a higher socioeconomic area decile (IRR 1.01; 95% CI 1.00, 1.02), small practice size (IRR 1.05; 95% CI 1.00, 1.10), shorter consultation duration (IRR 0.99 per minute; 95% CI 0.99, 1.00), and fewer problems addressed in the consultation (IRR 0.84; 95% CI 0.79, 0.89) for each additional problem]. Senior registrars' clinical practice entailed less 'questionable' clinical actions than junior registrars' practice. The association of lower QUIT-CAI scores with a measure of greater continuity of care (the patient not being new to the registrar) suggests that continuity should be supported and facilitated during GP training (and in established GPs' practice).
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Affiliation(s)
- Anna Ralston
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Alison Fielding
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Elizabeth Holliday
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
| | - Amanda Tapley
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Mieke van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
| | - Andrew Davey
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Rachel Turner
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Dominica Moad
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Kristen FitzGerald
- General Practice Training Tasmania (GPTT), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000, Australia
- University of Tasmania, School of Medicine, Level 1, Medical Science 1, 17 Liverpool Street, Hobart, TAS 7000, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training (EVGPT), 15 Cato Street, Hawthorn, VIC 3122, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street, Carlton, VIC 3053, Australia
- Monash University, School of Rural Health, Building 20/26 Mercy St, Bendigo, VIC 3550, Australia
| | - Ben Mitchell
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
| | - Michael Tran
- University of New South Wales, School of Population Health, High Street and Botany Road, Kensington, NSW 2052, Australia
| | - Katie Fisher
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Parker Magin
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
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Buch R, Tran M, Hinojosa J, Wooten D, Gokaslan S, Moeller D, Loomis M. Harnessing the Near-Peer Effect in Anatomy Education. Med Sci Educ 2023; 33:1033-1034. [PMID: 37886299 PMCID: PMC10597959 DOI: 10.1007/s40670-023-01841-9] [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] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 10/28/2023]
Abstract
Benefits of near-peer teaching are well-documented, but its time requirements can be prohibitive. We integrated the near-peer effect into a clinical anatomy course with weekly student-developed handouts vetted by faculty to provide an element of near-peer teaching without the burden of extra time.
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Affiliation(s)
- R. Buch
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, 925 City Central Ave, Conroe, TX 77304 USA
| | - M. Tran
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, 925 City Central Ave, Conroe, TX 77304 USA
| | - J. Hinojosa
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, 925 City Central Ave, Conroe, TX 77304 USA
| | - D. Wooten
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, 925 City Central Ave, Conroe, TX 77304 USA
| | - S. Gokaslan
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, 925 City Central Ave, Conroe, TX 77304 USA
| | - D. Moeller
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, 925 City Central Ave, Conroe, TX 77304 USA
| | - M. Loomis
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, 925 City Central Ave, Conroe, TX 77304 USA
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11
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Tran M, Shrake K, Chera BS, DePaoli B, Duffy EW, Hall MB, Steinman JS, Myers S, Igiebor OS, Sauls L, Pratt S, Callahan J, McDonald DG, Harper JL, Cooper SL. Reducing Patient Care Delays in Radiation Oncology via Optimization of Insurance Pre-Authorization. Int J Radiat Oncol Biol Phys 2023; 117:S97-S98. [PMID: 37784616 DOI: 10.1016/j.ijrobp.2023.06.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Difficulties and delays in insurance pre-authorization (pre-auth) can negatively impact patient care, resulting in postponing, modifying, or even cancelling radiation therapy for patients. Unfortunately, pre-auth delays are not uncommon. The purpose of our project was to perform a root cause analysis of reasons for pre-auth delays, and implement solutions to optimize our workflow to better serve our patients. Our primary objectives were to decrease the mean time for clinical treatment plan (CTP) completion, and for number of cases delayed/denied, by 50% each. MATERIALS/METHODS We performed a root cause analysis of reasons for pre-auth delays and used the PDSA & A3 quality improvement methods. We sampled ∼2 cases per disease site (total 19 cases from July - Aug 2022) to determine the "current state," pre-interventions. Countermeasures included: 1) customizing our CTP templates for each disease site to contain the specific clinical information required by each insurer, 2) formalizing earlier completion of CTPs through task automation at time of scheduling CT simulation in our Care Path, and 3) continuously refining our countermeasures based on monthly status updates and department meetings. We tracked various physician, authorization, and outcome-metrics between October 2022 and January 2023, including mean time for CTP completion, % usage of our Care Path, % usage of revised CTP templates, mean time until pre-auth initiated & completed, % of cases requiring peer-to-peer phone calls, and % of cases denied/delayed. RESULTS There were 417 patients from a variety of disease sites who had a CT simulation at our institution between October 1, 2022, and January 31, 2023. Mean time for CTP completion (from the time of CT simulation request) improved from 16 days at baseline to 7 days by the end of the project. In the beginning, only 5% of CTPs were completed within 2 days of scheduling the CT simulation, and this improved to 42-56% during the project period. Percent usage of the Care Path improved dramatically from 16% to 91%, as did % usage of our revised CTP templates, from 0% to 96%. Despite initial lag in pre-authorization team workflow changes, the % of pre-authorizations initiated by day 3 from CT request improved from 32% at baseline to 48% by month 4. Mean time to complete insurance pre-authorizations improved from 16 days at baseline to 10 days. The percent of cases requiring peer to peer or were denied was reduced significantly from 32% at baseline to 4-11%. CONCLUSION Improvingtimeliness and details of CTP documentation by using our Care Path and revising CTP templates improved efficiency of insurance pre-auth completion, and reduced the number of cases delayed/denied.
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Affiliation(s)
- M Tran
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - K Shrake
- Medical University of South Carolina, Charleston, SC
| | - B S Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - B DePaoli
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - E W Duffy
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - M B Hall
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - J S Steinman
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - S Myers
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - O S Igiebor
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - L Sauls
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - S Pratt
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - J Callahan
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - D G McDonald
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - J L Harper
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - S L Cooper
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
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Tran M, Lawrence R, Abalo C, Manski-Nankervis JA, Heal C, Douglas K, Rhee J. Improving general practice research in Australia. Aust J Gen Pract 2023; 52:734-736. [PMID: 37788696 DOI: 10.31128/ajgp-12-22-6642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
- Michael Tran
- MBBS (Hons), BSc (Med) (Hons), DCH, FRACGP, AFHEA, General Practitioner, Erskineville Doctors, Newtown, NSW; Lecturer in General Practice, Discipline of General Practice, School of Population Health, UNSW Medicine @ Health, Sydney, NSW
| | - Renae Lawrence
- BMed/MD, SCHP, FRACGP, AFHEA, General Practitioner, Kareela Family Practice, Kareela, NSW; Lecturer in General Practice, Discipline of General Practice, School of Population Health, UNSW Medicine @ Health, Sydney, NSW
| | - Christabel Abalo
- BPharm (Hons), MD, General Practice Registrar, Discipline of General Practice, School of Population Health, UNSW Medicine @ Health, Sydney, NSW
| | - Jo-Anne Manski-Nankervis
- BSc (Hons), MBBS@(Hons), CHIA, PhD, FRACGP, Academic General Practitioner; Lead @ Data Driven Quality Improvement Research Theme, Department of General Practice, The University of Melbourne, Melbourne, Vic
| | - Clare Heal
- MBChB, DRANZCOG, DipGUMed, SM Epi, FRACGP, MPHTM, PhD, General Practitioner; Promotional Chair, Discipline of General Practice, Mackay Clinical School, College of Medicine and Dentistry, James Cook University, Mackay, Qld
| | - Kirsty Douglas
- MBBS, DipRACOG, MD, FRACGP, General Practitioner at Interchange Health Cooperative, Greenway, ACT; Professor of General Practice, Australian National University School of Medicine and Psychology, Canberra, ACT; Director, Academic Unit of General Practice, Office of Professions, Leadership and Education, Health System, Policy and Research Division, ACT Health Directorate, Canberra, ACT
| | - Joel Rhee
- BSc (Med), MBBS (Hons), GCULT, PhD, FRACGP, General Practitioner, Residential Aged Care Homes, Sydney, NSW; Head of Discipline of General Practice, School of Population Health, UNSW Medicine @ Health, Sydney, NSW
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13
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Fisher K, Fielding A, Ralston A, Holliday E, Ball J, Tran M, Davey A, Tapley A, Magin P. Exam prediction and the general Practice Registrar Competency Assessment Grid (GPR-CAG). Educ Prim Care 2023; 34:268-276. [PMID: 38011869 DOI: 10.1080/14739879.2023.2269884] [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: 02/09/2023] [Accepted: 10/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND In GP training, identifying early predictors of poor summative examination performance can be challenging. We aimed to establish whether external clinical teaching visit (ECTV) performance, measured using a validated instrument (GP Registrar Competency Assessment Grid, GPR-CAG) is predictive of Royal Australian College of General Practitioners (RACGP) Fellowship examination performance. METHODS A retrospective cohort study including GP registrars in New South Wales/Australian Capital Territory with ECTV data recorded during their first training term (GPT1), between 2014 and 2018, who attempted at least one Fellowship examination. Independent variables of interest included the four GPR-CAG factors assessed in GPT1 ('patient-centredness/caring', 'formulating hypotheses/management plans', 'professional responsibilities', 'physical examination skills'). Outcomes of interest included individual scores of the three summative examinations (Applied Knowledge Test (AKT); Key Feature Problem (KFP); and the Objective Structured Clinical Examination (OSCE)) and overall Pass/Fail status. Univariable and multivariable regression analyses were performed. RESULTS Univariably, there were statistically significant associations (p < 0.01) between all four GPR-CAG factors and all four summative examination outcomes, except for 'formulating hypotheses/management plans' and OSCE score (p = 0.07). On multivariable analysis, each factor was significantly associated (p < 0.05) with at least one exam outcome, and 'physical examination skills' was significantly associated (p < 0.05) with all four exam outcomes. DISCUSSION ECTV performance, via GPR-CAG scores, is predictive of RACGP Fellowship exam performance. The univariable findings highlight the pragmatic utility of ECTVs in flagging registrars who are at-risk of poor exam performance, facilitating early intervention. The multivariable associations of GPR-CAG scores and examination performance suggest that these scores provide predictive ability beyond that of other known predictors.
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Affiliation(s)
- Katie Fisher
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Alison Fielding
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Anna Ralston
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Jean Ball
- Clinical Research Design IT and Statistical Support, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Michael Tran
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
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14
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Nowaskie RR, Kitch A, Adams A, Anandaraj A, Apawan E, Bañuelos L, Betz CJ, Bogunia JM, Buechlein N, Burns MR, Collier HA, Collins Z, Combs K, Dakarian VD, Daniel A, De Jesus III CM, Erickson JD, Estrada B, Estrada K, Fields S, Gabriel M, Garcia RM, Gitamo S, Granath E, Hardin SN, Hattling E, Henriquez AVL, Hernandez D, Johnson L, Kim AH, Kolley LK, Larue KM, Lockwood E, Longoria N, Lopez C, Lopez-Roca Fernandez RC, Lozano S, Manthie C, May T, Mehrzad Z, Mendoza I, Mohan S, Mounthachak C, Muyizere M, Myers MR, Newton J, Nwawueze A, Paredes AJ, Pezdek MN, Phat Nguyen H, Pobuda N, Sadat S, Sailor JJ, Santiago D, Sbarbaro M, Schultz III DE, Senobari AN, Shouse EM, Snarski SM, Solano E, Solis Campos N, Stewart E, Szczepaniak J, Tejeda M, Teoli DF, Tran M, Trivedi N, Uribe Aristizabal L, Vargas BZ, Walker III KW, Wasiqi J, Wong J, Zachrel A, Shah HP, Small E, Watts CT, Croonquist P, Devergne O, Jones AK, Taylor EE, Kagey JD, Merkle JA. clifford B.4.1 , an allele of CG1603 , causes tissue overgrowth in the Drosophila melanogaster eye. MicroPubl Biol 2023; 2023:10.17912/micropub.biology.000936. [PMID: 37680216 PMCID: PMC10481159 DOI: 10.17912/micropub.biology.000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
Mutant B.4.1 , generated via EMS mutagenesis in Drosophila melanogaster , was studied by undergraduate students participating in the Fly-CURE. After inducing genetically mosaic tissue in the adult eye, B.4.1 mutant tissue displays a robust increase in cell division and a rough appearance. Complementation mapping and sequence analysis identified a nonsense mutation in the gene CG1603 , which we named clifford ( cliff ) due to observed increases in red-pigmented mutant tissue compared to controls. cliff encodes a zinc finger-containing protein implicated in transcriptional control. RNAi knockdown of cliff similarly results in rough eyes, confirming a role for Cliff in eye development.
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Affiliation(s)
| | - Ashley Kitch
- University of Evansville, Evansville, Indiana, United States
| | - Abby Adams
- Northern Illinois University, DeKalb, Illinois, United States
| | - Abinaya Anandaraj
- Anoka-Ramsey Community College, Coon Rapids, Minnesota, United States
| | - Ethan Apawan
- The University of Texas at San Antonio, San Antonio, Texas, United States
| | | | - Cassandra J Betz
- Anoka-Ramsey Community College, Coon Rapids, Minnesota, United States
| | - Julia M Bogunia
- Northern Illinois University, DeKalb, Illinois, United States
| | | | - Morgan R Burns
- Northern Illinois University, DeKalb, Illinois, United States
| | | | - Zach Collins
- Northern Illinois University, DeKalb, Illinois, United States
| | - Kynzie Combs
- University of Evansville, Evansville, Indiana, United States
| | - Vana D Dakarian
- Northern Illinois University, DeKalb, Illinois, United States
| | - Abigail Daniel
- University of Evansville, Evansville, Indiana, United States
| | | | - John D Erickson
- University of Evansville, Evansville, Indiana, United States
| | - Bianca Estrada
- Northern Illinois University, DeKalb, Illinois, United States
| | - Kevin Estrada
- Northern Illinois University, DeKalb, Illinois, United States
| | - Sydney Fields
- Northern Illinois University, DeKalb, Illinois, United States
| | - Maya Gabriel
- The University of Texas at San Antonio, San Antonio, Texas, United States
| | | | - Sylvia Gitamo
- Anoka-Ramsey Community College, Coon Rapids, Minnesota, United States
| | - Emma Granath
- Northern Illinois University, DeKalb, Illinois, United States
| | - Sabrina N Hardin
- The University of Texas at San Antonio, San Antonio, Texas, United States
| | - Emily Hattling
- Anoka-Ramsey Community College, Coon Rapids, Minnesota, United States
| | | | - Destiny Hernandez
- The University of Texas at San Antonio, San Antonio, Texas, United States
| | - Luke Johnson
- Anoka-Ramsey Community College, Coon Rapids, Minnesota, United States
| | - Annie H Kim
- University of Evansville, Evansville, Indiana, United States
| | | | | | - Erin Lockwood
- Northern Illinois University, DeKalb, Illinois, United States
| | - Nelia Longoria
- The University of Texas at San Antonio, San Antonio, Texas, United States
| | - Cassandra Lopez
- Northern Illinois University, DeKalb, Illinois, United States
| | | | - Sofia Lozano
- The University of Texas at San Antonio, San Antonio, Texas, United States
| | - Carissa Manthie
- Anoka-Ramsey Community College, Coon Rapids, Minnesota, United States
| | - Trinity May
- Anoka-Ramsey Community College, Coon Rapids, Minnesota, United States
| | - Zorah Mehrzad
- University of Evansville, Evansville, Indiana, United States
| | - Itzel Mendoza
- Northern Illinois University, DeKalb, Illinois, United States
| | - Somya Mohan
- The University of Texas at San Antonio, San Antonio, Texas, United States
| | | | | | | | - Jayce Newton
- Northern Illinois University, DeKalb, Illinois, United States
| | | | | | | | - Hoang Phat Nguyen
- Anoka-Ramsey Community College, Coon Rapids, Minnesota, United States
| | - Nadia Pobuda
- Anoka-Ramsey Community College, Coon Rapids, Minnesota, United States
| | - Sahar Sadat
- Northern Illinois University, DeKalb, Illinois, United States
| | | | - David Santiago
- Northern Illinois University, DeKalb, Illinois, United States
| | | | | | | | - Emma M Shouse
- University of Evansville, Evansville, Indiana, United States
| | - Sarah M Snarski
- Northern Illinois University, DeKalb, Illinois, United States
| | | | | | - Elnora Stewart
- University of Evansville, Evansville, Indiana, United States
| | | | - Michael Tejeda
- Northern Illinois University, DeKalb, Illinois, United States
| | - Dominic F Teoli
- Northern Illinois University, DeKalb, Illinois, United States
| | - Michael Tran
- The University of Texas at San Antonio, San Antonio, Texas, United States
| | - Nishita Trivedi
- University of Evansville, Evansville, Indiana, United States
| | | | - Bryan Z Vargas
- Northern Illinois University, DeKalb, Illinois, United States
| | | | - Joseph Wasiqi
- Northern Illinois University, DeKalb, Illinois, United States
| | - Joyi Wong
- The University of Texas at San Antonio, San Antonio, Texas, United States
| | - Adira Zachrel
- Northern Illinois University, DeKalb, Illinois, United States
| | - Hemin P Shah
- Northern Illinois University, DeKalb, Illinois, United States
| | - Elizabeth Small
- Northern Illinois University, DeKalb, Illinois, United States
| | - Charlie T Watts
- University of Evansville, Evansville, Indiana, United States
| | - Paula Croonquist
- Anoka-Ramsey Community College, Coon Rapids, Minnesota, United States
| | | | - Amy K Jones
- The University of Texas at San Antonio, San Antonio, Texas, United States
| | | | - Jacob D Kagey
- University of Detroit Mercy, Detroit, Michigan, United States
| | - Julie A Merkle
- University of Evansville, Evansville, Indiana, United States
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15
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Tran M, Lea V, Zhao C, Kristoffersen S. Venous eczema and chronic venous disease. BMJ 2023; 382:e074602. [PMID: 37591526 DOI: 10.1136/bmj-2022-074602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Michael Tran
- Department of General Practice, The University of New South Wales, School of Population Health, NSW, Australia
- Erskineville Doctors, Newtown, NSW
| | - Vivienne Lea
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW
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Ambrosio FJ, Scribner MR, Wright SM, Otieno JR, Doughty EL, Gorzalski A, Siao DD, Killian S, Hua C, Schneider E, Tran M, Varghese V, Libuit KG, Pandori M, Sevinsky JR, Hess D. TheiaEuk: a species-agnostic bioinformatics workflow for fungal genomic characterization. Front Public Health 2023; 11:1198213. [PMID: 37593727 PMCID: PMC10428623 DOI: 10.3389/fpubh.2023.1198213] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/04/2023] [Indexed: 08/19/2023] Open
Abstract
Introduction The clinical incidence of antimicrobial-resistant fungal infections has dramatically increased in recent years. Certain fungal pathogens colonize various body cavities, leading to life-threatening bloodstream infections. However, the identification and characterization of fungal isolates in laboratories remain a significant diagnostic challenge in medicine and public health. Whole-genome sequencing provides an unbiased and uniform identification pipeline for fungal pathogens but most bioinformatic analysis pipelines focus on prokaryotic species. To this end, TheiaEuk_Illumina_PE_PHB (TheiaEuk) was designed to focus on genomic analysis specialized to fungal pathogens. Methods TheiaEuk was designed using containerized components and written in the workflow description language (WDL) to facilitate deployment on the cloud-based open bioinformatics platform Terra. This species-agnostic workflow enables the analysis of fungal genomes without requiring coding, thereby reducing the entry barrier for laboratory scientists. To demonstrate the usefulness of this pipeline, an ongoing outbreak of C. auris in southern Nevada was investigated. We performed whole-genome sequence analysis of 752 new C. auris isolates from this outbreak. Furthermore, TheiaEuk was utilized to observe the accumulation of mutations in the FKS1 gene over the course of the outbreak, highlighting the utility of TheiaEuk as a monitor of emerging public health threats when combined with whole-genome sequencing surveillance of fungal pathogens. Results A primary result of this work is a curated fungal database containing 5,667 unique genomes representing 245 species. TheiaEuk also incorporates taxon-specific submodules for specific species, including clade-typing for Candida auris (C. auris). In addition, for several fungal species, it performs dynamic reference genome selection and variant calling, reporting mutations found in genes currently associated with antifungal resistance (FKS1, ERG11, FUR1). Using genome assemblies from the ATCC Mycology collection, the taxonomic identification module used by TheiaEuk correctly assigned genomes to the species level in 126/135 (93.3%) instances and to the genus level in 131/135 (97%) of instances, and provided zero false calls. Application of TheiaEuk to actual specimens obtained in the course of work at a local public health laboratory resulted in 13/15 (86.7%) correct calls at the species level, with 2/15 called at the genus level. It made zero incorrect calls. TheiaEuk accurately assessed clade type of Candida auris in 297/302 (98.3%) of instances. Discussion TheiaEuk demonstrated effectiveness in identifying fungal species from whole genome sequence. It further showed accuracy in both clade-typing of C. auris and in the identification of mutations known to associate with drug resistance in that organism.
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Affiliation(s)
| | | | | | | | | | | | | | - Steve Killian
- Alameda County Public Health Laboratory, Oakland, CA, United States
| | - Chi Hua
- Public Health Laboratories, Division of Disease Control and Health Statistics, Washington State Department of Health, Shoreline, WA, United States
| | - Emily Schneider
- Public Health Laboratories, Division of Disease Control and Health Statistics, Washington State Department of Health, Shoreline, WA, United States
| | - Michael Tran
- Public Health Laboratories, Division of Disease Control and Health Statistics, Washington State Department of Health, Shoreline, WA, United States
| | - Vici Varghese
- Alameda County Public Health Laboratory, Oakland, CA, United States
| | | | - Mark Pandori
- Nevada State Public Health Laboratory, Reno, NV, United States
- Department of Pathology and Laboratory Medicine, Reno School of Medicine, University of Nevada, Reno, NV, United States
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV, United States
| | | | - David Hess
- Nevada State Public Health Laboratory, Reno, NV, United States
- Department of Pathology and Laboratory Medicine, Reno School of Medicine, University of Nevada, Reno, NV, United States
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17
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Tran M, Anderson K. Takeaway tinctures. Med J Aust 2023; 218:192. [PMID: 36623827 DOI: 10.5694/mja2.51822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 01/11/2023]
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Tran M, Wearne S, Fielding A, Moad D, Tapley A, Holliday E, Ball J, Davey A, van Driel M, FitzGerald K, Spike N, Bentley M, Kirby C, Magin P. Early-career general practitioners' perceptions of the utility of vocational training for subsequent independent practice. Educ Prim Care 2023; 34:74-82. [PMID: 36851829 DOI: 10.1080/14739879.2023.2176264] [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] [Indexed: 03/01/2023]
Abstract
PURPOSE To evaluate Australian early-career general practitioners' perceptions of the utility of their prior vocational training in preparing them for independent specialist practice. We hypothesised that in-practice teaching would be perceived as more useful than formal education delivered by Regional Training Organisations (RTOs). METHODS AND MATERIALS A cross-sectional questionnaire-based study of early-career general practitioners (RTO 'alumni'). The outcomes were Likert scale ratings of alumni's perceived impact of RTO education versus in-practice training on their preparedness for independent practice. Ratings were compared using Wilcoxon signed-rank tests. Multivariable linear regression was used to establish alumni characteristics associated with perceptions of utility of in-practice versus RTO-delivered education. RESULTS Three hundred and fifty-four alumni responded (response rate 28%). In-practice training was rated statistically significantly higher than RTO education for minor procedural skills, teaching skills, professional responsibilities, tolerating clinical uncertainty, and preparing for managing child and adolescent health, aged care, chronic disease, multi-morbidity and mental health. RTO education rated higher than in-practice training for practising evidence-based medicine and Aboriginal and Torres Strait Islander health. For a number of further areas, there was no statistically significant difference in alumni ratings of utility. CONCLUSIONS In-practice or RTO-led teaching was perceived as more useful for some components of independent practice, whilst for others there was no significant difference. The findings support recognition of the individual educational components of a blended education/training structure.
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Affiliation(s)
- Michael Tran
- Department of General Practice, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Wearne
- Academic Unit of General Practice, ANU Medical School, Australian National University, Canberra, ACT, Australia.,Health Workforce Division, Australian Government Department of Health, Canberra, ACT, Australia
| | - Alison Fielding
- School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, Australia
| | - Dominica Moad
- School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), New Lambton Heights, Newcastle, Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, Australia
| | - Mieke van Driel
- General Practice Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kristen FitzGerald
- Australian General Practice Training, General Practice Training Tasmania (GPPT), Regional Training Organisation, Hobart, Tasmania, Australia.,Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Neil Spike
- Australian General Practice Training, Eastern Victoria General Practice Training Regional Training Organisation, Hawthorn, Melbourne, Australia.,Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Melbourne, Australia.,Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Churchill, New South Wales, Australia
| | - Michael Bentley
- Australian General Practice Training, General Practice Training Tasmania (GPPT), Regional Training Organisation, Hobart, Tasmania, Australia
| | - Catherine Kirby
- Australian General Practice Training, Eastern Victoria General Practice Training Regional Training Organisation, Hawthorn, Melbourne, Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, Australia
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19
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Zogas A, Gillespie C, Kleinberg F, Reisman J, Ndiwane N, Tran M, Ourth H, Morreale A, Miller D, McCullough M. Clinical pharmacy practitioners' semi-visible labor: building referral relationships in interprofessional collaborative care. J Interprof Care 2023:1-8. [PMID: 36708309 DOI: 10.1080/13561820.2023.2169665] [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] [Indexed: 01/29/2023]
Abstract
Clinical pharmacy practitioners (CPP) in the Veterans Health Administration (VHA) prescribe medications and help manage chronic conditions such as diabetes, and they are increasingly working as part of interprofessional clinical teams. The challenges of integrating a new role in a clinical team are documented, but we know less about strategies new healthcare providers use to overcome these challenges. We studied how clinical pharmacy practitioners integrated into clinical teams. We conducted telephone interviews with clinical pharmacy practitioners (n = 53) and members of their clinical teams (n = 74), which were recorded, transcribed, and coded for concepts and themes. We identified four major themes. We found CPP perceived VHA as a "safe haven" for interprofessional care but found it necessary to build other prescribers' trust and confidence in their clinical skills to establish the referral relationships they needed for full integration. To facilitate their integration, CPP engaged in relational, untracked labor, which we characterize as semi-visible labor. While both CPP and clinical team members perceived CPPs' semi-visible labor as vital for implementing and maintaining strong interprofessional collaborations, such labor may be unsustainable as a long-term strategy for integrating CPP in clinical teams.
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Affiliation(s)
- Anna Zogas
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Chris Gillespie
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Felicia Kleinberg
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Joel Reisman
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Ndindam Ndiwane
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Michael Tran
- Pharmacy Benefits Management Services, National Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC, USA
| | - Heather Ourth
- Pharmacy Benefits Management Services, National Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC, USA
| | - Anthony Morreale
- Pharmacy Benefits Management Services, National Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC, USA
| | - Donald Miller
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Center for Population Health, University of Massachusetts, Lowell, Massachusetts, USA
| | - Megan McCullough
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Zuckerberg School of Health Sciences, Department of Public Health, University of Massachusetts, Lowell, Massachusetts, USA
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20
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Lefèvre C, Plocque A, Tran M, Creux M, Philippart F. [Should we interfere with the interleukin-6 receptor during COVID-19: What do we know?]. Rev Mal Respir 2023; 40:24-37. [PMID: 36577608 PMCID: PMC9791331 DOI: 10.1016/j.rmr.2022.11.085] [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: 09/20/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
COVID-19 is a viral infection with predominant respiratory tropism. In its most severe forms, the initial viral aggression leads to acute respiratory failure due to damage secondary to an exacerbated inflammatory response provoked by the activation of innate, followed by adaptive immunity. The inflammatory response may entail respiratory distress syndrome, if not multivisceral failure and death. IL-6 receptor inhibitors (Tocilizumab and Sarilumab) have been proposed as treatments. Numerous studies have provided new information, which remains heterogeneous and difficult to interpret. This review is aimed at clarifying the potential role of IL-6 receptor inhibitors in severe forms of COVID-19.
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Affiliation(s)
- C. Lefèvre
- Medical and Surgical Intensive Care Unit, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - A. Plocque
- Medical and Surgical Intensive Care Unit, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - M. Tran
- Medical and Surgical Intensive Care Unit, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - M. Creux
- Medical and Surgical Intensive Care Unit, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - F. Philippart
- Medical and Surgical Intensive Care Unit, groupe hospitalier Paris Saint-Joseph, Paris, France,Endotoxins, Structures and Host Response, Department of Microbiology, Institute for Integrative Biology of the Cell, UMR 9891 CNRS-CEA-Paris Saclay University, 98190 Gif-sur-Yvette, France,Auteur correspondant
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21
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Roosan D, Wu Y, Tran M, Huang Y, Baskys A, Roosan MR. Opportunities to integrate nutrigenomics into clinical practice and patient counseling. Eur J Clin Nutr 2023; 77:36-44. [PMID: 35444269 DOI: 10.1038/s41430-022-01146-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little progress has been made in translating nutrigenomics knowledge into clinical counseling in the past decade. Currently, clinicians are overwhelmed by nutrigenomics information without the proper scientific guidelines on patient counseling. METHODS In this study, we conducted a scoping review of the primary literature to assess the current evidence of nutrigenomics counseling. A literature search using PRISMA guidelines identified the current challenges and opportunities facing nutrigenomics counseling in clinical practice. RESULTS We identified four main themes: inadequate training, lack of awareness, underdeveloped nutrigenomics counseling skills, and unreliable evidence-based practice information. Many clinicians did not have the necessary knowledge to perform nutrigenomic counseling and were unaware of the available scientific information source. Moreover, there are no guidelines in the scientific community to counsel patients on nutrigenomics testing. CONCLUSION Opportunities exist for government and non-government entities to create an evidence-based information platform using clinical guidelines to integrate nutrigenomics knowledge from bench to bedside successfully.
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Affiliation(s)
- Don Roosan
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA.
| | - Yanting Wu
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Michael Tran
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Ying Huang
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Andrius Baskys
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA, USA
| | - Moom R Roosan
- School of Pharmacy, Chapman University, Irvine, CA, USA
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22
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Tran M, Wong LC, Thiruvilangam V, Moir D. Atypical melanoma: clinicopathological features and management in general practice. Br J Gen Pract 2022; 72:545-547. [PMID: 36302688 PMCID: PMC9591078 DOI: 10.3399/bjgp22x721169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michael Tran
- Church St Medical Practice, Newtown, NSW; lecturer, University of New South Wales, Sydney; conjoint lecturer, Western Sydney University, Sydney
| | - Li-Chuen Wong
- Children's Hospital, Westmead; clinical senior lecturer, University of Sydney, Sydney; chair, NSW Faculty, Australasian College of Dermatologists
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23
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Tran M, Yoon S, Teoh M, Andersen S, Lam PY, Purdue BW, Raghubar A, Hanson SJ, Devitt K, Jones K, Walters S, Monkman J, Kulasinghe A, Tuong ZK, Soyer HP, Frazer IH, Nguyen Q. A robust experimental and computational analysis framework at multiple resolutions, modalities and coverages. Front Immunol 2022; 13:911873. [PMID: 35967449 PMCID: PMC9373800 DOI: 10.3389/fimmu.2022.911873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
The ability to study cancer-immune cell communication across the whole tumor section without tissue dissociation is needed, especially for cancer immunotherapy development, which requires understanding of molecular mechanisms and discovery of more druggable targets. In this work, we assembled and evaluated an integrated experimental framework and analytical process to enable genome-wide scale discovery of ligand-receptors potentially used for cellular crosstalks, followed by targeted validation. We assessed the complementarity of four different technologies: single-cell RNA sequencing and Spatial transcriptomic (measuring over >20,000 genes), RNA In Situ Hybridization (RNAscope, measuring 4-12 genes) and Opal Polaris multiplex protein staining (4-9 proteins). To utilize the multimodal data, we implemented existing methods and also developed STRISH (Spatial TRanscriptomic In Situ Hybridization), a computational method that can automatically scan across the whole tissue section for local expression of gene (e.g. RNAscope data) and/or protein markers (e.g. Polaris data) to recapitulate an interaction landscape across the whole tissue. We evaluated the approach to discover and validate cell-cell interaction in situ through in-depth analysis of two types of cancer, basal cell carcinoma and squamous cell carcinoma, which account for over 70% of cancer cases. We showed that inference of cell-cell interactions using scRNA-seq data can misdetect or detect false positive interactions. Spatial transcriptomics still suffers from misdetecting lowly expressed ligand-receptor interactions, but reduces false discovery. RNAscope and Polaris are sensitive methods for defining the location of potential ligand receptor interactions, and the STRISH program can determine the probability that local gene co-expression reflects true cell-cell interaction. We expect that the approach described here will be widely applied to discover and validate ligand receptor interaction in different types of solid cancer tumors.
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Affiliation(s)
- M. Tran
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - S. Yoon
- Genome Innovation Hub, The University of Queensland, Brisbane, QLD, Australia
| | - M. Teoh
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - S. Andersen
- Genome Innovation Hub, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience (IMB) Sequencing Facility, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - PY. Lam
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - B. W. Purdue
- Genome Innovation Hub, The University of Queensland, Brisbane, QLD, Australia
| | - A. Raghubar
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - SJ. Hanson
- School of Medical Science, Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia
| | - K. Devitt
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - K. Jones
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - S. Walters
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - J. Monkman
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - A. Kulasinghe
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - ZK. Tuong
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Medical Research Council (MRC)-Laboratory of Molecular Biology, Brisbane, United Kingdom
- Cellular Genetics, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - HP. Soyer
- The University of Queensland Diamantina Institute, Dermatology Research Center, The University of Queensland, Brisbane, QLD, Australia
| | - I. H. Frazer
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Q. Nguyen
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- *Correspondence: Q. Nguyen,
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To MS, Lu L, Tran M, Chong C. Preferential reporting of significant p-values in radiology journal abstracts. Clin Radiol 2022; 77:743-748. [PMID: 35810024 DOI: 10.1016/j.crad.2022.05.025] [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] [Received: 01/31/2022] [Revised: 05/04/2022] [Accepted: 05/30/2022] [Indexed: 11/03/2022]
Abstract
AIM To assess the prevalence of publication bias in the radiology literature, data-mining techniques were used to extract p-values in abstracts published in key radiology journals over the past 20 years. MATERIALS AND METHODS A total of 34,699 abstracts published in Radiology, Investigative Radiology, European Radiology, American Journal of Roentgenology, and American Journal of Neuroradiology published between January 2000 and December 2019 were included in the analysis. Automated text mining using regular expressions was used to mine abstracts for p-values. RESULTS The text mining algorithm detected 43,489 p-values, the majority (82.4%) of which were reported as "significant", i.e., p<0.05. There has also been an increased propensity to report more p-values over time. The distribution of p-values showed a step change at the conventional significance threshold of 0.05. The odds ratio of a "significant" p-value being reported in the abstract compared to the full text was calculated to be 2.52 (95% confidence interval 1.78-3.58; p<0.001). Taken together, these results provide strong evidence for selective reporting of significant p-values in abstracts. CONCLUSION Statistically significant p-values are preferentially reported in radiology journal abstracts.
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Affiliation(s)
- M-S To
- Flinders Health and Medical Research Institute, Bedford Park, SA, Australia; Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia.
| | - L Lu
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - M Tran
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - C Chong
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
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Triantafillou T, HIckman C, Derick R, Tran M, Nikitos E, Kontopoulos G, Vasilopoulos I, Kostaras K, Mpotzaki D. O-123 FMEA analysis of an automatic integration of time-lapse incubators into electronic medical records using CHLOE(Fairtility) shows risk reduction through automation of data capture and processing. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.023] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Can integrations and automatic data processing between time-lapse incubators and EMRs reduce the risks associated with manual moving of data from time-lapse incubators to EMRs
Summary answer
Redesigning data workflow using CHLOE(Fairtility) decreased risk occurrence and increased risk detection possibilities associated with embryo classification and selection to freeze, biopsy, transfer and discard.
What is known already
Decisions are made from information derived from time-lapse incubators. Clinically, embryologists decide which embryos (and when) are suitable for transfer, cryopreservation, biopsy, or discarding based on data derived from time-lapse incubators, manually annotated and summarised into the electronic medical record (EMR) where further information useful for embryo selection is stored. Manual movement of data from time-lapse incubators to EMRs is time-consuming, administrative, reduces the granularity of the data available and incurs risk of human-error inaccuracies. These challenges limit the possibilities of how this data can be used to optimise clinical decisions, improve the patient experience and proactively detect operational anomalies.
Study design, size, duration
Failure mode effects analysis (FMEA) analysis was carried out on the workflow integration into a large (>5000 cycles per annum) IVF centre following ESHRE guidelines for laboratory and time-lapse practice (ESHRE,2015,2020), comparing before and after the introduction of CHLOE(Fairtility). The FMEA analysis evaluated the possible data capture, processing and associated clinical decision risks from embryos entering to leaving the time-lapse incubator. The Risk Priority Number (RPN=likelihoodxseverityxdetection of incidence) was calculated for each failure mode (Rienzi,2015).
Participants/materials, setting, methods
Through authenticated REST API calls according to the OpenAPI standard, CHLOE(Fairtility) linked the treatment unique identifier from the EMR(LIVO, inhouse developed) to the time-lapse incubator, automatically processed the time-lapse data, captured quantitative and qualitative information (such as morphokinetic time points, PNs, cleavage and blastocyst morphological grades, unusual embryo developmental anomalies and prediction scores for blastulation and implantation) and automatically loaded into the EMR.
Main results and the role of chance
Before CHLOE(Fairtility), 8 process phases were identified, with 81 associated failure modes, among which 45 risks were given a moderate RPN [RPN>15, i.e. data entry error into the EMR; image feature detection missed (i.e. 2PNs, Inner Cell Mass, incorrectly diagnosing fragments as cells and vice versa; incorrectly diagnosing vacuoles as a PNs, asynchronous PNs missed),with consequences including inaccurate KPI monitoring (n = 20, RPN=4); reduced patient experience and increased stress (n = 18, RPN range 3-16); wrong embryo being selected (n = 42, RPN range 8-36). Wrong embryo selection had three possible consequences: viable embryo discarded leading to a reduction in efficacy of treatment; viable embryo not prioritised for transfer causing reduced chance of pregnancy, or increased time to pregnancy, increasing cost and emotional burden); euploid embryo not prioritised for biopsy, increasing cost. Overall, RPN ranged from 3 to 36.
After CHLOE(Fairtility), 51 failure modes were eliminated completely, including quantitative and qualitative morphokinetic annotations, entering data into the EMR for daily embryo grades, and embryo fate decisions. A further 22 failure modes had reduced RPN, including blastocyst morphological grading, number of PNs, identification of unusual embryo cleavages; with 30 low RPNs and 6 moderate RPNs. Implementation of CHLOE(Fairtility) reduced the highest RPN from 36 to 16.
Limitations, reasons for caution
FMEA is a proactive method to identify potential incidents in order to develop strategies to mitigate risks, forming part of a framework for responsible innovation. The likelihood of incidences were estimated based on a PUBMED literature review, personal experience and the experience of colleagues.
Wider implications of the findings
CHLOE(Fairtility) has the potential to eliminate risks that exist when manually moving data from time-lapse incubators to EMRs: time-consuming, administrative, reduced data granularity and human-error-based inaccuracies. CHLOE(Fairtility) optimises clinical decisions, providing an opportunity for personalised patient care, improved patient engagement, and the potential to detect operational non-conformities before impacting clinically.
Trial registration number
NA
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Affiliation(s)
| | - C HIckman
- Fairtility, Fairtility , Tel Aviv, Israel
| | - R Derick
- Fairtility, Fairtility , Tel Aviv, Israel
| | - M Tran
- Fairtility, Fairtility , Tel Aviv, Israel
| | - E Nikitos
- Institute Of Life- IASO, IVF , Athens, Greece
| | | | | | - K Kostaras
- Institute Of Life- IASO, IVF , Athens, Greece
| | - D Mpotzaki
- Institute Of Life- IASO, IVF , Athens, Greece
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Teruel Lopez J, Miret Lucio C, Lozano Zamora M, Escribá Suarez M, Benavent Martínez M, Crespo Simó J, Erlich I, Tran M, Bergelson N. P-269 A validation study for artificial intelligence (AI) compared with manual annotation, using donor eggs reveals that AI accurately predicts blastulation. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Are the annotations produced by AI comparable to manual annotations? Does AI accurately assess fertilisation checks, and predict embryo usage and blastulation compared to embryologists?
Summary answer
Automatic annotations by AI was consistent with manual annotations. AI implantation algorithms had strong prediction of blastulation and embryo usage.
What is known already
Currently, embryos are manually annotated for specific morphokinetic features during embryo development. This is a labour-intensive process, and dependent on training and experience, leading to inter and intra clinic variation.
The decision to transfer, freeze or discard embryos relies heavily on these annotations. It is paramount that we develop a tool that will provide consistency and accuracy in annotation and produce scores that can facilitate decisions around embryo usage.
AI has demonstrated its potential to achieve this, but first must be validated before its integration into clinical practice. There have been no such studies demonstrating this so far.
Study design, size, duration
Retrospective cohort study, that took place between September to December 2021 at a private fertility clinic in Spain. To control for embryo variability, this study only included 179 time-lapse videos for embryos created from donor eggs. This was based on the understanding that donor eggs are more likely to produce better quality blastocysts and embryos and thus will give the most optimal conditions for annotation in a validation framework.
Participants/materials, setting, methods
The same time-lapse cultured embryos were annotated manually and automatically by CHLOE(Fairtility, an AI-based tool). Manual and CHLOE annotations were compared to assess the strength of agreement (i) using intra-class correlation (ICC), and (ii) the proportion of corrections required at the pronuclei (PN) stage. AI accuracy in predicting blastulation at 30hours, and blastulation before 116 hours, was also assessed using AUC as the efficacy metric. Embryo usage was compared with the AI-generated ranking of embryos.
Main results and the role of chance
The majority of morphokinetic variables showed a very-strong agreement, with an ICC range of (0.81-1.00), namely for; tPNf, t2, t3, t5, t7, tSB, tB and tEB. Only t4 (0.5) showed a moderate agreement. On average (Mean+-Standard deviation), AI annotated t4 later than embryologists (36+-5vs39+-10 (hours)). All other variables fell within a strong ICC of (0.61-0.8). There were no very weak (0-0.2) or weak (0.21-0.4) variables. PN agreement between AI and embryologists was 93%: PN’s had to be corrected by an embryologist only 7%(n = 179) of the time.
AI predicted blastulation on day 3 with a high level of sensitivity 0.77 and specificity 0.82, (AUC: 0.84,p<0.0001). Furthermore, the blastulation score given on day 3 was a predictor of blastulation before 116 hours with a high sensitivity 0.77 and specificity 0.80, (AUC: 0.81,p<0.0001).
Similarly, AI-generated ranking accurately correlated with embryologist decisions to freeze, transfer or discard embryos, with an overall high sensitivity 0.88 and specificity 0.67, (AUC: 0.84,p<0.0001). A rank of 1 was seen in 14%(n = 113) of embryos, all of which were frozen or transferred. Some embryos that scored a rank of 2 were discarded, but this was significantly lower than those that scored a rank of 3 or more (3%vs32%,p=0.0004).
Limitations, reasons for caution
This study only included embryos from donor eggs. Furthermore, this study occurred at a single site and is planned to be replicated at several clinics. Where there are discrepancies between human and AI, further studies are required to determine the ground truth.
Wider implications of the findings
This study demonstrates an AI framework to safely introduce AI in the fertility clinic. AI will accurately annotate embryos and give reliable scores to predict good quality blastulation, and inform decisions around embryo usage determination. AI provides a time-effective, objective tool in decision-making, with the potential to optimise success.
Trial registration number
not applicable
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Affiliation(s)
| | - C Miret Lucio
- Equipo Médico Crespo, IVF Laboratory , Valencia, Spain
| | | | | | | | - J Crespo Simó
- Equipo Médico Crespo, Medical Director , Valencia, Spain
| | - I Erlich
- Fairtility, Clinical , Tel Aviv, Israel
| | - M Tran
- Fairtility, Clinical , Tel Aviv, Israel
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Tran M, Wong LC. A waxy plaque on an infant aged six months. Aust J Gen Pract 2022; 51:431-432. [PMID: 35637589 DOI: 10.31128/ajgp-09-21-6182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael Tran
- MBBS (Hons), BSc (Med) (Hons), DCH, FRACGP, AFHEA, General Practitioner, Church St Medical Practice, Newtown, NSW; Conjoint Lecturer, Western Sydney University, NSW; Conjoint Lecturer, University of New South Wales, Sydney, NSW
| | - Li-Chuen Wong
- MBBS (Hons), MM, DCH, FACD, Head of Dermatology Department, Children@s Hospital, Westmead, NSW; Clinical Senior Lecturer, The University of Sydney, Sydney, NSW; Chair, NSW Faculty of the Australasian College of Dermatologists, Sydney, NSW
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Nasser MF, Tran M, Jabri A, Evans NS, Mahlay NF. Manifestations of circulatory assist devices in noninvasive arterial duplex evaluation: A pictorial review. Vasc Med 2022; 27:296-301. [PMID: 35466845 DOI: 10.1177/1358863x221086626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spectral Doppler and plethysmographic waveforms vary significantly in the presence of circulatory assist devices. Understanding the effect these devices have on the waveforms and flow characteristics is necessary for the appropriate interpretation of duplex ultrasound and other noninvasive vascular studies. We review the different arterial waveforms that can be seen with circulatory assist devices.
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Affiliation(s)
- Mohamed Farhan Nasser
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Michael Tran
- Section of Vascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ahmad Jabri
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Natalie S Evans
- Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Natalia Fendrikova Mahlay
- Section of Vascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Srabanti S, Tran M, Achim V, Fuller D, Canahuate G, Miranda F, Marai G. A Tale of Two Centers: Visual Exploration of Health Disparities in Cancer Care. IEEE Pac Vis Symp 2022; 2022:101-110. [PMID: 35928055 PMCID: PMC9344952 DOI: 10.1109/pacificvis53943.2022.00019] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The annual incidence of head and neck cancers (HNC) worldwide is more than 550,000 cases, with around 300,000 deaths each year. However, the incidence rates and disease-characteristics of HNC differ between treatment centers and different populations, due to undetermined reasons, which may or not include socioeconomic factors. The multi-faceted and multi-variate nature of the data in the context of the emerging field of health disparities research makes automated analysis impractical. Hence, we present a visual analysis approach to explore the health disparities in the data of HNC patients from two different cohorts at two cancer care centers. Our approach integrates data from multiple sources, including census data and city data, with custom visual encodings and with a nearest neighbor approach. Our design, created in collaboration with oncology experts, makes it possible to analyze the patients' demographic, disease characteristics, treatments and outcomes, and to make significant comparisons of these two cohorts and of individual patients. We evaluate this approach through two case studies performed with domain experts. The results demonstrate that this visual analysis approach successfully accomplishes the goal of comparing two cohorts in terms of different significant factors, and can provide insights into the main source of health disparities between the two centers.
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Tran M, Wearne S, Tapley A, Fielding A, Davey A, van Driel M, Holliday E, Ball J, FitzGerald K, Spike N, Magin P. Transitions in general practice training: quantifying epidemiological variation in trainees' experiences and clinical behaviours. BMC Med Educ 2022; 22:124. [PMID: 35197039 PMCID: PMC8867826 DOI: 10.1186/s12909-022-03178-0] [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: 06/11/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND General Practice training in Australia is delivered through the apprenticeship model. General Practice supervisors support trainees transitioning from hospital-based work towards competent independent community-based practice. The timing and manner in which support should be provided is still not well understood. This study aimed to establish the variation in clinical and educational experiences and behaviours, and location, of general practice trainees' consultations by stage of their vocational training. It was hypothesised that change is greater in earlier stages of training. METHODS A cross-sectional analysis of data (2010-2018) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars' in-consultation clinical and educational experience and behaviours. Multinomial logistic regression assessed the association of demographic, educational, and clinical factors in different stages of training. The outcome factor was the training term. RESULTS Two thousand four hundred sixteen registrars contributed data for 321,414 patient consultations. For several important variables (seeing patients with chronic disease; new patients; seeking in-consultation information or assistance; ordering pathology and imaging; and working in a small or regional practice), odds ratios were considerably greater for comparisons of Term 1 and 3, relative to comparisons of Term 2 and 3. CONCLUSION Differences experienced in demographic, clinical and educational factors are significantly more pronounced earlier in registrars' training. This finding has educational and training implications with respect to resource allocation, trainee supervision and curriculum design. Sociocultural learning theory enables an understanding of the impact of transitions on, and how to support, general practice trainees and supervisors.
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Affiliation(s)
- Michael Tran
- School of Medicine, Western Sydney University, Narellan Road & Gilchrist Drive, Campbelltown, NSW 2560 Australia
| | - Susan Wearne
- Academic Unit of General Practice, Australian National University, The Canberra Hospital, Yamba Drive Garran, Canberra, ACT 2605 Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Alison Fielding
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women’s Hospital, Brisbane, QLD 4029 Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Kristen FitzGerald
- School of Medicine, University of Tasmania, 17 Liverpool Street, TAS 7000 Hobart, Australia
- General Practice Training Tasmania (GPPT), Regional Training Organisation (RTO), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000 Australia
| | - Neil Spike
- Department of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street Carlton, Victoria, 3053 Australia
- Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation (RTO), 15 Cato Street, Hawthorn, VIC 3122 Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Northways Road, Churchill, VIC 3842 Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
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Gillespie C, Kleinberg F, Zogas A, Morreale A, Ourth H, Tran M, Moore T, Miller D, McCullough M. Perceptions of clinical pharmacy specialists' contributions in mental health clinical teams. Ment Health Clin 2022; 12:15-22. [PMID: 35116208 PMCID: PMC8788298 DOI: 10.9740/mhc.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Mental health (MH) clinical pharmacy specialists (CPS) are increasingly functioning as integral providers in MH care teams. MH providers may delegate many medication management tasks to the CPS. As there is a shortage of primary care and specialist MH providers, CPS are increasingly being utilized in MH care clinics. We assess provider and CPS perceptions of the contributions of CPS to MH clinical teams in the Veterans Health Administration. Methods We examined the roles and functions of CPS in MH clinics through surveys (n = 374) and semistructured interviews (n = 16) with MH CPS and other members of MH clinical teams (psychiatrists, nurse practitioners, registered nurses, social workers) to gain insight into how CPS were integrated in these settings. We assessed perceptions of CPS contributions to MH teams, interactions between CPS and other providers, and challenges of integrating CPS into MH clinical teams. Results Contributions of CPS in MH were received positively by clinical team members. Clinical pharmacy specialists providing comprehensive medication management were especially valuable in the management of clozapine. The knowledge and training of CPS reassured providers who frequently referred to them with questions about medication and medication therapy management. MH CPS were also perceived to be received well by patients. Discussion The integration of MH CPS into MH teams was well received by team members and patients alike. The MH CPS have become important members of the MH team and are widely viewed as being able to improve access, quality, and workflow.
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Affiliation(s)
| | - Felicia Kleinberg
- Health Science Specialist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts
| | - Anna Zogas
- Research Health Scientist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts
| | - Anthony Morreale
- Associate Chief Consultant for Clinical Pharmacy, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Heather Ourth
- Assistant Chief Consultant for Clinical Pharmacy, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Michael Tran
- National Pharmacy Benefits Management Program Manager, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Tera Moore
- National Pharmacy Benefits Management Program Manager, Clinical Pharmacy Practice Office, Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Donald Miller
- Research Health Scientist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts; Research Health Scientist, University of Massachusetts, Lowell, Zuckerberg School of Health Sciences, Department of Public Health, Lowell, Massachusetts
| | - Megan McCullough
- Research Health Scientist, Center for Healthcare Organization and Implementation (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts; Research Health Scientist, University of Massachusetts, Lowell, Zuckerberg School of Health Sciences, Department of Public Health, Lowell, Massachusetts
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Leoni S, Basso T, Tran M, Schnée S, Fabre AL, Kasparian J, Wolf JP, Dubuis PH. Highly sensitive spore detection to follow real-time epidemiology of downy and powdery mildew. BIO Web Conf 2022. [DOI: 10.1051/bioconf/20225004003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ng A, Nathan A, Campain N, Yuminaga Y, Mumtaz F, Gulamhusein A, Tran M, Barod R, Patki P. 1141 Robotic Assisted Surgery in Horseshoe Kidneys: A Safety and Feasibility Multicentre Case Series. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.794] [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]
Abstract
Abstract
Introduction
Horseshoe kidneys (HSK) are the most common renal fusion abnormality. However, they are only present in 0.2% of the population. Due to anatomical variation in vasculature, ectopia and malrotation, surgery has traditionally been performed via an open approach. We aimed to assess the safety and feasibility of robot-assisted surgery for HSK.
Method
Six patients (four female, two male) with HSKs were operated on between 2016 and 2019 across two high-volume centres by high-volume surgeons. All operations were robot-assisted, with three partial nephrectomies and one nephroureterectomy for renal masses and two benign nephrectomies for non-functioning kidneys. 3D reconstruction using CT renal angiograms was used to help identify vasculature and tumour location (where appropriate).
Results
The median age was 53 years (IQR 47-58.3) and the median BMI was 25 (IQR 25-25.8). Median tumour size in the four patients with renal masses was 35.5 mm (IQR 25.3-44.8). Median console time was 120 minutes (IQR 117-172.5) and the median estimated blood loss was 150 mL (IQR 112.5-262.5). The median pre-operative eGFR was 76 (IQR 70-86.5) and median post-operative eGFR was 65.5 (IQR 59.3-80.8). All operations were uneventful, there were no perioperative transfusions and no complications reported. Length of stay was two days for all patients.
Conclusions
We report the largest series of mixed robotic-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in high-volume centres with acceptable perioperative outcomes. Further prospective, longer-term, multi-centre studies are required to evaluative if robotic surgery for HSK is superior to open surgery.
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Affiliation(s)
- A Ng
- UCL Medical School, University College London, London, United Kingdom
| | - A Nathan
- Department of Urology, Royal Free Hospital, London, United Kingdom
| | - N Campain
- Department of Urology, Royal Free Hospital, London, United Kingdom
| | - Y Yuminaga
- Consultant Urologist, Royal Perth Hospital, Perth, Australia
| | - F Mumtaz
- Department of Urology, Royal Free Hospital, London, United Kingdom
| | - A Gulamhusein
- Consultant Urological and Robotic Surgeon, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M Tran
- Department of Urology, Royal Free Hospital, London, United Kingdom
| | - R Barod
- Department of Urology, Royal Free Hospital, London, United Kingdom
| | - P Patki
- Department of Urology, Royal Free Hospital, London, United Kingdom
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McFarland MS, Ourth H, Frank D, Mambourg S, Tran M, Morreale A. Development and validation of a systematic process for expansion of clinical pharmacy activities for comprehensive medication management in primary care within the Department of Veterans Affairs. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M. Shawn McFarland
- Clinical Pharmacy Practice Office U.S. Department of Veterans Affairs Washington DC USA
| | - Heather Ourth
- Clinical Pharmacy Practice Office U.S. Department of Veterans Affairs Washington DC USA
| | - Dana Frank
- Veterans Integrated Service Network 12 Chicago Illinois USA
| | - Scott Mambourg
- Veterans Integrated Service Network 21 Pleasant Hill California USA
| | - Michael Tran
- Clinical Pharmacy Practice Office U.S. Department of Veterans Affairs Washington DC USA
| | - Anthony Morreale
- Clinical Pharmacy Practice Office U.S. Department of Veterans Affairs Washington DC USA
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Tran M, Voronin GL, Roberts RF, Coupland JN, Ziegler GR, Harte FM. The effect of high-pressure jet processing on cocoa stability in chocolate milk. J Dairy Sci 2021; 104:11432-11441. [PMID: 34419273 DOI: 10.3168/jds.2021-20602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022]
Abstract
Fat-free chocolate milk formulations containing skim milk, cocoa powder, and sugar were thermally treated and then processed using high-pressure jet (HPJ) technology from 125 to 500 MPa. The rheological properties and stability of HPJ-treated chocolate milks were compared with controls (no HPJ processing) prepared both with and without added κ-carrageenan. As expected, carrageenan-free chocolate milk exhibited immediate phase separation of the cocoa powder, whereas formulations containing κ-carrageenan were stable for 14 d. An increased stability was observed with increasing HPJ processing pressure, with a maximum observed when chocolate milk was processed at 500 MPa. The apparent viscosity at 50 s-1 of HPJ-processed samples increased from ~3 mPa·s to ~9 mPa·s with increasing pressure, and shear-thinning behavior (n < 0.9) was observed for samples processed at HPJ pressures ≥250 MPa. We suggest that HPJ-induced structural changes in casein micelles and new casein-cocoa interactions increased cocoa stability in the chocolate milk. Because casein seemed to be the major component enhancing cocoa stability in HPJ-treated samples, a second study was conducted to determine the effect of additional micellar casein (1, 2, or 4%) and HPJ processing (0-500 MPa) on the stability of fat-free chocolate milk. Formulations with 4% micellar casein processed at 375 and 500 MPa showed no phase separation over a 14-d storage period at 4°C. The addition of micellar casein together with HPJ processing at 500 MPa resulted in a higher apparent viscosity (~17 mPa·s at 50s-1) and more pronounced shear-thinning behavior (n ≤ 0.81) compared with that without added micellar casein. The use of HPJ technology to improve the dispersion stability of cocoa provides the industry with a processing alternative to produce clean-label, yet stable, chocolate milk.
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Affiliation(s)
- M Tran
- Department of Food Science, Pennsylvania State University, University Park 16802
| | - G Lewis Voronin
- Department of Food Science, Pennsylvania State University, University Park 16802
| | - R F Roberts
- Department of Food Science, Pennsylvania State University, University Park 16802
| | - J N Coupland
- Department of Food Science, Pennsylvania State University, University Park 16802
| | - G R Ziegler
- Department of Food Science, Pennsylvania State University, University Park 16802
| | - F M Harte
- Department of Food Science, Pennsylvania State University, University Park 16802.
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Dong X, Tsang CCS, Kotian A, Zeng J, Tran M, Wang J. A comparison between the effects of drug costs and share of family income on drug costs in determining drug price. Medicine (Baltimore) 2021; 100:e26877. [PMID: 34397865 PMCID: PMC8341252 DOI: 10.1097/md.0000000000026877] [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] [Received: 10/28/2020] [Revised: 07/12/2021] [Accepted: 07/22/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT High health care and medication expenditures pose a financial burden on Americans seeking care. It is imperative to determine the role of affordability in influencing access to health care and medications.To investigate the association between financial burden and health care access by comparing the effects of absolute and relative financial burdens, measured by total health care/medication expenditure (Expenditure) and health care/medication expenditure as a share of annual family income (Expenditure Share), respectively.Delay in receiving health care services and delay in obtaining prescription medications.A cross-sectional analysis of the 2017 Medical Expenditure Panel Survey using multivariate logistic regressions with Expenditure and Expenditure Share variables standardized to facilitate comparison.While both absolute and relative financial burdens were found to be positively associated with the outcomes, the relative measure had a significantly higher association that was about twice as much as the absolute one. For the outcome of delay in getting health care, the standardized odds ratios (OR) for health care expenditure and health care expenditure as a share of family income were 1.13 (95% confidence interval [CI] = 1.09-1.18) and 1.25 (95% CI = 1.20-1.32), respectively. For the outcome of delay in getting medications, the standardized OR for medication expenditure and medication expenditure as a share of family income were 1.11 (95% CI = 1.08-1.15) and 1.23 (95% CI = 1.18-1.29), respectively.The study illustrated the importance of including income in policy considerations intended to balance value, access, and affordability. Specifically, income should be included in measures assessing the value of medications.
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Affiliation(s)
- Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Room 214, Memphis, TN
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Room 212, Memphis, TN
| | - Anoop Kotian
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN
| | - Jason Zeng
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN
| | - Michael Tran
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Room 221, Memphis, TN
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Cartledge S, Rawstorn J, Tran M, Ryan P, Howden E, Jackson A. Throwing cardiac rehabilitation into the 21st Century: a focus group study exploring the impact of COVID-19 on cardiac rehabilitation delivery in Victoria, Australia. Eur J Cardiovasc Nurs 2021. [PMCID: PMC8344710 DOI: 10.1093/eurjcn/zvab060.069] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Background Cardiac rehabilitation (CR) education and exercise are predominantly delivered in group face-to-face settings. This delivery model was challenged during the COVID-19 pandemic due to government enforced lockdowns which restricted the delivery of these models of care. The Australian state of Victoria experienced the longest and most severe local restrictions and was in lockdown for approximately 26 weeks of 2020. Purpose We aimed to explore the experience, barriers and enablers of delivering CR during a pandemic, and identify strategies for future COVID-safe programs among cardiac rehabilitation clinicians. Methods Victorian members of the Australian Cardiovascular Health and Rehabilitation Association (ACRA) were invited to attend an exploratory qualitative online focus group in November 2020. An inductive thematic analysis was undertaken before deductively applying the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework to identify barriers and enablers for technology adoption in CR. Results 30 members participated in a 106 minute focus group. 17 members who provided demographics represented multiple disciplines (nursing n = 13, exercise physiology n = 3, physiotherapy n = 1) and geographical settings (metropolitan n = 10, regional n = 4, rural n = 3). Four main themes were identified: Consequences of sudden service delivery change; Technology use – challenges and benefits; Capacity (program and staff); and The way forward. The deductive NASSS analysis demonstrated the main challenges of continuing remotely delivered CR lie with all adopters (staff, patients, carers) and with organisations. Future CR strategies included the importance of resuming face-to-face programs but important barriers including finding capacity, particularly staffing, to run concurrent telehealth programs remain to be addressed. Conclusion The COVID-19 pandemic forced and expedited significant changes to CR delivery models. While clinicians agreed that delivery of CR via telehealth will continue, it is now timely to review remote models of care and plan how they will integrate alongside traditional face-to-face programs.
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Affiliation(s)
- S Cartledge
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
| | - J Rawstorn
- Deakin University, Institute for Physical Activity and Nutrition, Melbourne, Australia
| | - M Tran
- St Vincent"s Hospital, Cardiopulmonary Rehabilitation , Melbourne, Australia
| | - P Ryan
- Heart Foundation , Melbourne, Australia
| | - E Howden
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - A Jackson
- Australian Centre for Heart Health, Melbourne, Australia
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Campain N, Nathan A, Abu-Ghanem Y, Tran M, Patki P, Mumtaz F, Bex A, Barod R. High volume robotic assisted nephro-ureterectomy allows improved perioperative outcomes. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Satish P, Kuusk T, Campain N, Abu-Ghanem Y, Neves J, Barod R, El-Sheikh S, Mumtaz F, Patki P, Tran M, Tran-Dang M, Grant L, Klatte T, Bex A. European Association of Urology COVID intermediate prioritisation group is poorly predictive of pathological high-risk among patients with renal tumours. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00996-9] [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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Papadopoulou A, Campain N, Abu-Ghanem Y, Mumtaz F, Barod R, Tran M, Bex A, Patki P. Minimally Invasive Surgery (MIS) in simple nephrectomy – differences in perioperative outcomes based on infectious or noninfectious aetiology. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00560-1] [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: 11/16/2022]
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Alexanian C, Liakos W, Toussi A, Kao J, Cheng MY, Wang EA, Nava J, Tran M, Marusina AI, Merleev AA, Leal AR, Fung MA, Le ST, Luxardi G, Maverakis E. Immune profiling of lupus miliaris disseminatus faciei and successful management with anti-tumour necrosis factor therapy. Clin Exp Dermatol 2021; 46:910-914. [PMID: 33864395 DOI: 10.1111/ced.14684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
Lupus miliaris disseminatus faciei (LMDF) is a chronic inflammatory dermatosis of unknown aetiology, most often seen in young adults. Although many treatments for LMDF exist, treatment guidelines have not been developed, and response to therapy is generally unpredictable. We present the results of transcriptomic analysis of LMDF lesional skin, which revealed a variety of differentially expressed genes linking LMDF to alterations in innate and adaptive T helper 1 immunity. Immunohistochemical analysis was also performed, identifying similar changes in T-cell immune responses. Given evidence for increased tumour necrosis factor (TNF) pathway activity, our patient, who had previously been refractory to multiple treatments, was initiated on TNF inhibitor therapy with excellent response. This characterization of the LMDF immune response may lead to improved treatment of this condition.
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Affiliation(s)
- C Alexanian
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - W Liakos
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - A Toussi
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - J Kao
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - M Y Cheng
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - E A Wang
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J Nava
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - M Tran
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - A I Marusina
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - A A Merleev
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - A R Leal
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - M A Fung
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA.,Department of, Pathology, University of California, Davis, Sacramento, CA, USA
| | - S T Le
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - G Luxardi
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
| | - E Maverakis
- Departments of, Department of, Dermatology, University of California, Davis, Sacramento, CA, USA
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Cristea MC, Ruel NH, Frankel PH, Synold TW, Stewart DB, Wang EW, Jung A, Wilczynski S, Tran M, Konecny GE, Eng M, Kilpatrick L, Chen YJ, Glaser S, Dellinger TH, Hakim A, Lee S, Morgan R, Han ES. A phase I study of mirvetuximab soravtansine (MIRV) and gemcitabine (G) in patients (Pts) with selected frα-positive solid tumors: Results in the ovarian cancer (EC) cohort. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5542] [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: 11/20/2022] Open
Abstract
5542 Background: Mirvetuximab soravtansine (MIRV) is an ADC comprising a FRα-binding antibody, cleavable linker, and the maytansinoid DM4, a potent tubulin-targeting agent. MIRV has promising single agent activity in FRα-positive medium/high expression epithelial ovarian cancer (EOC), at 6 mg/kg, based on adjusted ideal body weight (AIBW) IV every (q) 21 days. This study evaluated MIRV and G in recurrent EOC, endometrial and triple negative breast cancer. The recommended phase 2 dose (RP2D) was established at MIRV 6 mg/kg AIBW IV, day 1 and G 800 mg/m2 IV, d1, 8 q21 days (J Clin Oncol 37, 2019, Abs. #3009). Here we report the results from the EOC cohort. Methods: Patients (pts) with FRα-positive platinum resistant EOC with ≤4 prior chemotherapy (CT) regimens, were eligible. FRα positivity was initially defined as ≥ 25% of cells with PS2+ staining intensity (low to high FRα expression) and was subsequently revised to require medium/high FRα expression (≥50%/ ≥75% of cells with PS2+ staining intensity). Results: From 10/2017 to 12/2020, 113 EOC pts underwent FRα screening, with 74 FRα-positive results. Thirty total EOC pts (with median 3 prior lines of therapy) were treated; 8 pts during dose escalation and 22 EOC pts at the RP2D (all evaluable for response). Fifteen (50%) pts had high FRα, 10 pts (33%) medium FRα, and 5 pts (17%) low FRα expression. Eleven (36%) of the 30 EOC pts achieved a partial response (PR), 15 pts (50%) had SD and 4 pts (13%) progressed. Among the 11 responders, 5 pts had high FRα, 4 pts medium FRα and 2 pts low FRα expression. Non-heme clinically significant adverse events (AEs) included: G2 sensory neuropathy (4 pts) G3 diarrhea (3 pts), G3 fatigue (2 pts), G3 pneumonitis (2 pts), and 1 pt with G5 respiratory failure (secondary to pneumonia but drug-induced pneumonitis could not be ruled out). Conclusions: MIRV in combination with G has promising clinical activity in late line platinum resistant FRα-positive EOC, with best responses observed in high FRα expression. The regimen is well tolerated with expected AEs based on the known toxicities of each agent. This study was approved and funded by the National Comprehensive Cancer Network (NCCN) Oncology Research Program from general research support provided by ImmunoGen Corp and Cancer Center Support Grant P30CA033572. Clinical trial information: NCT02996825.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Melissa Eng
- City of Hope National Medical Center, Duarte, CA
| | | | | | - Scott Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | | | | | - Stephen Lee
- City of Hope National Medical Center, Duarte, CA
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Rahman J, Charalambous A, Aled L, Leonard X, Parsons C, Cole G, Sharma G, Skuse K, Tran M. From the lecture theatre to your digital device: Reflections on the production of educational podcasts within undergraduate psychiatry training. Eur Psychiatry 2021. [PMCID: PMC9480439 DOI: 10.1192/j.eurpsy.2021.2197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionThe COVID-19 pandemic has highlighted a need for engaging online resources to enrich psychiatry training for undergraduate medical students. Podcasting is a well-established digital communication platform utilised daily in a myriad of capacities, including education. A group of medical students were tasked with creating their own educational podcasts covering specific aspects of psychiatry.ObjectivesEach pair was set a sub-topic of psychiatry and utilised software to produce educational resources. The objective of this project was to reflect upon production as well as explore the efficacy of podcasting as a tool within undergraduate training.MethodsThe medical students conducted research and contacted experts within the field to contribute to their podcasts. The majority of the students then conducted reviews of the literature surrounding podcasting within medical education, which informed the production of their own podcasts. From this, it was discussed how this project could impact future practice, and indicated that podcasts may become crucial asynchronous learning tools in medical education.ResultsLiterature review and first-hand experience of podcast production enabled the students to appreciate the advantages of podcasting and the potential for its widespread future applications. Their wider reading revealed that podcast-using study participants outperformed or matched their peers in assessments, and overwhelmingly enjoyed using podcasts over traditional teaching methods.ConclusionsThe use of podcasting can complement traditional psychiatry training and appeal to a generation of digital natives that prefer this learning style. Podcast production is also an excellent revision method, highlighting the advantages of peer-to-peer education in both learning and increasing engagement with psychiatry.DisclosureNo significant relationships.
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Groppi JA, Ourth H, Tran M, Morreale AP, McFarland MS, Moore TD, Jorgenson T, Torrise V. Increasing rural patient access using clinical pharmacy specialist providers: Successful practice integration within the Department of Veterans Affairs. Am J Health Syst Pharm 2021; 78:712-719. [PMID: 33580241 DOI: 10.1093/ajhp/zxab011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Access to care is a critical issue facing healthcare and affects patients living in rural and underserved areas more significantly. This led the Department of Veterans Affairs (VA) to launch a project that leveraged the expertise of the clinical pharmacy specialist (CPS) provider, embedding 180 CPS providers into primary care, mental health, and pain management across the nation. METHODS This multidimensional project resulted in hiring 111 CPS providers in primary care, 40 CPS providers in mental health, and 35 CPS providers in pain management to serve rural veterans' needs. From October 2017 to March 2020, CPS providers provided direct patient care to 213,477 veterans within 606,987 visits. This was an average of 43,000 additional visits each quarter to support comprehensive medication management services, demonstrating an additional 219,823 visits in fiscal year 2018 and 232,030 visits in fiscal year 2019. Over the course of the project, the team provided mentorship to 164 CPS providers, performed consultative visits at 27 VA facilities, and trained 180 CPS providers in educational boot camps. CONCLUSION VA funding of rural health initiatives adding CPS providers to primary care, mental health, and pain teams has resulted in positive measures of comprehensive medication management, interdisciplinary team satisfaction, facility leadership acceptance, and multiple positive outcomes.
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Affiliation(s)
- Julie A Groppi
- Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Heather Ourth
- Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Michael Tran
- Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Anthony P Morreale
- Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | | | - Tera D Moore
- Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Terri Jorgenson
- Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
| | - Virginia Torrise
- Pharmacy Benefits Management Services, US Department of Veterans Affairs, Washington, DC
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Abstract
Aging is the time-dependent process that all living organisms go through characterized by declining physiological function due to alterations in metabolic and molecular pathways. Many decades of research have been devoted to uncovering the cellular changes and progression of aging and have revealed that not all organisms with the same chronological age exhibit the same age-related declines in physiological function. In assessing biological age, factors such as epigenetic changes, telomere length, oxidative damage, and mitochondrial dysfunction in rescue mechanisms such as autophagy all play major roles. Recent studies have focused on autophagy dysfunction in aging, particularly on mitophagy due to its major role in energy generation and reactive oxidative species generation of mitochondria. Mitophagy has been implicated in playing a role in the pathogenesis of many age-related diseases, including Alzheimer's disease (AD), Parkinson's, Huntington's, and amyotrophic lateral sclerosis. The purpose of our article is to highlight the mechanisms of autophagy and mitophagy and how defects in these pathways contribute to the physiological markers of aging and AD. This article also discusses how mitochondrial dysfunction, abnormal mitochondrial dynamics, impaired biogenesis, and defective mitophagy are related to aging and AD progression. This article highlights recent studies of amyloid beta and phosphorylated tau in relation to autophagy and mitophagy in AD.
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Affiliation(s)
- Michael Tran
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - P. Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Neuroscience and Pharmacology, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Public Health Department of Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, United States
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Cartledge S, Rawstorn J, Ryan P, Tran M, Howden E, Jackson A. Cardiac Rehabilitation During COVID-19 in Victoria, Australia: Telehealth is Here to Stay but it is Not Without Challenges. A Focus Group Study. Heart Lung Circ 2021. [PMCID: PMC8608273 DOI: 10.1016/j.hlc.2021.06.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Gulamhusein A, Berger L, Mumtaz F, Bex A, Barod R, Patki P, Tran M, Silva P, Kuusk T, Hyde E, Ourselin S. Clinical experience of using 3D models for pre and intraoperative guidance during robotic-assisted partial nephrectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Tsai T, Perez-Alvarez I, Woo J, Tran M. Efficacy of HLA-compatible Platelet Transfusion for Patients with Acute Myeloid Leukemia Refractory to Platelet Transfusion. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Acute myeloid leukemia (AML) patients often require transfusion support during induction chemotherapy. Platelet transfusion refractoriness (PTR) may develop due to HLA alloimmunization. Management of immune-refractory patients with HLA-compatible platelet transfusions is labor intensive and associated with increased costs. The purpose of this study is to evaluate the efficacy of HLA-compatible platelet units in AML patients.
Methods
Newly diagnosed AML patients undergoing induction chemotherapy in our institute between 2015 and 2018 were identified. Platelet counts and platelet transfusion data from initiation of chemotherapy until platelet recovery (> 20K/µL and increased consistently) were extracted. A 24-hour posttransfusion corrected count increment (CCI) was calculated to evaluate the efficacy of each platelet transfusion. PTR was declared if a patient had a 24-hour CCI < 4K following two consecutive transfusions. Student’s t-test was used for statistical analysis. Results were presented as mean ± SE, * if p < 0.05.
Results
We identified 39 patients with newly diagnosed AML. PTR developed in 22/39 (56%) patients during induction chemotherapy. The average CCI was higher among those without PTR compared to those with PTR (8,408 ± 585 vs. 2,923 ± 360*), and overall platelet transfusion burden (in number of units) was lower (7.29 ± 1.0 vs. 18.55 ± 1.71*). HLA antibodies were identified in 3/22 (14%) PTR patients, as 6/22 (27%) were tested. The average CCI during HLA matched transfusions for these 3 patients was higher than that with random units (2,059 ± 149 vs. -126 ± 306*). Compared to HLA-negative PTR patients receiving random units, the average CCI for HLA-compatible transfusions was still lower, though not significantly (2,059 ± 149 vs. 3,099 ± 390, p = 0.33), while the number of HLA- compatible units transfused was significantly higher (31.0 ± 3.0 vs. 16.6 ± 1.45*).
Conclusion
In a cohort of newly diagnosed AML patients undergoing induction chemotherapy whose PTR was associated with detectable HLA antibodies, transfusion support with HLA-matched products did not lead to reduced overall platelet transfusion rates and CCI remains in the refractory range. This suggests that use of HLA matched platelets among newly diagnosed AML patients with PTR, even in the setting of detectable HLA antibodies, does not appear to result in reduced overall product utilization.
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Affiliation(s)
- T Tsai
- Pathology, UCI Medical Center, Irvine, California, UNITED STATES
| | - I Perez-Alvarez
- Pathology, UCI Medical Center, Irvine, California, UNITED STATES
| | - J Woo
- Pathology, UCI Medical Center, Irvine, California, UNITED STATES
| | - M Tran
- Pathology, UCI Medical Center, Irvine, California, UNITED STATES
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Turbati MS, Smith AM, Yeh IT, Garrett JR, Tran M. Neurologic Symptoms Caused by Mature Cystic Teratoma of the Thymus. Ann Thorac Surg 2020; 111:e357-e359. [PMID: 33127405 DOI: 10.1016/j.athoracsur.2020.07.092] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/23/2020] [Accepted: 07/24/2020] [Indexed: 11/15/2022]
Abstract
This case report describes an unusual presentation of a rare mature cystic teratoma of the thymus. It was indistinguishable from other anterior mediastinal masses without surgical resection and histologic diagnosis. Malignant thymic masses and mediastinal masses that cause compression of the heart and surrounding vessels have been reported to cause paresthesia. However, this case documents a mediastinal teratoma, specifically a benign thymic teratoma, that presented with symptoms of sensory dysfunction among other neurologic deficits. Complete surgical resection of the teratoma was performed without complications, and all symptoms resolved.
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Affiliation(s)
- Mia S Turbati
- Department of Cardiothoracic Surgery, Virginia Hospital Center, Arlington, Virginia
| | - Andrew M Smith
- Department of Anesthesia, Virginia Hospital Center, Arlington, Virginia.
| | - I-Tien Yeh
- Department of Pathology, Virginia Hospital Center, Arlington, Virginia
| | - John R Garrett
- Department of Cardiothoracic Surgery, Virginia Hospital Center, Arlington, Virginia
| | - Michael Tran
- Department of Anesthesia, Virginia Hospital Center, Arlington, Virginia
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Abstract
Background Patients infected with SARS-CoV-2 often develop venous and arterial thrombosis. The high patient mortality is partly attributed to thrombotic events. An emerging trend is the presence of immunological phenomena including antiphospholipid antibodies which may promote thrombosis. The mechanism for these observations is not clear though many patients with SARS-CoV-2 develop thrombocytopenia. Case presentation We describe a patient with SARS-CoV-2 pneumonitis who presented with intermediate risk pulmonary embolism (PE). Careful attention to his daily platelet count suggested the possibility of immune mediated heparin-induced thrombocytopenia (HIT) which was confirmed by laboratory testing and resolved when anticoagulation was switched to a direct thrombin inhibitor. Conclusions Since excessive platelet activation and in situ thrombosis occur in HIT, this case underscores the need to consider that thrombocytopenia in patients with SARS-CoV-2—most of whom receive heparinoids—may be unrecognized HIT. A central role for the platelet in the etiology of thrombosis during the COVID-19 pandemic should be explored.
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Affiliation(s)
- Michael Tran
- Heart Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Desk J-35, Cleveland Clinic Foundation, Cleveland, OH 44195 USA
| | - Chirag Sheth
- Heart Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Desk J-35, Cleveland Clinic Foundation, Cleveland, OH 44195 USA
| | - Rohan Bhandari
- Heart Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Desk J-35, Cleveland Clinic Foundation, Cleveland, OH 44195 USA
| | - Scott J Cameron
- Department of Cardiovascular and Metabolic Sciences. Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195 USA
| | - Deborah Hornacek
- Heart Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Desk J-35, Cleveland Clinic Foundation, Cleveland, OH 44195 USA
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