1
|
Duan N, Wang Z. Re: CT predictive model for torsion angle as a marker for risk of necrosis in patients with adnexal torsion. A reply. Clin Radiol 2022; 77:637. [PMID: 35672166 DOI: 10.1016/j.crad.2022.05.003] [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] [Received: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022]
Affiliation(s)
- N Duan
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Z Wang
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
| |
Collapse
|
2
|
Duan N, Li H. W070 Clinical and microbiological analysis of infections among children in a neonatal and pediatric intensive care unit. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.808] [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]
|
3
|
Pang L, Jin B, Guan J, Duan N, Xing Y, Huang C, Du J, Li H. W009 Pay attention to peripheral smear in patients with methylmalonic academia combined homocystinuria. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
4
|
Wang SJ, Zhang MM, Duan N, Hu XY, Ren S, Cao YY, Zhang YP, Wang ZQ. Using transvaginal ultrasonography and MRI to evaluate ovarian volume and follicle count of infertile women: a comparative study. Clin Radiol 2022; 77:621-627. [PMID: 35636975 DOI: 10.1016/j.crad.2022.04.016] [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] [Received: 09/20/2021] [Accepted: 04/22/2022] [Indexed: 11/26/2022]
|
5
|
Duan N, Li H, Huang C. M268 Clinical manifestation and genetic mutations in two boys of dent disease and one boy of fanconi syndrome. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.977] [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]
|
6
|
Pang L, Duan N, Huang C, Xing Y, Du J, Huang H, Li H. M235 Contradiction between separation gel coagulation tube and heparin anticoagulation tube. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
7
|
Wang SJ, Duan N, Hu XY, Yin YY, Guo YH, Wang YJ, Chen X, Wang ZQ. [Characteristics of magnetic resonance imaging and clinical etiology of ovarian infertility]. Zhonghua Yi Xue Za Zhi 2021; 101:2798-2803. [PMID: 34551497 DOI: 10.3760/cma.j.cn112137-20210714-02749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the characteristics of magnetic resonance imaging (MRI) and clinical etiology of ovarian infertility. Methods: The data of infertile women who underwent 3.0T MRI and magnetic resonance hysterosalpingography (MR-HSG) examination in the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2017 to March 2020 were collected. The ovarian factors of infertility, as well as the abnormalities of bilateral fallopian tubes and uterus, were evaluated. Etiologies assessed by MRI were finally confirmed by hysteroscopy, laparoscopy, surgery, or a comprehensive clinical diagnosis. Results: Among 1 351 patients, 1 296 cases were eligible and included for further analysis. Evaluated by MRI and MR-HSG, 494(38.12%) cases had ovarian abnormalities, including 239(48.38%) cases of ovarian endometriosiss, 116(23.48%) cases of polycystic ovary syndrome (PCOS), 37(7.49%) cases of diminished ovarian reserve (DOR), 33(6.68%) cases of ovarian mass, 28(5.67%) cases of ovarian injury, and 41(8.30%) cases who had at least two kinds of ovarian diseases. Unilateral and bilateral ovarian abnormalities accounted for 52.02% (257/494) and 47.98%(237/494), respectively.In total, 453 of 494(91.7%) patients had only one kind of ovarian disease. Among the 494 patients, 103(20.85%) cases had abnormal ovary with normal uterus and fallopian tubes, and the other 391(79.15%) cases had abnormalities not only in ovary, but in fallopian tube and/or uterus. Conclusion: Infertility-related ovarian diseases have certain characteristics of MRI findings. 3.0T MRI is useful for comprehensive analysis of etiology in ovarian infertility. Combined with MR-HSG, it provides one-stop assessments of the pelvic factors in female infertility.
Collapse
Affiliation(s)
- S J Wang
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029,China
| | - N Duan
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029,China
| | - X Y Hu
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029,China
| | - Y Y Yin
- Department of Gynecology and Reproductive Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Y H Guo
- Department of Gynecology and Reproductive Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Y J Wang
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029,China
| | - X Chen
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029,China
| | - Z Q Wang
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029,China
| |
Collapse
|
8
|
Duan N, Chen X, Rao M, Zhou C, Wang Z. CT predictive model for torsion angle as a marker for risk of necrosis in patients with adnexal torsion. Clin Radiol 2021; 76:540-546. [PMID: 33863549 DOI: 10.1016/j.crad.2021.02.027] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/11/2021] [Indexed: 11/26/2022]
Abstract
AIM To assess the feasibility of preoperative computed tomography (CT) prediction of torsion angle for stratifying the risk of necrosis in patients with adnexal torsion. MATERIALS AND METHODS In this multicentre, retrospective study, 72 patients underwent preoperative CT and surgically verified adnexal torsion. Surgeons identified the torsion angle and adnexal necrosis requiring adnexectomy. The twisted angles were compared between conservative surgery group and salpingo-oophorectomy group. Variables included demographic, pathological and CT details. Logistic analysis was used to identify the indicators of twisted angle associated with high-risk necrosis. RESULTS The necrosis associated with adnexal torsion treated with adnexectomy was performed more often in patients with a torsion angle of ≥720° (odds ratio [OR]=7, 95% confidence interval [CI]: 1.314-37.295, p=0.023). The enlarged twisted pedicle (OR=14.592, 95% CI: 2.048-103.953, p=0.007) and pedicle haemorrhage (OR=5.612, 95% CI: 1.088-28.941, p=0.039) can predict a torsion angle of ≥720°, and area under the receiver operating characteristic (ROC) curve (AUC=0.758±0.058) was generated with the combined variables. CONCLUSION The risk of adnexal necrosis is high in patients with torsion angle of ≥720°. CT findings of enlarged twisted pedicle and pedicle haemorrhage can be used to predict torsion angle of ≥720° and can imply adnexal necrosis indirectly.
Collapse
Affiliation(s)
- N Duan
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - X Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - M Rao
- Department of Radiology, Ruijin Hospital North of the Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - C Zhou
- Department of Radiology, The first Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Z Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
| |
Collapse
|
9
|
Xiao Y, Zheng S, Duan N, Li X, Wen J. MicroRNA-26b-5p alleviates cerebral ischemia-reperfusion injury in rats via inhibiting the N-myc/PTEN axis by downregulating KLF10 expression. Hum Exp Toxicol 2021; 40:1250-1262. [PMID: 33559506 DOI: 10.1177/0960327121991899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
MicroRNAs plays important role in cerebral ischemia-reperfusion (CIR). However, the role of miR-26b-5p in CIR injury remains unclear. PC12 cells were treated with oxygen-glucose deprivation (OGD) for 0 h, 2 h, 4 h, 6 h, and then reoxygenated for 24 h to construct an in vitro I/R model. Then, miR-26b-5p mimic, small interfering RNA of KLF10 and KLF10 overexpression plasmid were transfected into cells respectively for mechanism study. Our results showed that miR-26b-5p was downregulated in OGD/R-induced PC12 cells. After overexpression of miR-26b-5p, cell proliferation ability was enhanced, apoptosis, ROS and inflammatory mediators were inhibited. Bioinformatics analysis indicated that miR-26b-5p was directly bound to the 3' UTR of KLF10, and downregulated the expression of KLF10. KLF10 was upregulated in OGD/R cells, and transfection with si-KLF10 promoted cell proliferation and reduced apoptosis, NO concentration and inflammatory factor secretion. Moreover, pcDNA-KLF10 reversed the inhibitory effects of miR-26b-5p mimic on apoptosis, NO content and inflammatory factor secretion, as well as the downregulation of N-myc and PTEN expression. Meanwhile, I/R rat models were constructed and divided into sham operation group (femoral artery isolation only), model group (middle cerebral artery occlusion model of rats was prepared by thread embolization), treatment group (200 µL of miR-26b-5p mimic was injected into the brain of model rats). We observed that the infarct size of brain tissue was reduced, KLF10 expression was downregulated, and apoptosis and inflammatory response were reduced. These results suggest that miR-26b-5p had protective effects on CIRI and it may be a potential treatment target.
Collapse
Affiliation(s)
- Y Xiao
- Department of Anesthesiology, The First Affiliated Hospital of 162798Xi'an Jiaotong University, Xi'an, China
| | - S Zheng
- Department of Anesthesiology, The First Affiliated Hospital of 162798Xi'an Jiaotong University, Xi'an, China
| | - N Duan
- Department of Anesthesiology, The First Affiliated Hospital of 162798Xi'an Jiaotong University, Xi'an, China
| | - X Li
- Department of Anesthesiology, The First Affiliated Hospital of 162798Xi'an Jiaotong University, Xi'an, China
| | - J Wen
- Department of Anesthesiology, The First Affiliated Hospital of 162798Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
10
|
Huang X, Duan N, Xu H, Xie TN, Xue YR, Liu CH. Erratum: “CTAB-PEG DNA Extraction from Fungi with High Contents of Polysaccharides”. Mol Biol 2019. [DOI: 10.1134/s0026893319080016] [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: 11/22/2022]
|
11
|
Huang X, Duan N, Xu H, Xie TN, Xue YR, Liu CH. [CTAB-PEG DNA Extraction from Fungi with High Contents of Polysaccharides]. Mol Biol (Mosk) 2019; 52:718-726. [PMID: 30113038 DOI: 10.1134/s0026898418040080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/19/2017] [Indexed: 11/23/2022]
Abstract
Polysaccharides influence concentration and purity of extracted DNA. Here we present rapid and efficient protocol for DNA extraction from samples rich in polysaccharides. The technique has been developed using cultures of Schizophyllum commune and involves a modification of known Cetyltrimethyl Ammonium Bromide (CTAB) protocol. To remove polysaccharides, Polyethylene Glycol (PEG) 8000 was added during DNA precipitation. Genomic DNA obtained with the CTAB-PEG method had high integrity, with average fragment size >30 kb, the concentration higher than 100 ng/μL, and the yield more than 30 μg/g. Presented technique is suitable for DNA extraction from fungi, bacteria, archaea or even mollusks with high polysaccharide content.
Collapse
Affiliation(s)
- X Huang
- State Key of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing, 210023 China
| | - N Duan
- State Key of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing, 210023 China
| | - H Xu
- State Key of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing, 210023 China
| | - T N Xie
- State Key of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing, 210023 China
| | - Y-R Xue
- State Key of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing, 210023 China
| | - C-H Liu
- State Key of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing, 210023 China.,
| |
Collapse
|
12
|
Cherukupalli A, Duan N, Papp A. A third of referrals are unnecessary: Critical review of burn outpatient clinic data. Burns 2019; 45:805-817. [PMID: 31031020 DOI: 10.1016/j.burns.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/19/2019] [Accepted: 03/26/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study was to establish patterns in types of burns referred to the Outpatient Clinic (OP) at Vancouver General Hospital (VGH). METHODS A 2-year retrospective chart review was conducted of patients presenting to the OP Clinic from June 1, 2016 - June 1, 2018. Data collected included: patient demographics, depth of burn, Total Body Surface Area (TBSA), anatomical location of burn, geographical location of referral, and operative versus non-operative management. RESULTS The OP Clinic served 470 patients for burn injuries with a total of 1852 visits. Of these, 20% were follow-up visits post-admission, and 73.6% were primary referrals from the emergency department (ED) or elsewhere. The vast majority (69.6%) of burns were less than 5% TBSA. Half involved the hands (50.9%), and half were superficial dermal in depth (45.1%). A third of patients attended only one appointment with the OP Clinic before discharge and 15% did not receive any treatment. CONCLUSIONS The results of our study demonstrate gaps in current provincial referral guidelines leading to a significant number of "unnecessary referrals." Further research could correlate the results to current provincial referral guidelines to estimate their current efficacy in practical use.
Collapse
Affiliation(s)
- A Cherukupalli
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - N Duan
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - A Papp
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; Division of Plastic Surgery, Vancouver General Hospital, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
| |
Collapse
|
13
|
|
14
|
Gao CC, Cao F, Liu DG, Liang K, Li J, Li A, Wang XH, Wang CX, Wang Z, Duan N, Wu YD, Li F. [Clinical study of no necrotic cavity lavage after debridement and drainage in patients with infected pancreatic necrosis]. Zhonghua Wai Ke Za Zhi 2018; 56:512-515. [PMID: 30032532 DOI: 10.3760/cma.j.issn.0529-5815.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To observe the outcomes of no necrotic cavity lavage after debridement and drainage in patients with infected pancreatic necrosis(IPN). Methods: From February 2014 to August 2017, there were 89 patients who were diagnosed as IPN undergoing minimally invasive surgery with no necrotic cavity lavage and large caliber-wide channel drainage in Department of General Surgery, Xuanwu Hospital, Capital Medical University. There were 57 male and 32 female patients aging of (49.5±14.4)years (ranging from 23 to 84 years). The body mass index of 89 patients was (25.4±3.8)kg/m(2) (ranging from 17.6 to 36.7 kg/m(2)). Among the 89 patients, 37 cases(41.6%) of biliary pancreatitis, 10 cases (11.2%) of alcoholic pancreatitis, 16 cases(18.0%) of hyperlipidemic pancreatitis, and 26 cases(29.2%) of other reasons. Results: Of 89 patients, IPN in 6 patients(6.7%) resolved using only percutaneous catheter drainage; another 83 patients underwent laparoscopic debridement(n=3, 3.4%) or video-assisted debridement(n=80, 89.9%). No patient was conversed to laparotomy. The average operation frequency and surgery time was (2.3±1.7) times and (56.5±31.7) minutes.The median bleeding volume and total length of stay was 10(0-600) ml and 34(6-172) days separately. The complication rate(Clavien-Dindo grade≥Ⅲ) was 9.0%(8/89) which involved mainly abdominal hemorrhage (5/8) and digestive tract fistula formation (3/8). The overall mortality rate was 6.7%(6/89). Among them, 3 cases died of abdominal infection, bacteremia and multiple organ failure, 2 cases died of pulmonary infection and bacteremia and 1 case died of fungal infection. Conclusion: No necrotic cavity lavage after debridement and drainage operation is considered effective and safe for IPN patients.
Collapse
Affiliation(s)
- C C Gao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Mauro C, Shear MK, Reynolds CF, Simon NM, Zisook S, Skritskaya N, Wang Y, Lebowitz B, Duan N, First MB, Ghesquiere A, Gribbin C, Glickman K. Performance characteristics and clinical utility of diagnostic criteria proposals in bereaved treatment-seeking patients. Psychol Med 2017; 47:608-615. [PMID: 27821201 DOI: 10.1017/s0033291716002749] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Persistent complex bereavement disorder (PCBD) is a protracted form of grief included in DSM Section 3 indicating a need for more research. Two other criteria sets [prolonged grief disorder (PGD) and complicated grief (CG) disorder] are also currently in use by researchers. This study evaluates rates of diagnosis of each proposed criteria set in a clinical sample of bereaved individuals participating in clinical research. METHOD Two groups in which persistent grief was judged to be present or absent completed an assessment instrument that included items needed to diagnose PCBD as well as PGD and CG. One group included grief treatment-seeking participants in our multicenter National Institute of Mental Health (NIMH)-sponsored study who scored ⩾30 on the Inventory of Complicated Grief (ICG) and the other comprised bereaved adults enrolled in clinical research studies who scored <20 on the ICG. Rates of diagnosis were determined for proposed PCBD, PGD and CG criteria. RESULTS PCBD criteria diagnosed 70 [95% confidence interval (CI) 64.2-75.8] % of the grief treatment-seeking group, PGD criteria identified 59.6 (95% CI 53.4-65.8) % of these individuals and CG criteria identified 99.6 (95% CI 98.8-100.0) %. None of the three proposed criteria identified any cases in the bereaved comparison group. CONCLUSIONS Both proposed DSM-5 criteria for PCBD and criteria for PGD appear to be too restrictive as they failed to identify substantial numbers of treatment-seeking individuals with clinically significant levels of grief-related distress and impairment. Use of CG criteria or a similar algorithm appears to be warranted.
Collapse
Affiliation(s)
- C Mauro
- Department of Biostatistics,Mailman School of Public Health,Columbia University,New York, NY,USA
| | - M K Shear
- Columbia University School of Social Work,New York, NY, USA
| | - C F Reynolds
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh, PA,USA
| | - N M Simon
- Center for Anxiety and Traumatic Stress Disorders,Massachusetts General Hospital,Boston, MA,USA
| | - S Zisook
- Department of Psychiatry,University of California,San Diego,La Jolla, CA,USA
| | - N Skritskaya
- Columbia University School of Social Work,New York, NY, USA
| | - Y Wang
- Department of Biostatistics,Mailman School of Public Health,Columbia University,New York, NY,USA
| | - B Lebowitz
- Department of Psychiatry,University of California,San Diego,La Jolla, CA,USA
| | - N Duan
- Division of Biostatistics,Department of Psychiatry,Columbia University,New York, NY,USA
| | - M B First
- Department of Psychiatry,Columbia University,College of Physicians and Surgeons,New York State Psychiatric Institute and New York Presbyterian Hospital,New York, NY,USA
| | - A Ghesquiere
- Brookdale Center for Healthy Aging,Hunter College,New York, NY,USA
| | - C Gribbin
- Columbia University School of Social Work,New York, NY, USA
| | - K Glickman
- Department of Social Work,York College/CUNY,Jamaica, NY,USA
| |
Collapse
|
16
|
Abstract
BACKGROUND This study is a randomized, prospective, investigation of the relationships between clinical trial design, patient expectancy and the outcome of treatment with antidepressant medication. Method Adult out-patients with major depressive disorder (MDD) were randomized to either placebo-controlled (PC, 50% probability of receiving active medication) or comparator (COMP, 100% probability of receiving active medication) administration of antidepressant medication. Independent-samples t tests and analysis of covariance (ANCOVA) were used to determine whether the probability of receiving active medication influenced patient expectancy and to compare medication response in the PC v. COMP conditions. We also tested the correlations between baseline expectancy score and final improvement in depressive symptoms across study groups. RESULTS Subjects randomized to the COMP condition reported greater expectancy of improvement compared to subjects in the PC condition (t = 2.60, df = 27, p = 0.015). There were no statistically significant differences in the analyses comparing antidepressant outcomes between subjects receiving medication in the COMP condition and those receiving medication in the PC condition. Higher baseline expectancy of improvement was correlated with lower final depression severity scores (r = 0.53, p = 0.021) and greater improvement in depressive symptoms over the course of the study (r = 0.44, p = 0.058). CONCLUSIONS The methods described represent a promising way of subjecting patient expectancy to scientific study. Expectancy of improvement is affected by the probability of receiving active antidepressant medication and seems to influence antidepressant response.
Collapse
Affiliation(s)
- B R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY 10032, USA.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Li J, Duan N, Guo S, Shao L, Lin C, Wang J, Hou J, Hou Y, Meng J, Han M. Renewable resource for agricultural ecosystem in China: Ecological benefit for biogas by-product for planting. ECOL INFORM 2012. [DOI: 10.1016/j.ecoinf.2012.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
18
|
Oquendo MA, Baca-Garcia E, Artés-Rodríguez A, Perez-Cruz F, Galfalvy HC, Blasco-Fontecilla H, Madigan D, Duan N. Machine learning and data mining: strategies for hypothesis generation. Mol Psychiatry 2012; 17:956-9. [PMID: 22230882 DOI: 10.1038/mp.2011.173] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [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] [Indexed: 11/09/2022]
Abstract
Strategies for generating knowledge in medicine have included observation of associations in clinical or research settings and more recently, development of pathophysiological models based on molecular biology. Although critically important, they limit hypothesis generation to an incremental pace. Machine learning and data mining are alternative approaches to identifying new vistas to pursue, as is already evident in the literature. In concert with these analytic strategies, novel approaches to data collection can enhance the hypothesis pipeline as well. In data farming, data are obtained in an 'organic' way, in the sense that it is entered by patients themselves and available for harvesting. In contrast, in evidence farming (EF), it is the provider who enters medical data about individual patients. EF differs from regular electronic medical record systems because frontline providers can use it to learn from their own past experience. In addition to the possibility of generating large databases with farming approaches, it is likely that we can further harness the power of large data sets collected using either farming or more standard techniques through implementation of data-mining and machine-learning strategies. Exploiting large databases to develop new hypotheses regarding neurobiological and genetic underpinnings of psychiatric illness is useful in itself, but also affords the opportunity to identify novel mechanisms to be targeted in drug discovery and development.
Collapse
Affiliation(s)
- M A Oquendo
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Lee SJ, Newman PA, Comulada WS, Cunningham WE, Duan N. Use of conjoint analysis to assess HIV vaccine acceptability: feasibility of an innovation in the assessment of consumer health-care preferences. Int J STD AIDS 2012; 23:235-41. [PMID: 22581945 DOI: 10.1258/ijsa.2011.011189] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Engaging consumers in prospectively shaping strategies for dissemination of health-care innovations may help to ensure acceptability. We examined the feasibility of using conjoint analysis to assess future HIV vaccine acceptability among three diverse communities: a multiethnic sample in Los Angeles, CA, USA (n = 143); a Thai resident sample in Los Angeles (three groups; n = 27) and an Aboriginal peoples sample in Toronto (n = 13). Efficacy had the greatest impact on acceptability for all three groups, followed by cross-clade protection, side-effects and duration of protection in the Los Angeles sample; side-effects and duration of protection in the Thai-Los Angeles sample; and number of doses and duration of protection in the Aboriginal peoples-Toronto sample. Conjoint analysis provided insights into universal and population-specific preferences among diverse end users of future HIV vaccines, with implications for evidence-informed targeting of dissemination efforts to optimize vaccine uptake.
Collapse
Affiliation(s)
- S J Lee
- University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Center for Community Health, Los Angeles, CA, USA.
| | | | | | | | | |
Collapse
|
20
|
Duan N, Lin C, Gao R, Wang Y, Wang J, Hou J. Ecological and economic analysis of planting greenhouse cucumbers with anaerobic fermentation residues. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.proenv.2011.03.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Duan N, Liu X, Dai J, Lin C, Xia X, Gao R, Wang Y, Chen S, Yang J, Qi J. Evaluating the environmental impacts of an urban wetland park based on emergy accounting and life cycle assessment: A case study in Beijing. Ecol Modell 2011. [DOI: 10.1016/j.ecolmodel.2010.08.028] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
22
|
Duan N, Lin C, Liu X, Wang Y, Zhang X, Hou Y. Study on the effect of biogas project on the development of lowcarbon circular economy -A case study of Beilangzhong eco-village. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.proenv.2011.03.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
23
|
Abstract
BACKGROUND Bulimia nervosa (BN) is a serious psychiatric disorder characterized by frequent episodes of binge eating and inappropriate compensatory behavior. Numerous trials have found that antidepressant medications are efficacious for the treatment of BN. Early response to antidepressant treatment, in the first few weeks after medication is initiated, may provide clinically useful information about an individual's likelihood of ultimately benefitting or not responding to such treatment. The purpose of this study was to examine the relationship between initial and later response to fluoxetine, the only antidepressant medication approved by the US Food and Drug Administration (FDA) for the treatment of BN, with the goal of developing guidelines to aid clinicians in deciding when to alter the course of treatment. METHOD Data from the two largest medication trials conducted in BN (n=785) were used. Receiver operating characteristic (ROC) curves were constructed to assess whether symptom change during the first several weeks of treatment was associated with eventual non-response to fluoxetine at the end of the trial. RESULTS Eventual non-responders to fluoxetine could be reliably identified by the third week of treatment. CONCLUSIONS Patients with BN who fail to report a 60% decrease in the frequency of binge eating or vomiting at week 3 are unlikely to respond to fluoxetine. As no reliable relationships between pretreatment characteristics and eventual response to pharmacotherapy have been identified for BN, early response is one of the only available indicators to guide clinical management.
Collapse
Affiliation(s)
- R Sysko
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA.
| | | | | | | | | |
Collapse
|
24
|
Abstract
This paper investigates the problem of globally asymptotically stable in probability by state-feedback for a class of stochastic high-order nonlinear systems with a ratio of odd integers power. By extending the adding a power integrator technique and choosing an appropriate Lyapunov function, a linear smooth state-feedback controller is explicitly constructed to render the system globally asymptotically stable in probability. Furthermore, we address the problem of state-feedback inverse optimal stabilization in probability. A simulation example is provided to show the effectiveness of the proposed approach.
Collapse
|
25
|
Abstract
Latinos are under-represented in HIV/AIDS medical research in the US. Although they are disproportionately impacted by HIV/AIDS, Latinos may be reluctant to participate in HIV vaccine trials. Three focus groups were conducted with 32 Spanish-speaking Latinos recruited from two community-based healthcare organizations in Los Angeles, California. A qualitative focus group interview guide was developed to explore concerns, motivators and intentions in regard to participation in HIV vaccine trials. Mistrust and fear of government emerged as important themes related to reluctance to participate in an HIV vaccine trial. Specific concerns regarding trial participation included: (1) fear of vaccine-induced HIV infection, (2) physical side effects, (3) stigma and (4) false-induced HIV-positive test results and their social repercussions. Motivators for enrolling in an HIV vaccine trial included: (1) incentives, (2) convenience of participating in a study, (3) sufficient and appropriate study information, (4) personal benefits and (5) altruism. Interventions to facilitate participation by Latinos in HIV vaccine trials should address mistrust and fear of government-sponsored HIV/AIDS medical research, increase access to and convenience of clinical trials, address fear of vaccine-induced infection, combat HIV/AIDS stigma and raise awareness of the relevance of HIV/AIDS to Latino communities.
Collapse
Affiliation(s)
- R A Brooks
- Center for HIV Identification, Prevention, and Treatment Services, Neuropsychiatric Institute, University of California, Los Angeles, USA.
| | | | | | | |
Collapse
|
26
|
|
27
|
Cohn SE, Berk ML, Berry SH, Duan N, Frankel MR, Klein JD, McKinney MM, Rastegar A, Smith S, Shapiro MF, Bozzette SA. The care of HIV-infected adults in rural areas of the United States. J Acquir Immune Defic Syndr 2001; 28:385-92. [PMID: 11707677 DOI: 10.1097/00126334-200112010-00013] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study describes the population of HIV-infected adults receiving care in rural areas of the United States and compares HIV care received in rural and urban areas. METHODS Interviews were conducted with a nationally representative sample of 367 HIV-infected adults receiving health care in rural areas and 2806 HIV-infected adults receiving health care in urban areas of the contiguous United States. RESULTS We estimate that 4800 HIV-infected persons received medical care in rural areas during the first half of 1996. Patients in rural HIV care were more likely than patients in urban HIV care to receive care from providers seeing few (<10) HIV-infected patients (38% vs. 3%; p <.001). Rural care patients were less likely than urban care patients to have taken highly active antiretroviral agents (57% vs. 73%; p <.001) or Pneumocystis carinii pneumonia prophylactic medication when indicated (60% vs. 75%; p =.006). CONCLUSIONS Few American adults received HIV care in rural areas of the United States. Our findings suggest ongoing disparities between urban and rural areas in access to high-quality HIV care.
Collapse
Affiliation(s)
- S E Cohn
- University of Rochester, Rochester, New York, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Golin CE, DiMatteo MR, Leake B, Duan N, Gelberg L. A diabetes-specific measure of patient desire to participate in medical decision making. Diabetes Educ 2001; 27:875-86. [PMID: 12211927 DOI: 10.1177/014572170102700613] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The goal of this study was to develop a diabetes-specific scale of patient desire to participate in medical decision making (DPMD) and examine its internal consistency reliability, stability, and validity (content, discriminant, convergent, and construct). METHODS In a cross-sectional study, 65 patients with type 2 diabetes from a teaching hospital's general medical clinic were interviewed at baseline and 2 weeks later to measure their DPMD scores. Data were collected on demographic/clinical features, health value, social support, desire to make a final decision, and value of patient autonomy. RESULTS Of the 11 DPMD items, 2 distinct factors emerged representing desire for discussion and desire for information. The DPMD scale had high internal consistency reliability, was stable over 2 weeks and demonstrated good content validity. DPMD scale items were more correlated with each other than with health value or social support. Overall, patients who obtained diabetes education reported greater desire to participate in decisions. Younger patients had a greater overall desire for discussion. The DPMD desire for discussion subscale correlated with patients' desire to make the final treatment decision but not with patients' value of autonomy. CONCLUSIONS The DPMD is a brief, reliable, valid measure for assessing patient desire to participate in diabetes medical decision making.
Collapse
Affiliation(s)
- C E Golin
- The Division of General Internal Medicine and Sheps Center for Health Services Research, University of North Carolina at Chapel Hill(Dr Golin)
| | - M R DiMatteo
- The Division of General Internal Medicine and Sheps Center for Health Services Research, University of North Carolina at Chapel Hill(Dr Golin)
- The Department of Psychology, University of California, Riverside (Dr DiMatteo)
| | - B Leake
- The Department of Family Medicine, University of California, Los Angeles (Drs Leake and Gelberg)
- School of Nursing, University of California, Los Angeles (Dr Leake)
| | - N Duan
- The Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (Dr Duan)
| | - L Gelberg
- The Department of Family Medicine, University of California, Los Angeles (Drs Leake and Gelberg)
| |
Collapse
|
29
|
|
30
|
Donald Sherbourne C, Unützer J, Schoenbaum M, Duan N, Lenert LA, Sturm R, Wells KB. Can utility-weighted health-related quality-of-life estimates capture health effects of quality improvement for depression? Med Care 2001; 39:1246-59. [PMID: 11606878 DOI: 10.1097/00005650-200111000-00011] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Utility methods that are responsive to changes in desirable outcomes are needed for cost-effectiveness (CE) analyses and to help in decisions about resource allocation. OBJECTIVES Evaluated is the responsiveness of different methods that assign utility weights to subsets of SF-36 items to average improvements in health resulting from quality improvement (QI) interventions for depression. DESIGN A group level, randomized, control trial in 46 primary care clinics in six managed care organizations. Clinics were randomized to one of two QI interventions or usual care. SUBJECTS One thousand one hundred thirty-six patients with current depressive symptoms and either 12-month, lifetime, or no depressive disorder identified through screening 27,332 consecutive patients. MEASURES Utility weighted SF-12 or SF-36 measures, probable depression, and physical and mental health-related quality of life scores. RESULTS Several utility-weighted measures showed increases in utility values for patients in one of the interventions, relative to usual care, that paralleled the improved health effects for depression and emotional well being. However, QALY gains were small. Directly elicited utility values showed a paradoxical result of lower utility during the first year of the study for intervention patients relative to controls. CONCLUSIONS The results raise concerns about the use of direct single-item utility measures or utility measures derived from generic health status measures in effectiveness studies for depression. Choice of measure may lead to different conclusions about the benefit and CE of treatment. Utility measures that capture the mental health and non-health outcomes associated with treatment for depression are needed.
Collapse
|
31
|
Unützer J, Rubenstein L, Katon WJ, Tang L, Duan N, Lagomasino IT, Wells KB. Two-year effects of quality improvement programs on medication management for depression. Arch Gen Psychiatry 2001; 58:935-42. [PMID: 11576031 DOI: 10.1001/archpsyc.58.10.935] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Significant underuse of evidence-based treatments for depression persists in primary care. We examined the effects of 2 primary care-based quality improvement (QI) programs on medication management for depression. METHODS A total of 1356 patients with depressive symptoms (60% with depressive disorders and 40% with subthreshold depression) from 46 primary care practices in 6 nonacademic managed care organizations were enrolled in a randomized controlled trial of QI for depression. Clinics were randomized to usual care or to 1 of 2 QI programs that involved training of local experts who worked with patients' regular primary care providers (physicians and nurse practitioners) to improve care for depression. In the QI-medications program, depression nurse specialists provided patient education and assessment and followed up patients taking antidepressants for up to 12 months. In the QI-therapy program, depression nurse specialists provided patient education, assessment, and referral to study-trained psychotherapists. RESULTS Participants enrolled in both QI programs had significantly higher rates of antidepressant use than those in the usual care group during the initial 6 months of the study (52% in the QI-medications group, 40% in the QI-therapy group, and 33% in the usual care group). Patients in the QI-medications group had higher rates of antidepressant use and a reduction in long-term use of minor tranquilizers for up to 2 years, compared with patients in the QI-therapy or usual care group. CONCLUSIONS Quality improvement programs for depression in which mental health specialists collaborate with primary care providers can substantially increase rates of antidepressant treatment. Active follow-up by a depression nurse specialist in the QI-medications program was associated with longer-term increases in antidepressant use than in the QI model without such follow-up.
Collapse
Affiliation(s)
- J Unützer
- Center for Health Services Research, Neuropsychiatric Institute, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA 90024, USA.
| | | | | | | | | | | | | |
Collapse
|
32
|
Schoenbaum M, Unützer J, Sherbourne C, Duan N, Rubenstein LV, Miranda J, Meredith LS, Carney MF, Wells K. Cost-effectiveness of practice-initiated quality improvement for depression: results of a randomized controlled trial. JAMA 2001; 286:1325-30. [PMID: 11560537 DOI: 10.1001/jama.286.11.1325] [Citation(s) in RCA: 217] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Depression is a leading cause of disability worldwide, but treatment rates in primary care are low. OBJECTIVE To determine the cost-effectiveness from a societal perspective of 2 quality improvement (QI) interventions to improve treatment of depression in primary care and their effects on patient employment. DESIGN Group-level randomized controlled trial conducted June 1996 to July 1999. SETTING Forty-six primary care clinics in 6 community-based managed care organizations. PARTICIPANTS One hundred eighty-one primary care clinicians and 1356 patients with positive screening results for current depression. INTERVENTIONS Matched practices were randomly assigned to provide usual care (n = 443 patients) or to 1 of 2 QI interventions offering training to practice leaders and nurses, enhanced educational and assessment resources, and either nurses for medication follow-up (QI-meds; n = 424 patients) or trained local psychotherapists (QI-therapy; n = 489). Practices could flexibly implement the interventions, which did not assign type of treatment. MAIN OUTCOME MEASURES Total health care costs, costs per quality-adjusted life-year (QALY), days with depression burden, and employment over 24 months, compared between usual care and the 2 interventions. RESULTS Relative to usual care, average health care costs increased $419 (11%) in QI-meds (P =.35) and $485 (13%) in QI-therapy (P =.28); estimated costs per QALY gained were between $15 331 and $36 467 for QI-meds and $9478 and $21 478 for QI-therapy; and patients had 25 (P =.19) and 47 (P =.01) fewer days with depression burden and were employed 17.9 (P =.07) and 20.9 (P =.03) more days during the study period. CONCLUSIONS Societal cost-effectiveness of practice-initiated QI efforts for depression is comparable with that of accepted medical interventions. The intervention effects on employment may be of particular interest to employers and other stakeholders.
Collapse
Affiliation(s)
- M Schoenbaum
- RAND, 1200 S Hayes St, Arlington, VA 22202, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Rost KM, Duan N, Rubenstein LV, Ford DE, Sherbourne CD, Meredith LS, Wells KB. The Quality Improvement for Depression collaboration: general analytic strategies for a coordinated study of quality improvement in depression care. Gen Hosp Psychiatry 2001; 23:239-53. [PMID: 11600165 DOI: 10.1016/s0163-8343(01)00157-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
It is difficult to evaluate the promise of primary care quality-improvement interventions for depression because published studies have evaluated diverse interventions by using different research designs in dissimilar populations. Preplanned meta-analysis provides an alternative to derive more precise and generalizable estimates of intervention effects; however, this approach requires the resolution of analytic challenges resulting from design differences that threaten internal and external validity. This paper describes the four-project Quality Improvement for Depression (QID) collaboration specifically designed for preplanned meta-analysis of intervention effects on outcomes. This paper summarizes the interventions the four projects tested, characterizes commonalities and heterogeneity in the research designs used to evaluate these interventions, and discusses the implications of this heterogeneity for preplanned meta-analysis.
Collapse
Affiliation(s)
- K M Rost
- Department of Family Medicine, University of Colorado Health Sciences Center, 1180 Clermont Street, Campus Box B155, Denver, CO 80220, USA.
| | | | | | | | | | | | | |
Collapse
|
34
|
Sherbourne CD, Wells KB, Duan N, Miranda J, Unützer J, Jaycox L, Schoenbaum M, Meredith LS, Rubenstein LV. Long-term effectiveness of disseminating quality improvement for depression in primary care. Arch Gen Psychiatry 2001; 58:696-703. [PMID: 11448378 DOI: 10.1001/archpsyc.58.7.696] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND This article addresses whether dissemination of short-term quality improvement (QI) interventions for depression to primary care practices improves patients' clinical outcomes and health-related quality of life (HRQOL) over 2 years, relative to usual care (UC). METHODS The sample included 1299 patients with current depressive symptoms and 12-month, lifetime, or no depressive disorder from 46 primary care practices in 6 managed care organizations. Clinics were randomized to UC or 1 of 2 QI programs that included training local experts and nurse specialists to provide clinician and patient education, assessment, and treatment planning, plus either nurse care managers for medication follow-up (QI-meds) or access to trained psychotherapists (QI-therapy). Outcomes were assessed every 6 months for 2 years. RESULTS For most outcomes, differences between intervention and UC patients were not sustained for the full 2 years. However, QI-therapy reduced overall poor outcomes compared with UC by about 8 percentage points throughout 2 years, and by 10 percentage points compared with QI-meds at 24 months. Both interventions improved patients' clinical and role outcomes, relative to UC, over 12 months (eg, a 10-11 and 6-7 percentage point difference in probable depression at 6 and 12 months, respectively). CONCLUSIONS While most outcome improvements were not sustained over the full 2 study years, findings suggest that flexible dissemination of short-term, QI programs in managed primary care can improve patient outcomes well after program termination. Models that support integrated psychotherapy and medication-based treatment strategies in primary care have the potential for relatively long-term patient benefits.
Collapse
Affiliation(s)
- C D Sherbourne
- Health Program, RAND, 1700 Main St, Santa Monica, CA 90407-2138, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Duan N, Zhang X, Gao X, Liu S, Xu X, Tao D, Xu Y, Wu J. [Green electroluminescence generated from a new rare earth complex: Tb(asprin)3phen]. Guang Pu Xue Yu Guang Pu Fen Xi 2001; 21:267-270. [PMID: 12947642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Pure Green and narrow bandwidth emission from organic electroluminescent device was presented by using a new rare earth complex Tb(asprin)3phen as emissive layer. The structure of the device was ITO/PVK:Tb(asprin)3phen/Al, where PVK was used to improve the film-forming ability and conductivity of Tb(asprin)3phen. The electroluminescent property of the device was studied. It proved that this new kind of rare earth complex has excellent optoluminescent and electroluminescent properties. The electroluminescent mechanism of the device was proposed by measuring and analyzing the emission and excitation spectra of the emissive layer. The excitation spectrum of Tb(asprin)3phen-dispersed PVK film was very similar to that of the PVK. We proposed that the excited carriers of PVK and Tb(asprin)3phen were captured by Tb3+ and light was emitted when the electrons and holes recombined at Tb3+.
Collapse
Affiliation(s)
- N Duan
- Institute of Optoelectronics Technology, Laboratory of Materials for Information Storage and Display, Ministry of Railway Key Laboratory, Northern Jiaotong University, 100044 Beijing
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
To assess a guideline-based intervention's impact on depression care provided in rural vs. urban primary care settings, 12 community primary care practices (four rural, eight urban) were randomized to enhanced (i.e., intervention) and usual care study conditions. The study enrolled 479 depressed patients, with 432 (90.2 percent) completing telephone follow-up at six months. Multilevel analytic models revealed that rural enhanced care patients had 2.70 times the odds (P = 0.02) of rural usual care patients of taking a three-month course of antidepressant medication at recommended dosages in the six months following baseline; urban enhanced care patients had 2.43 times the odds compared with their urban usual care counterparts (P = 0.007). Rural enhanced care patients had 3.00 times the odds of rural usual care patients of making eight or more visits to a mental health specialist for counseling in the six months following baseline (P = 0.03). Comparisons of patients in enhanced care practices showed that rural enhanced care patients had 2.00 times the odds (P = 0.12) of urban enhanced care patients of making at least one visit to a mental health specialist for counseling in the six months following baseline and had comparable odds to urban enhanced care patients (odds ratio [OR] = 1.06, P = 0.77) of making eight or more visits to such specialists during that interval. The study's intervention improved the care received by both rural and urban depressed primary care patients. Moreover, the intervention's effect appears to have been greater in rural settings, particularly in terms of increasing depressed rural patients' use of mental health specialists for counseling.
Collapse
Affiliation(s)
- J L Smith
- Center for Studies in Family Medicine, University of Colorado Health Sciences Center, 1180 Clermont Street, Box B155, Denver, Colorado 80220, USA.
| | | | | | | | | |
Collapse
|
37
|
Reise SP, Duan N. Introduction to the Special Issue on Multilevel Models. Multivariate Behav Res 2001; 36:153. [PMID: 26822106 DOI: 10.1207/s15327906mbr3602_01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
38
|
|
39
|
Abstract
An econometric model estimated the disutility of traveling long distances for depression treatment, and simulations calculated the utility loss associated with selective contracting in rural and urban areas. A representative sample of depression patients (n = 106) and all practicing providers (n = 3,710) in Arkansas were identified and the distances between them were calculated. Using discrete choice analysis, patient preferences for provider type and travel distance were estimated. Simulations calculated the utility loss associated with alternative scenarios of selective contracting. Provider type and distance were significant predictors of provider choice. To equate the utility loss associated with selective contracting in rural and urban areas, a slightly higher proportion of rural physicians and a substantially higher proportion of rural mental health specialists must be contracted. To avoid further reductions in geographic access, managed care organizations should contract with a higher proportion of rural providers than urban providers.
Collapse
Affiliation(s)
- J Fortney
- University of Arkansas for Medical Sciences and VA HSR&D Center for Mental Healthcare and Outcomes Research, USA
| | | | | | | | | |
Collapse
|
40
|
Rost K, Nutting P, Smith J, Werner J, Duan N. Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. Quality Enhancement by Strategic Teaming. J Gen Intern Med 2001; 16:143-9. [PMID: 11318908 PMCID: PMC1495192 DOI: 10.1111/j.1525-1497.2001.00537.x] [Citation(s) in RCA: 202] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether redefining primary care team roles would improve outcomes for patients beginning a new treatment episode for major depression. DESIGN Following stratification, 6 of 12 practices were randomly assigned to the intervention condition. Intervention effectiveness was evaluated by patient reports of 6-month change in 100-point depression symptom and functional status scales. SETTING Twelve community primary care practices across the country employing no onsite mental health professional. PATIENTS Using two-stage screening, practices enrolled 479 depressed adult patients (73.4% of those eligible); 90.2% completed six-month follow-up. INTERVENTION Two primary care physicians, one nurse, and one administrative staff member in each intervention practice received brief training to improve the detection and management of major depression. MAIN RESULTS In patients beginning a new treatment episode, the intervention improved depression symptoms by 8.2 points (95% confidence interval [CI], 0.2 to 16.1; P =.04). Within this group, the intervention improved depression symptoms by 16.2 points (95% CI, 4.5 to 27.9; P =.007), physical role functioning by 14.1 points (95% CI, 1.1 to 29.2; P =.07), and satisfaction with care (P =.02) for patients who reported antidepressant medication was an acceptable treatment at baseline. Patients already in treatment at enrollment did not benefit from the intervention. CONCLUSIONS In practices without onsite mental health professionals, brief interventions training primary care teams to assume redefined roles can significantly improve depression outcomes in patients beginning a new treatment episode. Such interventions should target patients who report that antidepressant medication is an acceptable treatment for their condition. More research is needed to determine how primary care teams can best sustain these redefined roles over time.
Collapse
Affiliation(s)
- K Rost
- Center for Studies in Family Medicine, Department of Family Medicine, University of Colorado Health Sciences Center, Denver, Colo 80220, USA.
| | | | | | | | | |
Collapse
|
41
|
Rotheram-Borus MJ, Lee MB, Murphy DA, Futterman D, Duan N, Birnbaum JM, Lightfoot M. Efficacy of a preventive intervention for youths living with HIV. Am J Public Health 2001; 91:400-5. [PMID: 11236404 PMCID: PMC1446609 DOI: 10.2105/ajph.91.3.400] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES HIV transmission behaviors and health practices of HIV-infected youths were examined over a period of 15 months after they received a preventive intervention. METHODS HIV-infected youths aged 13 to 24 years (n = 310; 27% African American, 37% Latino) were assigned by small cohort to (1) a 2-module ("Stay Healthy" and "Act Safe") intervention totaling 23 sessions or (2) a control condition. Among those in the intervention condition, 73% attended at least 1 session. RESULTS Subsequent to the "Stay Healthy" module, number of positive lifestyle changes and active coping styles increased more often among females who attended the intervention condition than among those in the control condition. Social support coping also increased significantly among males and females attending the intervention condition compared with those attending the control condition. Following the "Act Safe" module, youths who attended the intervention condition reported 82% fewer unprotected sexual acts, 45% fewer sexual partners, 50% fewer HIV-negative sexual partners, and 31% less substance use, on a weighted index, than those in the control condition. CONCLUSIONS Prevention programs can effectively reduce risk acts among HIV-infected youths. Alternative formats need to be identified for delivering interventions (e.g., telephone groups, individual sessions).
Collapse
|
42
|
Abstract
OBJECTIVE We evaluated the effect of implementing quality improvement (QI) programs for depression, relative to usual care, on primary care clinicians' knowledge about treatment. DESIGN AND METHODS Matched primary care clinics (46) from seven managed care organizations were randomized to usual care (mailed written guidelines only) versus one of two QI interventions. Self-report surveys assessed clinicians' knowledge of depression treatments prior to full implementation (June 1996 to March 1997) and 18 months later. We used an intent-to-treat analysis to examine intervention effects on change in knowledge, controlling for clinician and practice characteristics, and the nested design. PARTICIPANTS One hundred eighty-one primary care clinicians. INTERVENTIONS The interventions included institutional commitment to QI, training local experts, clinician education, and training nurses for patient assessment and education. One intervention had resources for nurse follow-up on medication use (QI-meds) and the other had reduced copayment for therapy from trained, local therapists (QI-therapy). RESULTS Clinicians in the intervention group had greater increases compared with clinicians in the usual care group over 18 months in knowledge of psychotherapy (by 20% for QI-meds, P =.04 and by 33% for QI-therapy, P =.004), but there were no significant increases in medication knowledge. Significant increases in knowledge scores (P =.01) were demonstrated by QI-therapy clinicians but not clinicians in the QI-meds group. Clinicians were exposed to multiple intervention components. CONCLUSIONS Dissemination of QI programs for depression in managed, primary care practices improved clinicians' treatment knowledge over 18 months, but breadth of learning was somewhat greater for a program that also included active collaboration with local therapists.
Collapse
|
43
|
Stockdale SE, Keeler E, Duan N, Derose KP, Fox SA. Costs and cost-effectiveness of a church-based intervention to promote mammography screening. Health Serv Res 2000; 35:1037-57. [PMID: 11130802 PMCID: PMC1089182] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVES To evaluate the costs of implementing a church-based, telephone-counseling program for increasing mammography use, and to identify the components of costs and the likely cost-effectiveness in hypothetical communities with varying characteristics. DATA SOURCES/STUDY SETTING An ethnically and socioeconomically diverse sample of 1,443 women recruited from 45 churches participating in the Los Angeles Mammography Promotion (LAMP) program were followed from 1995 to 1997. STUDY DESIGN Churches were stratified into blocks and randomized into three intervention arms-telephone counseling, mail counseling, and control. We surveyed participants before and after the intervention to collect data on mammography use and demographic characteristics. DATA COLLECTION/EXTRACTION METHODS We used call records, activity reports, and interviews to collect data on the time and materials needed to organize and carry out the intervention. We constructed a standard model of costs and cost-effectiveness based on these data and the Year One results of the LAMP program. PRINCIPAL FINDINGS The cost in materials and overhead to the church site was $10.89 per participant and $188 per additional screening. However, when the estimated cost for church volunteers' time was included, the cost of the intervention increased substantially. CONCLUSIONS A church-based program to promote the use of mammography would be feasible for many churches with the use of volunteer labor and resources.
Collapse
|
44
|
Schuster MA, Duan N, Regalado M, Klein DJ. Anticipatory guidance: what information do parents receive? What information do they want? Arch Pediatr Adolesc Med 2000; 154:1191-8. [PMID: 11115301 DOI: 10.1001/archpedi.154.12.1191] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine whether parents are receiving anticipatory guidance, whether they could use more information on anticipatory guidance topics, and how receipt of anticipatory guidance relates to satisfaction with care. DESIGN AND SAMPLE Analysis of data from a telephone interview of 2017 respondents between July 1995 and January 1996. A stratified random-digit dialing design was used to obtain a nationally representative sample of parents with children between 0 and 3 years old. MAIN OUTCOME MEASURES Discussions with a physician or nurse about 6 anticipatory guidance topics and whether parents could use more information on these topics. Willingness of parents to pay extra to discuss these topics and receive additional care. Ratings of how well clinicians provide health care. RESULTS The percentage of parents who had not discussed each subject with a clinician varied by topic: newborn care (< 3 months old), 38%; crying, 65%; sleep patterns, 59%; encouraging learning, 77%; discipline (ages 6-36 months), 75%; and toilet training (ages 18-36 months), 66%. Thirty-seven percent of parents had not discussed any of these topics. Among parents who had not discussed a particular issue, the percentage who reported that they could use more information ranged from 22% for both newborn care and crying to 55% for encouraging learning; similar percentages who had discussed the topics could also use more information. Parents who had discussed more of these topics with a clinician were more likely to report excellent care. Parents who could use more information on a larger number of topics were much more willing to pay for additional care. CONCLUSIONS Although anticipatory guidance is considered an important component of well-child care, the majority of parents reported that they had not discussed most standard topics with a clinician. Many parents could use more information on these topics. Effort is required to provide parents with the information they need to take good care of their children. Arch Pediatr Adolesc Med. 2000;154:1191-1198.
Collapse
Affiliation(s)
- M A Schuster
- RAND Corporation, 1700 Main St, Santa Monica, CA 90407, USA.
| | | | | | | |
Collapse
|
45
|
Turner BJ, Cunningham WE, Duan N, Andersen RM, Shapiro MF, Bozzette SA, Nakazono T, Morton S, Crystal S, St Clair P, Stein M, Zierler S. Delayed medical care after diagnosis in a US national probability sample of persons infected with human immunodeficiency virus. Arch Intern Med 2000; 160:2614-22. [PMID: 10999975 DOI: 10.1001/archinte.160.17.2614] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To identify health care and patient factors associated with delayed initial medical care for human immunodeficiency virus (HIV) infection. DESIGN Survey of a national probability sample of persons with HIV in care. SETTING Medical practices in the contiguous United States. PATIENTS Cohort A (N = 1540) was diagnosed by February 1993 and was in care within 3 years; cohort B (N = 1960) was diagnosed by February 1995 and was in care within 1 year of diagnosis. MAIN OUTCOME MEASURE More than 3- or 6-month delay. RESULTS Delay of more than 3 months occurred for 29% of cohort A (median, 1 year) and 17% of cohort B. Having a usual source of care at diagnosis reduced delay, with adjusted odds ratios (ORs) of 0.61 (95% confidence interval [CI], 0.48-0.77) in cohort A and 0. 70 (95% CI, 0.50-0.99) in cohort B. Medicaid coverage at diagnosis showed lower adjusted ORs of delay compared with private insurance (cohort A: adjusted OR, 0.52; 95% CI, 0.30-0.92; cohort B: adjusted OR, 0.48; 95% CI, 0.27-0.85). Compared with whites, Latinos had 53% and 95% higher adjusted ORs of delay (P<.05) in cohorts A and B, respectively, and African Americans had a higher adjusted OR in cohort A (1.56; 95% CI, 1.19-2.04). The health care factors showed similar effects on delay of greater than 6 months. CONCLUSIONS Medicaid insurance and a usual source of care were protective against delay after HIV diagnosis. After full adjustment, delay was still greater for Latinos and, to a lesser extent, African Americans compared with whites.
Collapse
Affiliation(s)
- B J Turner
- University of Pennsylvania, General Internal Medicine, 1119 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
OBJECTIVES This study assessed the effectiveness of telephone counseling in a church-based mammography promotion intervention trial. METHODS Thirty churches were randomized to telephone counseling and control conditions; telephone interview data were used in assessing intervention effects on mammography adherence. Separate analyses were conducted for baseline-adherent participants (maintaining adherence) and baseline-nonadherent participants (conversion to adherence). RESULTS Year 1 follow-up data indicated that the telephone counseling intervention maintained mammography adherence among baseline-adherent participants and reduced the nonadherence rate from 23% to 16%. CONCLUSIONS Partnerships between the public health and faith communities are potentially effective conduits to promote maintenance of widely endorsed health behaviors such as regular cancer screening.
Collapse
Affiliation(s)
- N Duan
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles.
| | | | | | | |
Collapse
|
47
|
Evans JSO, Hanson PA, Ibberson RM, Duan N, Kameswari U, Sleight AW. Low-Temperature Oxygen Migration and Negative Thermal Expansion in ZrW2-xMoxO8. J Am Chem Soc 2000. [DOI: 10.1021/ja0013428] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J. S. O. Evans
- Contribution from the Department of Chemistry, University of Durham, Science Laboratories, South Road, Durham DH1 3LE, UK, ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, UK, and Department of Chemistry, Oregon State University, Corvallis, Oregon 97331
| | - P. A. Hanson
- Contribution from the Department of Chemistry, University of Durham, Science Laboratories, South Road, Durham DH1 3LE, UK, ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, UK, and Department of Chemistry, Oregon State University, Corvallis, Oregon 97331
| | - R. M. Ibberson
- Contribution from the Department of Chemistry, University of Durham, Science Laboratories, South Road, Durham DH1 3LE, UK, ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, UK, and Department of Chemistry, Oregon State University, Corvallis, Oregon 97331
| | - N. Duan
- Contribution from the Department of Chemistry, University of Durham, Science Laboratories, South Road, Durham DH1 3LE, UK, ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, UK, and Department of Chemistry, Oregon State University, Corvallis, Oregon 97331
| | - U. Kameswari
- Contribution from the Department of Chemistry, University of Durham, Science Laboratories, South Road, Durham DH1 3LE, UK, ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, UK, and Department of Chemistry, Oregon State University, Corvallis, Oregon 97331
| | - A. W. Sleight
- Contribution from the Department of Chemistry, University of Durham, Science Laboratories, South Road, Durham DH1 3LE, UK, ISIS Facility, Rutherford Appleton Laboratory, Chilton, Didcot, UK, and Department of Chemistry, Oregon State University, Corvallis, Oregon 97331
| |
Collapse
|
48
|
|
49
|
Abstract
BACKGROUND Pediatric asthma survey measures have not been adequately tested in non-English-speaking populations. OBJECTIVES To test the reliability and validity of an English and Spanish symptom scale to measure asthma control in children. SUBJECTS Parents (54% Spanish-speaking; 61% not high school graduates) of 234 children seen in the emergency department for an asthma exacerbation. MEASURES Parent report of frequency and perceived severity of child asthma symptoms during the beginning and after resolution of the exacerbation. RESULTS An 8-item scale composed of reports of cough, wheezing, shortness of breath, asthma attacks, chest pain, night symptoms, and overall perceived severity had very good psychometric properties in both English and Spanish. The reliability (Cronbach's alpha) of the scale ranged from 0.81 to 0.87 for both languages and time frames. In both languages, the validity of the scale was supported by responsiveness to changes in clinical status (lower symptom score after resolution of the exacerbation, P < 0.001) and by moderate to strong correlations (P < 0.001) with other asthma morbidity measures (parent report of child bother: r = 0.59-0.65; school days lost: r = 0.38-0.67; and activity days lost: r = 0.41-0.59). There were no statistically significant differences in the reliability or construct validity of the summary symptom scale by language, although Spanish speakers reported a lower frequency of some symptoms than did English speakers. CONCLUSIONS A reliable and valid 8-item scale can be used to measure control of asthma symptoms in Spanish-speaking populations of low literacy. Additional research to evaluate language equivalency of asthma measures is necessary.
Collapse
Affiliation(s)
- M Lara
- UCLA Department of Pediatrics, and RAND Health, Los Angeles, California, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Affiliation(s)
- R D Gibbons
- University of Illinois at Chicago, Chicago, IL 60612, USA.
| | | | | |
Collapse
|