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Buss VH, Barr M, Parker SM, Kabir A, Lau AYS, Liaw ST, Stocks N, Harris MF. Correction: Mobile App Intervention of a Randomized Controlled Trial for Patients With Obesity and Those Who Are Overweight in General Practice: User Engagement Analysis Quantitative Study. JMIR Mhealth Uhealth 2024; 12:e58507. [PMID: 38564771 PMCID: PMC11022129 DOI: 10.2196/58507] [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: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
[This corrects the article DOI: 10.2196/45942.].
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Affiliation(s)
- Vera Helen Buss
- Centre for Primary Health Care and EquityUniversity of New South WalesSydneyAustralia
| | - Margo Barr
- Centre for Primary Health Care and EquityUniversity of New South WalesSydneyAustralia
| | - Sharon M Parker
- Centre for Primary Health Care and EquityUniversity of New South WalesSydneyAustralia
| | - Alamgir Kabir
- Centre for Primary Health Care and EquityUniversity of New South WalesSydneyAustralia
| | - Annie Y S Lau
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
| | - Siaw-Teng Liaw
- School of Population HealthUniversity of New South WalesSydneyAustralia
| | - Nigel Stocks
- Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
| | - Mark F Harris
- Centre for Primary Health Care and EquityUniversity of New South WalesSydneyAustralia
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Buss VH, Barr M, Parker SM, Kabir A, Lau AYS, Liaw ST, Stocks N, Harris MF. Mobile App Intervention of a Randomized Controlled Trial for Patients With Obesity and Those Who Are Overweight in General Practice: User Engagement Analysis Quantitative Study. JMIR Mhealth Uhealth 2024; 12:e45942. [PMID: 38335014 PMCID: PMC10891495 DOI: 10.2196/45942] [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: 01/22/2023] [Revised: 08/21/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The Health eLiteracy for Prevention in General Practice trial is a primary health care-based behavior change intervention for weight loss in Australians who are overweight and those with obesity from lower socioeconomic areas. Individuals from these areas are known to have low levels of health literacy and are particularly at risk for chronic conditions, including diabetes and cardiovascular disease. The intervention comprised health check visits with a practice nurse, a purpose-built patient-facing mobile app (mysnapp), and a referral to telephone coaching. OBJECTIVE This study aimed to assess mysnapp app use, its user profiles, the duration and frequency of use within the Health eLiteracy for Prevention in General Practice trial, its association with other intervention components, and its association with study outcomes (health literacy and diet) to determine whether they have significantly improved at 6 months. METHODS In 2018, a total of 22 general practices from 2 Australian states were recruited and randomized by cluster to the intervention or usual care. Patients who met the main eligibility criteria (ie, BMI>28 in the previous 12 months and aged 40-74 years) were identified through the clinical software. The practice staff then provided the patients with details about this study. The intervention consisted of a health check with a practice nurse and a lifestyle app, a telephone coaching program, or both depending on the participants' choice. Data were collected directly through the app and combined with data from the 6-week health check with the practice nurses, the telephone coaching, and the participants' questionnaires at baseline and 6-month follow-up. The analyses comprised descriptive and inferential statistics. RESULTS Of the 120 participants who received the intervention, 62 (52%) chose to use the app. The app and nonapp user groups did not differ significantly in demographics or prior recent hospital admissions. The median time between first and last app use was 52 (IQR 4-95) days, with a median of 5 (IQR 2-10) active days. App users were significantly more likely to attend the 6-week health check (2-sided Fisher exact test; P<.001) and participate in the telephone coaching (2-sided Fisher exact test; P=.007) than nonapp users. There was no association between app use and study outcomes shown to have significantly improved (health literacy and diet) at 6 months. CONCLUSIONS Recruitment and engagement were difficult for this study in disadvantaged populations with low health literacy. However, app users were more likely to attend the 6-week health check and participate in telephone coaching, suggesting that participants who opted for several intervention components felt more committed to this study. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12617001508369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373505. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-023239.
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Affiliation(s)
- Vera Helen Buss
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Alamgir Kabir
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Annie Y S Lau
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Siaw-Teng Liaw
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Nigel Stocks
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Parker SM, Aslani P, Harris-Roxas B, Wright MC, Barr M, Doolan-Noble F, Javanparast S, Sharma A, Osborne RH, Cullen J, Harris E, Haigh F, Harris M. Community health navigator-assisted transition of care from hospital to community: protocol for a randomised controlled trial. BMJ Open 2024; 14:e077877. [PMID: 38309760 PMCID: PMC10840031 DOI: 10.1136/bmjopen-2023-077877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION The objective of this parallel group, randomised controlled trial is to evaluate a community health navigator (CHN) intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes. Unplanned hospital readmissions are costly for the health system and negatively impact patients. METHODS AND ANALYSIS Patients are randomised post hospital discharge to the CHN intervention or usual care. A comparison of outcomes between intervention and control groups will use multivariate regression techniques that adjust for age, sex and any independent variables that are significantly different between the two groups, using multiple imputation for missing values. Time-to-event analysis will examine the relationship between seeing a CHN following discharge from the index hospitalisation and reduced rehospitalisations in the subsequent 60 days and 6 months. Secondary outcomes include medication adherence, health literacy, quality of life, experience of healthcare and health service use (including the cost of care). We will also conduct a qualitative assessment of the implementation of the navigator role from the viewpoint of stakeholders including patients, health professionals and the navigators themselves. ETHICS APPROVAL Ethics approval was obtained from the Research Ethics and Governance Office, Sydney Local Health District, on 21 January 2022 (Protocol no. X21-0438 and 2021/ETH12171). The findings of the trial will be disseminated through peer-reviewed journals and national and international conference presentations. Data will be deposited in an institutional data repository at the end of the trial. This is subject to Ethics Committee approval, and the metadata will be made available on request. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN 12622000659707). ARTICLE SUMMARY The objective of this trial is to evaluate a CHN intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Parisa Aslani
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael C Wright
- Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - F Doolan-Noble
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Sara Javanparast
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Anurag Sharma
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard H Osborne
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - John Cullen
- Aged Health, Rehabilitation and Chronic Care, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Haigh
- Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Cook SK, Parker SM, Woody NM, Vos DJ, Campbell SR, Lamarre E, Scharpf J, Geiger JL, Yilmaz E, Miller JA, Silver N, Ku J, Koyfman SA, Prendes B. Oral Cavity Squamous Cell Carcinomas in Patients with a History of Oral Lichen Planus: Frequency and Outcomes. Int J Radiat Oncol Biol Phys 2023; 117:e573. [PMID: 37785747 DOI: 10.1016/j.ijrobp.2023.06.1906] [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) Oral lichen planus (OLP) is an inflammatory condition which affects the mucous membranes of the oral cavity. While previous studies have described the association between OLP and development of oral cavity cancer, there is currently a paucity of literature examining the impact of this disease on treatment response and prognosis. As such, we present a retrospective cohort study of Oral cavity squamous cell carcinoma (OCSCC) patients with a history of OLP to explore the course of their disease. MATERIALS/METHODS Using an IRB approved tertiary care registry of head and neck cancer patients, we identified patients with OCSCC who had a prior diagnosis of OLP. The number of new primary tumors, rates of local (LF), regional (RF) and distant failure (DF), as well as overall survival (OS) were assessed using Cox proportional hazards and Kaplan Meier analysis for actuarial survival estimates. RESULTS Fifty-four patients with OCSCC and OLP were identified with 109 individual OCSCC diagnoses. Patients had a median age of 67 years, were predominantly female (n = 42, 77.8%) and never smokers (n = 29, 53.7%) with a median follow up after diagnosis of OCSCC of 46.5 months. Nine patients (16.7%) had a history of immunosuppression of whom 6 (11.1%) had chronic steroid use for treatment of OLP. Within the cohort, 33 (61.1%) of OLP patients had a single OCSCC, 11 (20.4%) had 2, and 10 (18.5%) had >3 separate tumors develop. The most common oral cavity subsites were oral tongue (n = 42, 38.5%), followed by alveolar ridge (n = 14, 12.8%) and gingiva (n = 13, 11.9%). Papillary SCC subtype was identified in 10.1%. 92.7% of tumors (n = 101) were treated with primary surgery, with 23 (21.1%) receiving adjuvant RT and 10 of those patients receiving concurrent chemotherapy. Among resected patients, pathologic stages were predominantly T1-2 (84.1%) and N0 (50% vs N1 15.6% and N2a-3 34.4%). The mean RT dose was 62 Gy in 32 fractions. Locoregional failure occurred in 24.8% of cancers (n = 27), with local and regional failure occurring in 13.8% (n = 15) and 11% (n = 12) of lesions, respectively. Recurrence free survival at 3 and 5 years was 75% and 70.3%, respectively, with overall survival at 3 and 5 years of 71.1% and 67%, respectively. CONCLUSION Patients with OCSCC and a history of OLP are predominantly female and never smokers. The tumors that develop in such patients are often early stage but a proportion of patients appear to be at higher risk of developing multiple malignancies and surveillance of this patient population to identify new tumors is crucial.
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Affiliation(s)
- S K Cook
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH
| | - S M Parker
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH
| | - N M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - D J Vos
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - S R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - E Lamarre
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - J Scharpf
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - J L Geiger
- Cleveland Clinic Foundation, Cleveland, OH
| | - E Yilmaz
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - J A Miller
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - N Silver
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - J Ku
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - S A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - B Prendes
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
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Parker SM, Mayo ZS, Shah CS, Scott JG, Mesko N, Nystrom L, Campbell SR. Dosimetric Analysis of Major Wound Complications Following Preoperative Ultra-Hypofractionated Radiation Therapy for Soft Tissue Sarcoma. Int J Radiat Oncol Biol Phys 2023; 117:e331-e332. [PMID: 37785170 DOI: 10.1016/j.ijrobp.2023.06.2383] [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) Preoperative radiation therapy (RT) for soft tissue sarcomas (STS), delivered with conventional fractionation, has been shown to reduce long-term toxicity at the expense of increased postoperative major wound complications (MWC). Ultra-hypofractionated RT has emerged as a potential alternative preoperative modality with early but comparable outcomes to conventional regimens. However, limited data are available evaluating dosimetric, patient, and treatment specific factors associated with development of MWC in this setting. MATERIALS/METHODS This IRB approved review included STS patients treated with preoperative 5 fraction daily RT followed by surgical resection within 7 days. Patients were evaluated for MWCs in association with patient and tumor characteristics, dosimetric parameters, and treatment techniques. MWCs were defined as a return to operating room, readmission for wound care or IV antibiotics, and persistent deep packing for >120 days. Prescription isodose line, PTV mean dose and the PTV volume exposed to 105% and 110% of prescribed dose were recorded. Dose to tissue likely to be involved in wound healing was assessed by creating a 1 cm thick superficial skin strip within 2 cm of the PTV which was then evaluated for volume, mean dose, V15, V21, V27, and V30. Secondary endpoints were locoregional control (LRC), metastasis free survival (MFS), and overall survival (OS). RESULTS A total of 31 patients with a median age of 66 years (range 28-87) and a median follow up of 21 months (IQR 8-43) were included. All patients received 30 Gy in 5 fractions using IMRT/VMAT. There were 11 upper limb (36%) and 20 lower limb (65%) tumors included. Median time to resection following RT was 1 day (IQR 0-3). Median tumor size was 8 cm (IQR 5-13). MWC occurred in 13 patients (42%) with 10 patients (32%) requiring additional surgery. Dehiscence and infection requiring IV antibiotics occurred in 12 (39%) and 6 patients (19%), respectively. RT plans were predominately prescribed to the PTV mean (87%) with a median prescription isodose of 97% (IQR 96-97) and PTV mean dose of 3110 cGy (IQR 3089-3142). Median PTV volume, mean dose, and volume of PTV receiving 105% and 110% of the prescribed dose were higher in the MWC cohort although none reached significance. Similarly, for the 1 cm skin strip the median volume, mean dose, V30, V27, V21, and V15 were all higher in the MWC cohort without significant difference. Among patient, treatment, and tumor factors: tumor size, location, grade, margin status, type of wound closure, and prior non-oncologic resection were not associated with MWC. LRC, MFS, and OS at 3-years were 96%, 67%, and 76%, respectively. CONCLUSION Although not reaching significance, increased plan homogeneity and reduced dose/volume relationships in proximity to the skin trended to reduced MWC in this limited cohort. Multi-institutional collaboration may be warranted to better identify factors associated with MWC in patients treated with preoperative ultra-hypofractionated RT.
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Affiliation(s)
- S M Parker
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH
| | - Z S Mayo
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - C S Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | - N Mesko
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - L Nystrom
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - S R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Parker SM, Halima A, Woody NM, Stephans KL. Liver Stereotactic Body Radiation Therapy (SBRT) to Downstage Patients with Hepatocellular Carcinoma prior to Liver Transplant. Int J Radiat Oncol Biol Phys 2023; 117:e332. [PMID: 37785171 DOI: 10.1016/j.ijrobp.2023.06.2384] [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) Orthotopic liver transplantation (OLT) marks the most successful treatment for hepatocellular carcinoma (HCC) patients meeting Milan criteria. The process of reducing the disease burden of HCC patients not currently meeting criteria for OLT with local therapy is referred to as "downstaging" and has proven to be a feasible approach. RTOG 1112 recently demonstrated the efficacy and acceptable toxicity of liver SBRT for treating HCC. However, limited data currently exists describing the efficacy of SBRT for downstaging HCC patients and facilitating OLT. MATERIALS/METHODS A single institution IRB approved prospective liver SBRT registry was surveyed for all patients outside of Milan criteria (1 lesion >5 cm; 2-3 lesions >3 cm) without vascular invasion or extrahepatic disease. Patients felt least likely to become OLT candidates with downstaging (age >80, >4 lesions, lesion >12 cm) were excluded. The primary endpoints were downstaging and OLT. Secondary endpoints were time to transplant, local control (LC), recurrence free survival (RFS) and overall survival (OS). RESULTS A total of 38 HCC patients with a median age of 65 years (range 28 - 80) met inclusion criteria. Median follow up was 14 months (IQR 3 - 35). At baseline, median KPS was 80 (range 60 - 100) with 16 Child-Pugh (CP) A (42%), 13 CP B (34%), and 9 CP C patients (24%). All patients were outside of Milan criteria and 25 patients (66%) were outside of UCSF criteria at time of SBRT. No patients had extrahepatic disease or vascular invasion. Median number of lesions, largest tumor size, and total sum of lesions were 2 (range 1 - 4), 5.0 cm (IQR, 4.0 - 6.5), and 6.6 cm (IQR 5.9 - 9.2), respectively. Prior to SBRT, 22 patients (58%) had received non-SBRT local therapy. At time of SBRT a variety of dose fractionation schedules were selected with a median BED10 of 78 (IQR 62 - 100). Concurrent sorafenib was used in 2 patients (8%). Following completion of SBRT, 21 patients (55%) were successfully downstaged at a median 3.0 months (IQR 1.9 - 6.1) after treatment, most frequently secondary to decrease in size of the largest lesion (86%). Twelve patients (32%) proceeded to undergo OLT at a median 7 months (IQR 3 - 14) after SBRT and 105 days (IQR 18 - 344) following successful downstaging. Of the 25 patients initially exceeding UCSF criteria, 7 (28%) underwent OLT. Among those receiving OLT, 5 patients (42%) remain alive without evidence of disease, 3 patients (25%) have recurred, 3 patients (33%) died within 2 years from transplant complications, and 1 patient (8%) died from an unrelated cause. LC at 2 years was 83%. Median RFS and OS for the overall cohort were 7 months (95% CI 0 - 21) and 24 months (95% CI 11 - 36), respectively. Among the transplant recipients, the median OS was 37 months (95% CI 30 - 44) compared to 15 months (95% CI 6 - 23) among those not receiving transplant. CONCLUSION With careful patient selection, liver SBRT serves as a feasible downstaging method to facilitate OLT in HCC patients.
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Affiliation(s)
- S M Parker
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH
| | - A Halima
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - N M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - K L Stephans
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Fane L, Halima A, Parker SM, Obi E, Hall EF, Cherian S, Al-Hilli Z, Tendulkar RD, Shah CS. Outcomes with Five Fraction Image-Guided Partial Breast Irradiation to Reduced Target Volumes. Int J Radiat Oncol Biol Phys 2023; 117:e174. [PMID: 37784786 DOI: 10.1016/j.ijrobp.2023.06.1019] [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) The use of 5-fraction partial breast irradiation has been shown in a randomized trial to provide comparable rates of local control and reduced toxicities as compared to standard fractionation whole breast irradiation. The initial technique utilized a 2 cm expansion on the lumpectomy cavity (1 cm for clinical target volume [CTV], and 1 cm planning target volume [PTV]) without consistent image guidance (ex. cone beam computed tomography [CBCT]) or motion management recommendations. We present clinical outcomes using a 5-fraction image guided PBI technique (IG-PBI) to reduced target volumes for patients with early-stage breast cancer. MATERIALS/METHODS A retrospective review of an IRB approved institutional registry was performed to identify patients treated with IG-PBI. A total of 258 patients with early-stage breast cancer (Stage 0-IIA) receiving IG-PBI were identified. Patients received a dose of 30 Gy in 5 fractions delivered daily or every other day. An expansion of 1 cm on the lumpectomy cavity was used for those patients using deep inspiration breath hold (DIBH) while an expansion of 1.5 cm was utilized for those not using DIBH. All patients received daily CBCT. Plans were delivered using intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) technique; while the prescription isodose line covered the PTV, the 26 Gy line was allowed to expand beyond the PTV. Kaplan-Meier analyses were used to assess rates of local control and survival. Patient demographics, stage, hormone therapy use, recurrence, mortality, and toxicity data were collected. Survival was analyzed with Kaplan-Meier curve. RESULTS Median age at diagnosis was 67 years (range 40-87) with a median follow-up of 29 months (IQR 22-40). Forty-six (18%) patients had in situ disease, 200 (78%) patients T1 tumors, and 12 (5%) patients had T2 tumors. Two hundred thirty-four (91%) patients were White, 15 (6%) were Black, and 9 (4%) were other races. One hundred ninety-six (76%) patients received endocrine therapy, and 16 (6%) patients received chemotherapy. Thirty-two (12%) patients developed grade 1 dermatitis and no grade 2 events were observed. One (0.4%) patient had a cardiac event (aortic stenosis) 19 months after breast radiotherapy. At last follow-up, one (0.4%) patient had a local recurrence and one (0.4%) developed a distant metastasis, with no regional nodal failures. Overall, 4 (1.5%) patients had died, all due to other causes. At 3 years, locoregional control was 99.4%. CONCLUSION Outcomes with IG-PBI demonstrate low rates of local recurrence and limited toxicity. The use of reduced target volumes is not associated with increased rates of local recurrence.
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Affiliation(s)
- L Fane
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH
| | - A Halima
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - S M Parker
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH
| | - E Obi
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - E F Hall
- Cleveland Clinic Foundation, Cleveland, OH
| | - S Cherian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Z Al-Hilli
- Department of Surgery, Division of Breast Services, Cleveland, OH
| | - R D Tendulkar
- Dept of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - C S Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Mayo ZS, Jia X, Parker SM, Kocsis J, Shah CS, Scott JG, Campbell SR. Meta-Analysis of Five Fraction Preoperative Radiotherapy for Soft Tissue Sarcoma. Int J Radiat Oncol Biol Phys 2023; 117:S146-S147. [PMID: 37784373 DOI: 10.1016/j.ijrobp.2023.06.563] [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) There is increasing interest in shorter courses of radiation therapy (RT) in the management of soft tissue sarcoma (STS). Studies investigating preoperative ultra-hypofractionated 5-fraction RT for STS are few and often limited to single institution experiences with less than 50 patients. We therefore performed a meta-analysis to determine the efficacy and safety of preoperative 5-fraction RT for STS based on currently published literature, with an analysis evaluating effects of dose delivered. MATERIALS/METHODS This study level meta-analysis was conducted using Bayesian methods. Statistical estimation for risk of outcome rates were conducted by posterior mean and 95% highest posterior density (HPD) intervals. Studies with two-year local control (LC) and description of major wound complications (MWC) per the CAN-NCIC-SR2 study were included in this meta-analysis, and these served as the primary endpoints. Secondary endpoints included rates of acute and late toxicity. A total of ten studies were identified; seven met inclusion criteria (Kalbasi 2020, Kubicek 2021, Leite 2021, Spalek 2021, Gobo Silva 2021, Bedi 2022, Mayo 2022). Three studies (Kosela-Paterczyk 2014, Kosela-Paterczyk 2021, Potkrajcic 2021) did not include adequate information to accurately determine 2-year LC or MWC. Subgroup analyses were performed for ≥30 Gy vs <30 Gy as the EQD2 of 30 Gy in 5 fractions for an α/β of 3-4 is 50-54 Gy, equivalent to standard preoperative RT fractionation. RESULTS A total of 208 patients were included from seven studies. Five studies used ≥30 Gy (n = 144) and 2 studies <30 Gy (n = 64). The median follow-up was 29 months (range: 21-57). Primary tumor location was lower extremity in 68%, upper extremity in 22%, and trunk in 10%. In studies with available information, most tumors were intermediate (27%, 46/169) or high grade (67%, 114/169) and 50% (79/158) were >10 cm. Two-year LC for the entire cohort was 96.9% (95% HPD: 0.9374-0.9889) and the rate of MWC was 30.6% (95% HPD: 0.2106-0.4149). Acute grade 2 and 3 dermatitis was seen in 12.7% and 2.2%, respectively. Late grade 2 toxicities included fibrosis (11.1%), stiffness (6.0%), and lymphedema (4.0%) and late grade 3 toxicities included fibrosis (1.8%) and stiffness (0.4%). Grade 4 toxicity was rare and included fibrosis (0.6%) and stiffness (0.6%). There was a trend toward improved LC with ≥ 30 Gy (95% HPD: 0.949-0.997 vs 0.838-0.986). There was no difference in MWC (95% HPD: 0.185-0.420 vs 0.172-0.553) or late toxicity between the two groups. Acute grade 3 dermatitis was seen less frequently with regimens <30 Gy (95% HPD: 0-0 vs 0.009-0.072), however rare overall. CONCLUSION Preoperative 5-fraction RT for STS demonstrates excellent 2-year LC with MWC and toxicity similar to standard fractionation preoperative RT. Multi-institutional trials with a universal RT protocol and larger sample size are warranted to assess this novel treatment paradigm.
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Affiliation(s)
- Z S Mayo
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - X Jia
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - S M Parker
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH
| | - J Kocsis
- Cleveland Clinic, Cleveland, OH, United States
| | - C S Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - J G Scott
- Dept of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - S R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Halima A, Parker SM, Fane L, Hall EF, Obi E, Al-Hilli Z, Valente S, Gentle C, Cherian S, Tendulkar RD, Shah CS. Five Fraction Accelerated Partial Breast Irradiation vs. Intraoperative Radiation Therapy for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e177. [PMID: 37784793 DOI: 10.1016/j.ijrobp.2023.06.1025] [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) Accelerated partial breast irradiation (APBI) represents an alternative to whole breast irradiation (WBI), reducing the target volume and potentially treatment duration. APBI delivered in 5 fractions with intensity modulated radiation therapy (IMRT) has been shown to have comparable outcomes to WBI with reduced toxicity profiles. In contrast, intraoperative radiation therapy (IORT) offers patients the potential to complete adjuvant radiation therapy in a single treatment. While early data were initially promising, concerns regarding long-term rates of local recurrence exist. We present a comparison of 5 fraction APBI versus IORT. MATERIALS/METHODS We performed a retrospective review of 473 patients with early-stage breast cancer (Stage 0-IIA) treated at a single institution with 258 receiving APBI and 215 IORT from October 2011 to May 2021. APBI patients received 30 Gy in 5 fractions delivered with IMRT daily or every other day. IORT patients received 20 Gy in 1 fraction prescribed to the applicator surface delivered at the time of surgery. Kaplan-Meier analysis was used to estimate locoregional control rates and overall survival among the 2 groups. RESULTS Mean age was 70.7 years old (IQR:67-74) for the IORT patients and 66.6 years old (IQR:62-72) for the APBI patients (p<0.001). Median follow up was 5.7 years for IORT patients and 2.4 years for APBI patients (p<0.001). For IORT patients, 11%/83.5%/5.5% of patients and for APBI 17.8%/77.5%/4.7% of patients had Tis/T1/T2 disease (p = 0.005). With regards to adjuvant therapies, 79%/76% of IORT/APBI patients were offered endocrine therapy (p = 0.50) and 1.4%/6.2% chemotherapy (p = 0.008). Recurrence at any time was seen in 7.9% (n = 17) of patients receiving IORT as compared to 0.8% (n = 2) of patients receiving APBI. APBI was however no differences in recurrence free survival (92.6% vs. 98.5%, p = .079) or overall survival were noted (92.8% vs. 95.1%, p = 0.99). CONCLUSION In a series of almost 500 patients with stage 0-IIA breast cancer, IORT was associated with higher rates of locoregional recurrence compared to APBI with no survival difference at 5 years. These outcomes, consistent with other series and current guidelines, suggest a limited role for IORT as monotherapy following breast conserving surgery.
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Affiliation(s)
- A Halima
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - S M Parker
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH
| | - L Fane
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - E F Hall
- Cleveland Clinic Foundation, Cleveland, OH
| | - E Obi
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Z Al-Hilli
- Department of Surgery, Division of Breast Services, Cleveland, OH
| | - S Valente
- Department of Breast Surgery, Cleveland Clinic, Cleveland, OH
| | - C Gentle
- Department of Breast Surgery, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH
| | - S Cherian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - R D Tendulkar
- Dept of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - C S Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Parker SM, Paine K, Spooner C, Harris M. Barriers and facilitators to the participation and engagement of primary care in shared-care arrangements with community mental health services for preventive care of people with serious mental illness: a scoping review. BMC Health Serv Res 2023; 23:977. [PMID: 37697280 PMCID: PMC10494334 DOI: 10.1186/s12913-023-09918-2] [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: 01/24/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND People with serious mental illness die about 20 years earlier than the general population from preventable diseases. Shared-care arrangements between general practitioners and mental health services can improve consumers' access to preventive care, but implementing shared care is challenging. This scoping review sought to describe current evidence on the barriers and facilitators to the participation and engagement of primary care (specifically general practitioners) in shared-care arrangements with community mental health services for preventive health care of this population. METHODS We searched Medline, Embase, CINAHL, Scopus, APA PsychINFO and EBM Reviews from 2010 to 2022. Data was extracted against a Microsoft Excel template developed for the review. Data was synthesised through tabulation and narrative methods. RESULTS We identified 295 records. After eligibility screening and full-text review, seven studies were included. Facilitators of engagement included a good fit with organisation and practice and opportunities to increase collaboration, specific roles to promote communication and coordination and help patients to navigate appointments, multidisciplinary teams and teamwork, and access to shared medical/health records. Barriers included a lack of willingness and motivation on the part of providers and low levels of confidence with tasks, lack of physical structures to produce capacity, poor alignment of funding/incentives, inability to share patient information and challenges engaging people with severe mental illness in the service and with their care. CONCLUSION Our results were consistent with other research on shared care and suggests that the broader literature is likely to be applicable to the context of general practitioner/mental health services shared care. Specific challenges relating to this cohort present difficulties for recruitment and retention in shared care programs. Sharing "goals and knowledge, mutual respect" and engaging in "frequent, timely, accurate, problem-solving communication", supported by structures such as shared information systems are likely to engage primary care in shared care arrangements more than the traditional focus on incentives, education, and guidelines.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
| | - Katrina Paine
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales , Australia
| | - Catherine Spooner
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Parker SM, Barr M, Stocks N, Denney-Wilson E, Zwar N, Karnon J, Kabir A, Nutbeam D, Roseleur J, Liaw ST, McNamara C, Frank O, Tran A, Osborne R, Lau AYS, Harris M. Preventing chronic disease in overweight and obese patients with low health literacy using eHealth and teamwork in primary healthcare (HeLP-GP): a cluster randomised controlled trial. BMJ Open 2022; 12:e060393. [PMID: 36450426 PMCID: PMC9716831 DOI: 10.1136/bmjopen-2021-060393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To evaluate a multifaceted intervention on diet, physical activity and health literacy of overweight and obese patients attending primary care. DESIGN A pragmatic two-arm cluster randomised controlled trial. SETTING Urban general practices in lower socioeconomic areas in Sydney and Adelaide. PARTICIPANTS We aimed to recruit 800 patients in each arm. Baseline assessment was completed by 215 patients (120 intervention and 95 control). INTERVENTION A practice nurse-led preventive health check, a mobile application and telephone coaching. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were measured at baseline, 6 and 12 months, and included patient health and eHealth literacy, weight, waist circumference and blood pressure. Secondary outcomes included changes in diet and physical activity, preventive advice and referral, blood lipids, quality of life and costs. Univariate and multivariate analyses of difference-in-differences (DiD) estimates for each outcome were conducted. RESULTS At 6 months, the intervention group, compared with the control group, demonstrated a greater increase in Health Literacy Questionnaire domain 8 score (ability to find good health information; mean DiD 0.22; 95% CI 0.01 to 0.44). There were similar differences for domain 9 score (understanding health information well enough to know what to do) among patients below the median at baseline. Differences were reduced and non-statistically significant at 12 months. There was a small improvement in diet scores at 6 months (DiD 0.78 (0.10 to 1.47); p=0.026) but not at 12 months. There were no differences in eHealth literacy, physical activity scores, body mass index, weight, waist circumference or blood pressure. CONCLUSIONS Targeted recruitment and engagement were challenging in this population. While the intervention was associated with some improvements in health literacy and diet, substantial differences in other outcomes were not observed. More intensive interventions and using codesign strategies to engage the practices earlier may produce a different result. Codesign may also be valuable when targeting lower socioeconomic populations. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN 12617001508369) (http://www.ANZCTR.org.au/ACTRN12617001508369.aspx). TRIAL PROTOCOL The protocol for this trial has been published (open access; https://bmjopen.bmj.com/content/8/6/e023239).
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Nicholas Zwar
- Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jon Karnon
- Flinders Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Alamgir Kabir
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Don Nutbeam
- Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jackie Roseleur
- Flinders Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Siaw-Teng Liaw
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Carmel McNamara
- College of Nursing and Health Sciences, Flinders University, Adelaide, New South Wales, Australia
| | - Oliver Frank
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - An Tran
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Burwood, Victoria, Australia
| | - Annie Y S Lau
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Parker SM, Stocks N, Nutbeam D, Thomas L, Denney-Wilson E, Zwar N, Karnon J, Lloyd J, Noakes M, Liaw ST, Lau A, Osborne R, Harris MF. Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: protocol for a cluster randomised controlled trial. BMJ Open 2018; 8:e023239. [PMID: 29866737 PMCID: PMC5988137 DOI: 10.1136/bmjopen-2018-023239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/20/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Adults with lower levels of health literacy are less likely to engage in health-promoting behaviours. Our trial evaluates the impacts and outcomes of a mobile health-enhanced preventive intervention in primary care for people who are overweight or obese. METHODS AND ANALYSIS A two-arm pragmatic practice-level cluster randomised trial will be conducted in 40 practices in low socioeconomic areas in Sydney and Adelaide, Australia. Forty patients aged 40-70 years with a body mass index ≥28 kg/m2 will be enrolled per practice. The HeLP-general practitioner (GP) intervention includes a practice-level quality improvement intervention (medical record audit and feedback, staff training and practice facilitation visits) to support practices to implement the clinical intervention for patients. The clinical intervention involves a health check visit with a practice nurse based on the 5As framework (assess, advise, agree, assist and arrange), the use of a purpose-built patient-facing app, my snapp, and referral for telephone coaching. The primary outcomes are change in health literacy, lifestyle behaviours, weight, waist circumference and blood pressure. The study will also evaluate changes in quality of life and health service use to determine the cost-effectiveness of the intervention and examine the experiences of practices in implementing the programme. ETHICS AND DISSEMINATION The study has been approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC17474) and ratified by the University of Adelaide Human Research Ethics committee. There are no restrictions on publication, and findings of the study will be made available to the public via the Centre for Primary Health Care and Equity website and through conference presentations and research publications. Deidentified data and meta-data will be stored in a repository at UNSW and made available subject to ethics committee approval. TRIAL REGISTRATIONREGISTRATION NUMBER ACTRN12617001508369; Pre-results.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Nigel Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Don Nutbeam
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Thomas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Nicholas Zwar
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jon Karnon
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Manny Noakes
- Nutrition and Health Program, CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Annie Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Richard Osborne
- School of Health and Social Development, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Harris MF, Parker SM, Litt J, van Driel M, Russell G, Mazza D, Jayasinghe UW, Smith J, Del Mar C, Lane R, Denney-Wilson E. An Australian general practice based strategy to improve chronic disease prevention, and its impact on patient reported outcomes: evaluation of the preventive evidence into practice cluster randomised controlled trial. BMC Health Serv Res 2017; 17:637. [PMID: 28886739 PMCID: PMC5591527 DOI: 10.1186/s12913-017-2586-4] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 08/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementing evidence-based chronic disease prevention with a practice-wide population is challenging in primary care. METHODS PEP Intervention practices received education, clinical audit and feedback and practice facilitation. Patients (40‑69 years) without chronic disease from trial and control practices were invited to participate in baseline and 12 month follow up questionnaires. Patient-recalled receipt of GP services and referral, and the proportion of patients at risk were compared over time and between intervention and control groups. Mean difference in BMI, diet and physical activity between baseline and follow up were calculated and compared using a paired t-test. Change in the proportion of patients meeting the definition for physical activity diet and weight risk was calculated using McNemar's test and multilevel analysis was used to determine the effect of the intervention on follow-up scores. RESULTS Five hundred eighty nine patients completed both questionnaires. No significant changes were found in the proportion of patients reporting a BP, cholesterol, glucose or weight check in either group. Less than one in six at-risk patients reported receiving lifestyle advice or referral at baseline with little change at follow up. More intervention patients reported attempts to improve their diet and reduce weight. Mean score improved for diet in the intervention group (p = 0.04) but self-reported BMI and PA risk did not significantly change in either group. There was no significant change in the proportion of patients who reported being at-risk for diet, PA or weight, and no changes in PA, diet and BMI in multilevel linear regression adjusted for patient age, sex, practice size and state. There was good fidelity to the intervention but practices varied in their capacity to address changes. CONCLUSIONS The lack of measurable effect within this trial may be attributable to the complexities around behaviour change and/or system change. This trial highlights some of the challenges in providing suitable chronic disease preventive interventions which are both scalable to whole practice populations and meet the needs of diverse practice structures. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000578808 (29/5/2012). This trial registration is retrospective as our first patient returned their consent on the 21/5/2012. Patient recruitment was ongoing until 31/10/2012.
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Affiliation(s)
- Mark Fort Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, 2052, NSW, Australia.
| | - Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, 2052, NSW, Australia
| | - John Litt
- Discipline of General Practice, Health Sciences Building, Flinders University, Adelaide, 5042, SA, Australia
| | - Mieke van Driel
- Academic Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, 4072, QLD, Australia
| | - Grant Russell
- Southern Academic Primary Care Research Unit, Monash University, Melbourne, 3800, VIC, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Melbourne, 3800, VIC, Australia
| | - Upali W Jayasinghe
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, 2052, NSW, Australia
| | - Jane Smith
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4229, QLD, Australia
| | - Chris Del Mar
- Health Sciences and Medicine, Bond University, Gold Coast, 4229, QLD, Australia
| | - Riki Lane
- Southern Academic Primary Care Research Unit, Monash University, Melbourne, 3800, VIC, Australia
| | - Elizabeth Denney-Wilson
- Sydney Nursing School and Sydney Local Health District, The University of Sydney , Sydney, 2006, NSW, Australia
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Jayasinghe UW, Harris MF, Parker SM, Litt J, van Driel M, Mazza D, Del Mar C, Lloyd J, Smith J, Zwar N, Taylor R. The impact of health literacy and life style risk factors on health-related quality of life of Australian patients. Health Qual Life Outcomes 2016; 14:68. [PMID: 27142865 PMCID: PMC4855442 DOI: 10.1186/s12955-016-0471-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [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] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited evidence exists regarding the relationship between health literacy and health-related quality of life (HRQoL) in Australian patients from primary care. The objective of this study was to investigate the impact of health literacy on HRQoL in a large sample of patients without known vascular disease or diabetes and to examine whether the difference in HRQoL between low and high health literacy groups was clinically significant. METHODS This was a cross-sectional study of baseline data from a cluster randomised trial. The study included 739 patients from 30 general practices across four Australian states conducted in 2012 and 2013 using the standard Short Form Health Survey (SF-12) version 2. SF-12 physical component score (PCS-12) and mental component score (MCS-12) are derived using the standard US algorithm. Health literacy was measured using the Health Literacy Management Scale (HeLMS). Multilevel regression analysis (patients at level 1 and general practices at level 2) was applied to relate PCS-12 and MCS-12 to patient reported life style risk behaviours including health literacy and demographic factors. RESULTS Low health literacy patients were more likely to be smokers (12 % vs 6 %, P = 0.005), do insufficient physical activity (63 % vs 47 %, P < 0.001), be overweight (68 % vs 52 %, P < 0.001), and have lower physical health and lower mental health with large clinically significant effect sizes of 0.56 (B (regression coefficient) = -5.4, P < 0.001) and 0.78(B = -6.4, P < 0.001) respectively after adjustment for confounding factors. Patients with insufficient physical activity were likely to have a lower physical health score (effect size = 0.42, B = -3.1, P < 0.001) and lower mental health (effect size = 0.37, B = -2.6, P < 0.001). Being overweight tended to be related to a lower PCS-12 (effect size = 0.41, B = -1.8, P < 0.05). Less well-educated, unemployed and smoking patients with low health literacy reported worse physical health. Health literacy accounted for 45 and 70 % of the total between patient variance explained in PCS-12 and MCS-12 respectively. CONCLUSIONS Addressing health literacy related barriers to preventive care may help reduce some of the disparities in HRQoL. Recognising and tailoring health related communication to those with low health literacy may improve health outcomes including HRQoL in general practice.
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Affiliation(s)
- Upali W Jayasinghe
- Centre for Primary Health Care and Equity, Level 3 AGSM, University of New South Wales Australia, Sydney, NSW, 2052, Australia.
| | - Mark Fort Harris
- Centre for Primary Health Care and Equity, Level 3 AGSM, University of New South Wales Australia, Sydney, NSW, 2052, Australia
| | - Sharon M Parker
- Centre for Primary Health Care and Equity, Level 3 AGSM, University of New South Wales Australia, Sydney, NSW, 2052, Australia
| | - John Litt
- Discipline of General Pratice, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Mieke van Driel
- Discipline of General Practice, University of Queensland, Brisbane, QLD, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, VIC, Australia
| | - Chris Del Mar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, Level 3 AGSM, University of New South Wales Australia, Sydney, NSW, 2052, Australia
| | - Jane Smith
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales Australia, Sydney, NSW, Australia
| | - Richard Taylor
- School of Public Health and Community Medicine, University of New South Wales Australia, Sydney, NSW, Australia
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Harris MF, Parker SM, Litt J, van Driel M, Russell G, Mazza D, Jayasinghe UW, Del Mar C, Lloyd J, Smith J, Zwar N, Taylor R, Powell Davies G. Implementing guidelines to routinely prevent chronic vascular disease in primary care: the Preventive Evidence into Practice cluster randomised controlled trial. BMJ Open 2015; 5:e009397. [PMID: 26656984 PMCID: PMC4679885 DOI: 10.1136/bmjopen-2015-009397] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease. SETTING 32 urban general practices in 4 Australian states. RANDOMISATION Stratified randomisation of practices. PARTICIPANTS 122 general practitioners (GPs) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21,848 patient records were audited for those aged 40-69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness. INTERVENTION The practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information. OUTCOME MEASURES Primary: 1. Change in proportion of patients aged 40-69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45-69 years with lipids, fasting blood glucose and cardiovascular risk in the medical record. 2. Change in the level of risk for each factor. SECONDARY change in self-reported frequency and confidence of GPs and PNs in assessment. RESULTS Risk recording improved in the intervention but not the control group for WC (OR 2.52 (95% CI 1.30 to 4.91)), alcohol consumption (OR 2.19 (CI 1.04 to 4.64)), smoking status (OR 2.24 (1.17 to 4.29)) and cardiovascular risk (OR 1.50 (1.04 to 2.18)). There was no change in recording of BP, lipids, glucose or BMI and no significant change in the level of risk factors based on audit data. The confidence but not reported practices of GPs and PNs in the intervention group improved in the assessment of some risk factors. CONCLUSIONS This intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.
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Affiliation(s)
- Mark Fort Harris
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - John Litt
- Discipline of General Practice, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Mieke van Driel
- Academic Discipline of General Practice, University of Queensland, Brisbane, Queensland, Australia
| | - Grant Russell
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Upali W Jayasinghe
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Chris Del Mar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Jane Smith
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Taylor
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gawaine Powell Davies
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia
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Hulme K, Dogan S, Deary V, Parker SM. P236 Psychological profile of individuals presenting with chronic cough. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.372] [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]
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Kelly BJ, Perkins DA, Fuller JD, Parker SM. Shared care in mental illness: A rapid review to inform implementation. Int J Ment Health Syst 2011; 5:31. [PMID: 22104323 PMCID: PMC3235059 DOI: 10.1186/1752-4458-5-31] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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] [Received: 06/14/2011] [Accepted: 11/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While integrated primary healthcare for the management of depression has been well researched, appropriate models of primary care for people with severe and persistent psychotic disorders are poorly understood. In 2010 the NSW (Australia) Health Department commissioned a review of the evidence on "shared care" models of ambulatory mental health services. This focussed on critical factors in the implementation of these models in clinical practice, with a view to providing policy direction. The review excluded evidence about dementia, substance use and personality disorders. METHODS A rapid review involving a search for systematic reviews on The Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects (DARE). This was followed by a search for papers published since these systematic reviews on Medline and supplemented by limited iterative searching from reference lists. RESULTS Shared care trials report improved mental and physical health outcomes in some clinical settings with improved social function, self management skills, service acceptability and reduced hospitalisation. Other benefits include improved access to specialist care, better engagement with and acceptability of mental health services. Limited economic evaluation shows significant set up costs, reduced patient costs and service savings often realised by other providers. Nevertheless these findings are not evident across all clinical groups. Gains require substantial cross-organisational commitment, carefully designed and consistently delivered interventions, with attention to staff selection, training and supervision. Effective models incorporated linkages across various service levels, clinical monitoring within agreed treatment protocols, improved continuity and comprehensiveness of services. CONCLUSIONS "Shared Care" models of mental health service delivery require attention to multiple levels (from organisational to individual clinicians), and complex service re-design. Re-evaluation of the roles of specialist mental health staff is a critical requirement. As expected, no one model of "shared" care fits diverse clinical groups. On the basis of the available evidence, we recommended a local trial that examined the process of implementation of core principles of shared care within primary care and specialist mental health clinical services.
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Affiliation(s)
- Brian J Kelly
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, Faculty of Health University of Newcastle, University Drive, Callaghan 2308, Australia
| | - David A Perkins
- School of Nursing & Midwifery, Flinders University, Sturt Rd, Bedford Park 5024, Australia
| | - Jeffrey D Fuller
- Centre for Remote Health Research, Broken Hill University Department of Rural Health, University of Sydney, Corrindah Court, Broken Hill 2880, Australia
| | - Sharon M Parker
- Centre for Remote Health Research, Broken Hill University Department of Rural Health, University of Sydney, Corrindah Court, Broken Hill 2880, Australia
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Borthwick LA, Parker SM, Brougham KA, Johnson GE, Gorowiec MR, Ward C, Lordan JL, Corris PA, Kirby JA, Fisher AJ. Epithelial to mesenchymal transition (EMT) and airway remodelling after human lung transplantation. Thorax 2009; 64:770-7. [PMID: 19213777 DOI: 10.1136/thx.2008.104133] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Aberrant epithelial repair is a key event in the airway remodelling which characterises obliterative bronchiolitis (OB) in the transplanted lung. The potential for airway epithelium from lung transplant recipients to undergo epithelial to mesenchymal cell transition (EMT) was assessed in culture and in vivo in lung allograft tissue. METHODS Change in epithelial and mesenchymal marker expression was assessed after stimulation with transforming growth factor beta(1) (TGF-beta(1)) alone or in combination with tumour necrosis factor alpha (TNFalpha) and compared with untreated controls. The ability of cells to deposit extracellular matrix, secrete matrix metalloproteinases (MMPs) and invade collagen was investigated. Immunolocalisation of epithelial and mesenchymal markers was compared in airway tissue from stable recipients and those with OB. RESULTS Untreated cells maintained epithelial morphology and phenotype. TGF-beta(1) reduced expression of epithelial markers, increased expression of vimentin and fibronectin, promoted collagen I and fibronectin deposition and increased MMP-9 production. Co-treatment with TNFalpha dramatically accentuated phenotypic and some functional features of EMT. Airway epithelial biopsies from recipients with OB demonstrated significantly increased staining for mesenchymal markers and significantly reduced E-cadherin staining compared with stable recipients. CONCLUSIONS These observations demonstrate the ability of human airway epithelium to undergo EMT and suggest this phenomenon may be a potential link between inflammatory injury and TGF-beta(1)-driven airway remodelling in the development of OB.
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Affiliation(s)
- L A Borthwick
- Applied Immunobiology and Transplantation Research Group, Institute of Cellular Medicine, Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH, UK
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Parker SM, Goriwiec MR, Borthwick LA, Johnson G, Ward C, Lordan JL, Corris PA, Saretzki GC, Fisher AJ. Airway epithelial cell senescence in the lung allograft. Am J Transplant 2008; 8:1544-9. [PMID: 18557742 DOI: 10.1111/j.1600-6143.2008.02284.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chronic lung allograft dysfunction, manifesting as bronchiolitis obliterans syndrome (BOS), is characterized by airway epithelial injury, impaired epithelial regeneration and subsequent airway remodeling. Increased cellular senescence has been reported in renal and liver allografts affected by chronic allograft dysfunction but the significance of cellular senescence in the airway epithelium of the transplanted lung is unknown. Thirty-four lung transplant recipients, 20 with stable graft function and 14 with BOS, underwent transbronchial lung biopsy and histochemical studies for senescence markers in small airways. Compared to nontransplant control lung tissue (n = 9), lung allografts demonstrate significantly increased airway epithelial staining for senescence-associated beta galactosidase (SA beta-gal) (p = 0.0215), p16(ink4a) (p = 0.0002) and p21(waf1/cip) (p = 0.0138) but there was no difference in expression of these markers between stable and BOS affected recipients (p > 0.05). This preliminary cross-sectional study demonstrates that cellular senescence occurs with increased frequency in the airway epithelium of the lung allograft but does not establish any association between airway epithelial senescence and BOS. A prospective longitudinal study is required to better address any potential causal association between airway epithelial senescence in stable allograft recipients and the subsequent development of BOS.
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Affiliation(s)
- S M Parker
- Applied Immunobiology and Transplantation Research Group, Institute of Cellular Medicine, Newcastle University, UK
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Hancock K, Clayton JM, Parker SM, Wal der S, Butow PN, Carrick S, Currow D, Ghersi D, Glare P, Hagerty R, Tattersall MHN. Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review. Palliat Med 2007; 21:507-17. [PMID: 17846091 DOI: 10.1177/0269216307080823] [Citation(s) in RCA: 291] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many health professionals (HPs) express discomfort at having to broach the topic of prognosis, including limited life expectancy, and may withhold information or not disclose prognosis. A systematic review was conducted of 46 studies relating to truth-telling in discussing prognosis with patients with progressive, advanced life-limiting illnesses and their caregivers. Relevant studies meeting the inclusion criteria were identified by searching computerized databases (MEDLINE, EMBASE, CINAHL, PsychINFO and Cochrane Register of Controlled Trials) up to November 2004, with handsearching of studies, as well as inclusion of studies satisfying selection criteria reported in 2005 by the authors. The reference lists of identified studies were hand-searched for further relevant studies. Inclusion criteria were studies of any design evaluating communication of prognostic information that included adult patients with an advanced, life-limiting illness; their caregivers; and qualified HPs. Results showed that although the majority of HPs believed that patients and caregivers should be told the truth about the prognosis, in practice, many either avoid discussing the topic or withhold information. Reasons include perceived lack of training, stress, no time to attend to the patient's emotional needs, fear of a negative impact on the patient, uncertainty about prognostication, requests from family members to withhold information and a feeling of inadequacy or hopelessness regarding the unavailability of further curative treatment. Studies suggest that patients can discuss the topic without it having a negative impact on them. Differences and similarities in findings from different cultures are explored.
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Affiliation(s)
- Karen Hancock
- Medical Psychology Research Unit, University of Sydney, New South Wales, Australia
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Hancock K, Clayton JM, Parker SM, Walder S, Butow PN, Carrick S, Currow D, Ghersi D, Glare P, Hagerty R, Tattersall MHN. Discrepant perceptions about end-of-life communication: a systematic review. J Pain Symptom Manage 2007; 34:190-200. [PMID: 17544247 DOI: 10.1016/j.jpainsymman.2006.11.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 11/08/2006] [Accepted: 11/11/2006] [Indexed: 12/12/2022]
Abstract
Little research has compared the perceptions of health professionals (HPs), patients, and caregivers about the communication of prognostic information. The objectives of this literature review were to determine 1) patient and caregiver perceptions of levels of information received about prognosis and end-of-life (EoL) issues regarding a life-limiting illness; 2) patient perceptions of and factors related to their understanding and awareness of prognosis; 3) HPs' perceptions of patients' wishes about disclosure of prognosis and factors related to their decision whether to disclose; and 4) concordance between HPs and patients/caregivers regarding the information given by HPs about prognostic and EoL issues. Relevant studies meeting the inclusion criteria were identified by searching computerized databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Cochrane Register of Controlled Trials [Central]) up to November 2004. The reference lists of identified studies were hand searched for further relevant studies. Inclusion criteria were studies of any design evaluating communication of prognostic information that included adult patients with an advanced, life-limiting illness; their caregivers; and qualified HPs. Fifty-one studies were identified. There was a large discrepancy between patients/caregivers and HPs regarding the amount of information they believed had been given. Patients' understanding and awareness of information received conflicted with the HPs' perceptions of patients' understanding and awareness of the information that had been given. HPs tended to underestimate patients' need for information and overestimate patients' understanding and awareness of their prognosis and EoL issues. HPs need to repeatedly check patients' understanding and preferences for information.
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Affiliation(s)
- Karen Hancock
- Medical Psychology Research Unit, NHMRC Clinical Trials Centre, School of Psychology, University of Sydney, Camperdown, New South Wales, Australia
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Parker SM, Clayton JM, Hancock K, Walder S, Butow PN, Carrick S, Currow D, Ghersi D, Glare P, Hagerty R, Tattersall MHN. A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information. J Pain Symptom Manage 2007; 34:81-93. [PMID: 17531434 DOI: 10.1016/j.jpainsymman.2006.09.035] [Citation(s) in RCA: 352] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 09/26/2006] [Indexed: 11/30/2022]
Abstract
Evidence-based recommendations concerning how to discuss dying, life expectancy, and likely future symptoms with patients with a limited life expectancy and their families are lacking. The aim of this systematic review was to review studies regarding prognostic/end-of-life communication with adult patients in the advanced stages of a life-limiting illness and their caregivers. Relevant studies meeting the inclusion criteria were identified by searching computerized databases up to November 2004. One hundred twenty-three studies met the criteria for the full review, and 46 articles reported on patient/caregiver preferences for content, style, and timing of information. The majority of the research was descriptive. Although there were individual differences, patients/caregivers in general had high levels of information need at all stages of the disease process regarding the illness itself, likely future symptoms and their management, and life expectancy and information about clinical treatment options. Patient and caregiver information needs showed a tendency to diverge as the illness progressed, with caregivers needing more and patients wanting less information. Patients and caregivers preferred a trusted health professional who showed empathy and honesty, encouraged questions, and clarified each individual's information needs and level of understanding. In general, most patients/caregivers wanted at least some discussion of these topics at the time of diagnosis of an advanced, progressive, life-limiting illness, or shortly after. However, they wanted to negotiate the content and extent of this information.
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Affiliation(s)
- Sharon M Parker
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
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Parker SM, Gibson GJ. Evaluation of a transcutaneous carbon dioxide monitor (“TOSCA”) in adult patients in routine respiratory practice. Respir Med 2007; 101:261-4. [PMID: 16814537 DOI: 10.1016/j.rmed.2006.05.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 05/06/2006] [Accepted: 05/11/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Non-invasive measurement of oxygenation is routine in adult clinical practice but transcutaneous monitoring of PCO(2) (PtcCO(2)) is used much less due to technical difficulties with earlier transcutaneous electrodes. OBJECTIVE Our aim was to determine the reliability of estimating arterial PCO(2) (PaCO(2)) using a recently introduced combined SaO(2)/PtcCO(2) monitor ("TOSCA", Linde Medical Systems) in adult patients in routine clinical respiratory practice. METHODS PtcCO(2) was measured in patients requiring arterial blood gases for clinical reasons. Ten minutes after the probe had been attached to an earlobe PtcCO(2) was recorded, immediately before arterial blood sampling. The PCO(2) values obtained were compared by Bland-Altman analysis. RESULTS Samples were taken from 48 unselected patients with varied pathology. There were no technical problems. Median age was 56 years (range 20-86 years). The mean difference between PaCO(2) and PtcCO(2) was -0.04kPa, sd of the difference 0.67kPa. Bland-Altman analysis showed generally good agreement between the two measurements across the range of PaCO(2) values (4-10.9kPa). Four of 48 measurements showed a PCO(2) difference >1kPa with no technical or clinical explanations apparent. CONCLUSIONS The accuracy of estimation of PaCO(2) by the TOSCA transcutaneous electrode was generally good and the device appears promising for use in routine clinical respiratory practice.
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Affiliation(s)
- S M Parker
- Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, UK
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Bolton PGM, Parker SM. Impact of Medication Review by General Practitioners and Patient Peer Education. Journal of Pharmacy Practice and Research 2004. [DOI: 10.1002/jppr20043418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The mechanisms whereby fatty acids (FA) potentiate glucose-induced insulin secretion from the pancreatic beta cell are incompletely understood. In this study, the effects of palmitate on insulin secretion were investigated in isolated rat islets. Palmitate did not initiate insulin secretion at nonstimulatory glucose concentrations, but markedly stimulated insulin release at concentrations of glucose > or = 5.6 mmol/L. At concentrations of palmitate > or =0.5 mmol/L, the important determinant of the potency of the FA was its unbound concentration. At total concentrations < or = 0.5 mmol/L, both the total and unbound concentrations appeared important. Surprisingly, 2-bromopalmitate did not affect palmitate oxidation, but significantly diminished palmitate esterification into cellular lipids. Neither methyl palmitate, which is not activated into a long-chain acyl-CoA ester, nor 2-bromopalmitate affected glucose-stimulated insulin release. Further, 2-bromopalmitate partly inhibited the potentiating effect of palmitate. These results support the concept that FA potentiation of insulin release is mediated by FA-derived signals generated in the esterification pathway.
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Affiliation(s)
- S M Parker
- Pacific Nortwest Research Institute, Seattle, WA 98122, USA
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G. Bolton P, M. Parker S, J. Fergusson K, D. Orman J. The Impact of a Clinical Audit on GP Detection of Depression. Aust J Prim Health 2003. [DOI: 10.1071/py03011] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: To determine if a clinical audit and linked educational workshop would improve the ability of general practitioners to accurately detect depression. Design: Pre- and post-data collection over a six-month period (two eight-week collection periods), associated educational workshop, and comprehensive treatment guidelines. Setting: General Practice in the Central Sydney Area. Study participants: A total of 1106 patients (592 pre-, 514 post-collection) from six general practices. Patients were required to be 18-65yrs and willing and able to complete a self-administered depression rating scale. Main Outcome Measures: General practitioner rating of consecutive patients using a tick box scale matched to patients' self-report on the Hospital Anxiety and Depression Scale. Comparison of patients' scores on the two sub-scales of the Scale (depression and anxiety) and the reason for presentation rated by the general practitioner. Results: The mean age of participants was 35 years for audit one and 33 years for audit two with substantially more females participating (73.6% and 68.1%) as opposed to males (26.4% and 31.9%). The presence of psychological problems as identified by the HADS was higher than that reported in the literature and actually decreased from 65.9% in audit one to 59.7% in audit two. There were non-significant increases in the rate at which participating general practitioners detected depression with the proportion of "true negatives" increasing between the audits and the proportion of "false negatives" decreasing. No change occurred in either the true or false positive rates. Conclusions: Within this study, the audit, feedback and educational workshop in combination achieved poor results. This, and the prevalence of depression in the population, suggests further research is warranted to determine an effective method of educating general practitioners to detect depression.
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Parker SM. Bringing the "gospel of life" to American jurisprudence: a religious, ethical and philosophical critique of federal funding for embryonic stem cell research. J Contemp Health Law Policy 2001; 17:771-808. [PMID: 11475575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Bolton PG, Fergusson KJ, Parker SM, Orman JD. Randomised controlled trial of cognitive-behavioural therapy and routine GP care for major depression. Med J Aust 2001; 175:118-9. [PMID: 11556412 DOI: 10.5694/j.1326-5377.2001.tb143545.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bolton PG, Parker SM, Fergusson KJ, Orman JD. Doctors could know better. Med J Aust 2001; 174:543; author reply 544. [PMID: 11419784 DOI: 10.5694/j.1326-5377.2001.tb143417.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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G. M. Bolton P, M. Parker S, Chera J. Australian Health Care Workers Use of a Telephone Advice Line. Aust J Prim Health 2001. [DOI: 10.1071/py01049] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An evaluation of the Health Resource Line (HRL), a telephone information service for use by General Practitioners and Area Health employees in Northern and Central Sydney Area Health Services, was conducted following an eight month pilot. This evaluation found that no more than half of the target population were aware of the service, and that fewer than a third of these had trialed the service. This is consistent with the experience in other published trials of this kind. The experience of health care providers using the service was generally positive, but despite this, overall levels of use were low and declined after an initial peak. The low level of use brings into question the cost effectiveness of such a service and the need for possible alternatives.
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Geisler JP, Gates RW, Shirrell W, Parker SM, Maloney CD, Wiemann MC, Geisler HE. Extramammary Paget's disease with diffuse involvement of the lower female genito-urinary system. Int J Gynecol Cancer 1997; 7:84-7. [PMID: 12795809 DOI: 10.1046/j.1525-1438.1997.00405.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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
Extramammary Paget's disease of the lower female genito-urinary system is an uncommon neoplasm with a high rate of recurrence. A 52-year-old white female with a history of extramammary Paget's disease, originally excised in 1985 by skinning vulvectomy and who had multiple recurrences, including two in a vaginal graft and with extension to the urethra and the uterine cervix, in 1992 underwent an anterior pelvic exenteration for control of the disease process. Standard surgical management for extramammary Paget's disease without invasion or without an underlying adenocarcinoma is simple or skinning vulvectomy. However, because the disease commonly recurs, diffuse involvement may require more extensive surgery including pelvic exenteration in extraordinary cases.
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Affiliation(s)
- J P Geisler
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, St. Vincent Hospital and Health Care Center, Indianapolis, Indiana 46260, USA
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Abstract
This report describes a patient with end-stage renal disease secondary to long-standing type II diabetes mellitus who received a cadaveric renal transplant from a 37-year-old woman who died of massive cerebral infarction. An autopsy performed on the donor following organ procurement revealed no obvious contraindications to transplantation. A renal biopsy of the donor kidney performed at the time of transplantation, however, subsequently showed early membranous nephropathy by electron microscopy. There was immediate graft function and the recipient continues to have good renal function 3 years post-transplantation.
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Affiliation(s)
- S M Parker
- Department of Pathology, University of Massachusetts Medical Center, Worcester 01655, USA
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Holland CD, Schraeder C, Smith KE, Weber D, Wisor BS, Parker SM. CRAHCA (Center for Research in Ambulatory Health Care Administration): member involvement leads to practical applications. Med Group Manage J 1993; 40:30-2, 34, 81-4. [PMID: 10130105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The research undertaken by CRAHCA results in many new techniques and ideas being adopted by medical practice managers. However, it is not merely a one-way street. In this article, six group practice managers respond to questions about how they have used and been involved with research activities the Center has developed.
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Affiliation(s)
- C D Holland
- Southern West Virginia Clinic, Beckley, WV 25801
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Parker SM. Scheduling satisfaction: a job enhancement project Medicine Hat Regional Hospital. AARN News Lett 1991; 47:9-10. [PMID: 1750306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Parker SM, Werthman L. Making room in the marketplace: a special initiative for the poor. Health Prog 1988; 69:53-6, 65. [PMID: 10287461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Faced with increased concern over the role of the voluntary healthcare sector, specifically Catholic providers, in the care of the poor, Mercy Health Services (MHS), a healthcare system, established a two-year, three-phase planning and development effort known as the Special Initiative for the Poor (SIP). Established in March 1986, SIP was designed to find out: Who are the poor? What are their needs? What is MHS's responsibility in meeting these needs? Among its objectives, SIP was charged with: 1. Educating and raising awareness of governance and management staffs. 2. Developing a way to assess human needs. 3. Determining the financial implications of the organization's commitment to the poor. 4. Recommending ways to enhance the understanding, energy, and commitment to the poor throughout the system. During the first six months, SIP staffers traveled to hospitals and subsidiaries throughout the system, meeting with management and staff, explaining the project, laying the groundwork, and gaining support. In the development phase, SIP created the Community Assessment of Human Needs, a systematic approach to identify and understand the unmet human needs of the poor. It also developed a simple inventory formula to help hospitals determine which of their programs were specifically for the poor and determine what these programs cost. Finally, in the implementation stage, several of SIP's recommendations are challenging the organization to move beyond its current commitments.
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Parker SM, Sinnamon HM. Forward locomotion elicited by electrical stimulation in the diencephalon and mesencephalon of the awake rat. Physiol Behav 1983; 31:581-7. [PMID: 6607477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Stimulation electrodes were implanted in 63 rats at a total of 208 sites in the diencephalon and midbrain. The sites were tested for elicited forward locomotion, i.e., alternate stepping of the forelimbs and/or hindlimbs, while the rats stood on a treadmill belt in a 27 X 9 X 24-cm chamber. Current levels of 50-300 microA and pulse frequencies of 50, 100 and 154 Hz were presented as single 5-sec trains and as 20 repetitive trains of 1-sec duration with a 3-sec intertrain interval. Locomotion was elicited with low current (50 or 100 microA) single trains at 28% of the sites. Of the regions sufficiently well sampled to warrent comparisons, two showed high densities of locomotion-positive sites with single low current trains. They were the medial hypothalamus (the dorsomedial and the posterior nuclei) and the ventral tegmental area. The medial forebrain bundle and the zona incerta were generally positive but many sites in these regions required repetitive trains. Among the regions with few locomotion-positive sites were the subthalamic nucleus, the fields of Forel and the habenular complex. In the dorsal midbrain, in and around the central gray, low current single trains elicited leaping. The results are discussed in terms of the existence of a delimited subthalamic locomotor region and a ventral midbrain locomotor system independent of a dorsal midbrain system.
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Abstract
This experiment determined the effects of large unilateral lesions of the anteromedial cortex (AMC) on visually guided performance of rats in a cross maze. Deficits were found in the approach to only visual cues that were located in the arm contralateral to the lesion. The deficit appeared in three testing conditions: when the cue was continuously visible throughout the trial; when it was visible only at the choice point; and when it was seen only at the start of the trial but not at the choice point. The failure to approach a contralateral cue was not due to a simple ipsilateral turning bias; rats with lesions could approach cues in the anterior arm as efficiently as controls. The deficit was most apparent on the initial sessions and recovery occurred for all conditions. The findings indicate that the AMC participates in the visual guidance of approach behavior.
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Abstract
Protrusio acetabuli is common is rheumatoid arthritis. Progression of this deformity can be measured by serial roentgenograms. The inward progression of the femoral head is the result of upward migration of the acetabular roof and collapse of the femoral head which appears to occur in a ratio of approximately two to one. Adrenal cortical steroids may play a significant role in the etiology of this condition in rheumatoid arthritis. This complication of intrapelvic protrusion of the prosthetic acetabulum following total hip replacement has been presented and suggestions made to overcome this problem. Early operation on those patients showing rapid development of protrusio may prevent complications.
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Parker SM, Hastings DE, Fornasier VL. Giant cell tumour of distal radius replaced by massive fibular autograft: a case report. Can J Surg 1974; 17:266-8. [PMID: 4424371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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