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Venkatesh KK, Lynch CD, Costantine MM, Backes CH, Slaughter JL, Frey HA, Huang X, Landon MB, Klebanoff MA, Khan SS, Grobman WA. Trends in Active Treatment of Live-born Neonates Between 22 Weeks 0 Days and 25 Weeks 6 Days by Gestational Age and Maternal Race and Ethnicity in the US, 2014 to 2020. JAMA 2022; 328:652-662. [PMID: 35972487 PMCID: PMC9382444 DOI: 10.1001/jama.2022.12841] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Birth in the periviable period between 22 weeks 0 days and 25 weeks 6 days' gestation is a major source of neonatal morbidity and mortality, and the decision to initiate active life-saving treatment is challenging. OBJECTIVE To assess whether the frequency of active treatment among live-born neonates in the periviable period has changed over time and whether active treatment differed by gestational age at birth and race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional descriptive study using National Center for Health Statistics natality data from 2014 to 2020 for 61 908 singleton live births without clinical anomalies between 22 weeks 0 days and 25 weeks 6 days in the US. EXPOSURES Year of delivery, gestational age at birth, and race and ethnicity of the pregnant individual, stratified as non-Hispanic Asian/Pacific Islander, non-Hispanic Black, Hispanic/Latina, and non-Hispanic White. MAIN OUTCOMES AND MEASURES Active treatment, determined by whether there was an attempt to treat the neonate and defined as a composite of surfactant therapy, immediate assisted ventilation at birth, assisted ventilation more than 6 hours in duration, and/or antibiotic therapy. Frequencies, mean annual percent change (APC), and adjusted risk ratios (aRRs) were estimated. RESULTS Of 26 986 716 live births, 61 908 (0.2%) were periviable live births included in this study: 5% were Asian/Pacific Islander, 37% Black, 24% Hispanic, and 34% White; and 14% were born at 22 weeks, 21% at 23 weeks, 30% at 24 weeks, and 34% at 25 weeks. Fifty-two percent of neonates received active treatment. From 2014 to 2020, the overall frequency (mean APC per year) of active treatment increased significantly (3.9% [95% CI, 3.0% to 4.9%]), as well as among all racial and ethnic subgroups (Asian/Pacific Islander: 3.4% [95% CI, 0.8% to 6.0%]); Black: 4.7% [95% CI, 3.4% to 5.9%]; Hispanic: 4.7% [95% CI, 3.4% to 5.9%]; and White: 3.1% [95% CI, 1.1% to 4.4%]) and among each gestational age range (22 weeks: 14.4% [95% CI, 11.1% to 17.7%] and 25 weeks: 2.9% [95% CI, 1.5% to 4.2%]). Compared with neonates born to White individuals (57.0%), neonates born to Asian/Pacific Islander (46.2%; risk difference [RD], -10.81 [95% CI, -12.75 to -8.88]; aRR, 0.82 [95% CI, [0.79-0.86]), Black (51.6%; RD, -5.42 [95% CI, -6.36 to -4.50]; aRR, 0.90 [95% CI, 0.89 to 0.92]), and Hispanic (48.0%; RD, -9.03 [95% CI, -10.07 to -7.99]; aRR, 0.83 [95% CI, 0.81 to 0.85]) individuals were significantly less likely to receive active treatment. CONCLUSIONS AND RELEVANCE From 2014 to 2020 in the US, the frequency of active treatment among neonates born alive between 22 weeks 0 days and 25 weeks 6 days significantly increased, and there were differences in rates of active treatment by race and ethnicity.
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MESH Headings
- Clinical Decision-Making
- Cross-Sectional Studies
- Ethnicity/statistics & numerical data
- Female
- Fetal Viability
- Gestational Age
- Humans
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/ethnology
- Infant, Premature, Diseases/therapy
- Intensive Care, Neonatal/methods
- Intensive Care, Neonatal/statistics & numerical data
- Intensive Care, Neonatal/trends
- Live Birth/epidemiology
- Live Birth/ethnology
- Patient Care/methods
- Patient Care/statistics & numerical data
- Patient Care/trends
- Pregnancy
- Retrospective Studies
- United States/epidemiology
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Affiliation(s)
- Kartik K. Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Courtney D. Lynch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Maged M. Costantine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Carl H. Backes
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Jonathan L. Slaughter
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Heather A. Frey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Xiaoning Huang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark B. Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Mark A. Klebanoff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Sadiya S. Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
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Williams PA, Zaidi SK, Sengupta R. AACR Report on the Impact of COVID-19 on Cancer Research and Patient Care. Clin Cancer Res 2022; 28:609-610. [PMID: 35140125 DOI: 10.1158/1078-0432.ccr-22-0192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
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Abstract
Unacceptable healthcare disparities in endocrine disease have persisted for decades, and 2021 presents a difficult evolving environment. The COVID-19 pandemic has highlighted the gross structural inequities that drive health disparities, and antiracism demonstrations remind us that the struggle for human rights continues. Increased public awareness and discussion of disparities present an urgent opportunity to advance health equity. However, it is more complicated to change the behavior of individuals and reform systems because societies are polarized into different factions that increasingly believe, accept, and live different realities. To reduce health disparities, clinicians must (1) truly commit to advancing health equity and intentionally act to reduce health disparities; (2) create a culture of equity by looking inwards for personal bias and outwards for the systemic biases built into their everyday work processes; (3) implement practical individual, organizational, and community interventions that address the root causes of the disparities; and (4) consider their roles in addressing social determinants of health and influencing healthcare payment policy to advance health equity. To care for diverse populations in 2021, clinicians must have self-insight and true understanding of heterogeneous patients, knowledge of evidence-based interventions, ability to adapt messaging and approaches, and facility with systems change and advocacy. Advancing health equity requires both science and art; evidence-based roadmaps and stories that guide the journey to better outcomes, judgment that informs how to change the behavior of patients, providers, communities, organizations, and policymakers, and passion and a moral mission to serve humanity.
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Affiliation(s)
- Marshall H Chin
- Section of General Internal Medicine, Department of Medicine, University of Chicago
- Corresponding author contact information: Marshall H. Chin, MD, MPH, University of Chicago, Section of General Internal Medicine, 5841 South Maryland Avenue, MC2007, Chicago, Illinois 60637 USA, (773) 702-4769 (telephone), (773) 834-2238 (fax), (e-mail)
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4
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Siedhoff MT, Truong MD, Wright KN. How COVID-19 has affected minimally invasive gynecologic procedures. Curr Opin Obstet Gynecol 2021; 33:421-424. [PMID: 34354002 DOI: 10.1097/gco.0000000000000739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew T Siedhoff
- Cedars-Sinai Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Los Angeles, California, USA
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Abstract
Scholars are increasingly aware that studies-across many disciplines-cannot be replicated by independent researchers. Here, the authors describe how medical education research may be vulnerable to this "replication crisis," explain how researchers can act together to reduce risks, and discuss the positive steps that can increase confidence in research findings. Medical education research contributes to policy and influences practitioner behavior. Findings that cannot be replicated suggest that the original research was not credible. This risk raises the possibility that unhelpful or even harmful changes to medical education have been implemented as a result of research that appeared defensible but was not. By considering these risk factors, researchers can increase the likelihood that studies are generating credible results. The authors discuss and provide examples of 6 factors that may endanger the replicability of medical education research: (1) small sample sizes, (2) small effect sizes, (3) exploratory designs, (4) flexibility in design choices, analysis strategy, and outcome measures, (5) conflicts of interest, and (6) very active fields with many competing research teams. Importantly, medical education researchers can adopt techniques used successfully elsewhere to improve the rigor of their investigations. Researchers can improve their work through better planning in the development stage, carefully considering design choices, and using sensible data analysis. The wider medical education community can help by encouraging higher levels of collaboration among medical educators, by routinely evaluating existing educational innovations, and by raising the prestige of replication and collaborative medical education research. Medical education journals should adopt new approaches to publishing. As medical education research improves, so too will the quality of medical education and patient care.
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Affiliation(s)
- David Hope
- D. Hope is a senior lecturer in medical education, Medical Education Unit, University of Edinburgh, Edinburgh, Scotland, United Kingdom; ORCID: https://orcid.org/0000-0001-6623-2857
| | - Avril Dewar
- A. Dewar is a fellow in medical education, Medical Education Unit, University of Edinburgh, Edinburgh, Scotland, United Kingdom; ORCID: https://orcid.org/0000-0003-1992-6148
| | - Christopher Hay
- C. Hay is an interventional radiologist, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
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6
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Roth AR, Lazris A. Benefits of Avoiding Unnecessary Medical Care During the COVID-19 Pandemic. Am Fam Physician 2021; 103:584-585. [PMID: 33982996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Alan R Roth
- Jamaica Hospital Medical Center, Jamaica, NY, USA
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7
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Affiliation(s)
- Alison While
- Emeritus Professor of Community Nursing, King's College London, Florence Nightingale Faculty of Nursing and Midwifery; Fellow, Queen's Nursing Institute
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8
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Abstract
"Starting in Wuhan, China, followed quickly in the United States in January 2020, an outbreak of a novel coronavirus, or COVID-19, escalated to a global pandemic by March. Significant disruptions occurred to breast imaging, including deferred screening mammography, triaging diagnostic breast imaging, and changes in breast cancer care algorithms. This article summarizes the effect of the global pandemic-and efforts to curtail its spread-on both breast cancer care and on breast imaging practices including effects on patients, clinical workflow, education, and research."
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Affiliation(s)
- Phoebe E Freer
- Breast Imaging, Department of Radiology and Imaging Sciences, University of Utah Health / Huntsman Cancer Institute, 30 North 1900 East #1A071, Salt Lake City, UT 84132, USA.
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Burr O, Berry A, Joule N, Rayman G. Inpatient diabetes care during the COVID-19 pandemic: A Diabetes UK rapid review of healthcare professionals' experiences using semi-structured interviews. Diabet Med 2021; 38:e14442. [PMID: 33112438 PMCID: PMC7645862 DOI: 10.1111/dme.14442] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
AIMS Inpatient care for people with diabetes can and must be improved. The COVID-19 pandemic has impacted the way care is delivered across the UK. Diabetes UK needed to understand how inpatient care for people with diabetes has been affected and to identify opportunities, areas of concerns and recommendations for the future. METHODS We interviewed 28 healthcare professionals and hospital teams from across the UK to find out about their experiences of delivering inpatient diabetes care during the first peak of the COVID-19 pandemic. RESULTS We found that disruption to inpatient diabetes services created positive environments and opportunities for new ways of working, but in the minority, impacted on the quality of care clinicians felt they were able to deliver. CONCLUSIONS It is important that these positive ways of working be maintained and as a result of these experiences we have outlined urgent recommendations for the challenging winter months ahead.
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Affiliation(s)
| | | | | | - Gerry Rayman
- Ipswich HospitalEast Suffolk and North East Essex NHS Foundation TrustColchesterUK
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10
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Lindsay E. Management of service change and culture in a new era! Br J Community Nurs 2020; 25:S41-S42. [PMID: 33300845 DOI: 10.12968/bjcn.2020.25.sup12.s41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Ellie Lindsay
- OBE, Fellow of the Queen's Nursing Institute Life President, The Lindsay Leg Club Foundation
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11
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Slockers MT, van Laere IRA, van der Gevel AR, Slockers CG, van Marlen-Bos C, Mackenbach JP, van Beeck EF. [Homeless patients in Rotterdam with a need for medical care: data from the Rotterdam Street Doctors' office in the years 2006-2017]. Ned Tijdschr Geneeskd 2020; 164:D4656. [PMID: 33201624] [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: 06/11/2023]
Abstract
OBJECTIVE To describe the demographic and medical characteristics and changes of the patients who visit the Rotterdam Street Doctors' office hours. DESIGN Retrospective study of registered patient contacts from 2006-2017. METHOD Street doctors registered age, gender and ICPC diagnoses of patients in a GP information system. The characteristics of these patients have been analysed for three periods of four years: 2006-2009, 2010-2013, 2014-2017. For each of these periods, the number of individual patients visiting the Rotterdam Street Doctors' office hours at least once, have been documented. Data from the period 2014-2017, have been used to describe characteristics of homeless patients and have been compared with a regular GP practice. RESULTS At the street doctors' office, patients with mental problems are most often documented, followed by patients with heart diseases and endocrine problems. Serious illnesses that require extra care are registered , such as drug and alcohol addiction, HIV, tuberculosis and hepatitis C. Patients with mental problems and trauma have a larger share at the street doctor's office than in a regular GP practice. The proportion of women has increased since 2006 as has the proportion of elderly patients. The proportion of patients with documented needs for cardiovascular diseases (in particular hypertension), endocrine disorders (in particular diabetes and thyroid diseases) and cancer has increased. CONCLUSION A relatively large part of the patient contacts at the street doctor's office is devoted to mental problems and trauma. As the proportion of patients with chronic diseases and risk factors is rising, street doctor care seems to move towards regular care. But extra care for serious classical illnesses among the homeless is still necessary.
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Affiliation(s)
| | | | | | | | | | | | - Ed F van Beeck
- Erasmus MC, afd. Maatschappelijke Gezondheidszorg, Rotterdam
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12
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Nair DR, Satheesh K, Raghavan A, Nanditha A, Vinitha R, Susairaj P, Snehalatha C, Ramachandran A. Trend in the clinical profile of type 2 diabetes in India - Study from a diabetes care centre in South India. Diabetes Metab Syndr 2020; 14:1851-1857. [PMID: 32977086 DOI: 10.1016/j.dsx.2020.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM Study the changing clinical and therapeutic profiles of type 2 diabetes (T2D) patients during a 10-year period in a diabetes care centre in Southern India. METHODS Retrospective, cross-sectional data of newly registered and review patients at four periods between 2009 and 2018 were analysed (n = 50,322). Clinical findings, anthropometry, blood pressure (BP), glycaemia, lipids, treatment, and co-morbid conditions were analysed. We studied the trends in age and gender distributions, body mass index (BMI), glycaemia, (Glycosylated haemoglobin A1c (HbA1c) levels), BP, cholesterol, triglycerides and therapeutic regimen during this period. Trend analyses were done. RESULTS Approximately 60% of patients were men. Percentages in 30-40 years increased, ∼60% were aged 50-69 years and proportion of older patients decreased (p < 0.0001). In 10 years, 85.9% was overweight, obesity increased from 22.1% to 25.0% (p < 0.0001) and <13% maintained normal BMI. HbA1c <7.0% remained approximately at 22%, percentage with moderate glycaemic control (HbA1c 7.0-7.9%) increased significantly, HbA1c of ≥9.0% decreased from 35.1% to 29.1% (p < 0.0001). Use of monotherapy decreased. Prevalence of hypertension increased from 16.2% to 21.6% (p < 0.0001); use of Angiotensin Receptor Blockers (ARB) and calcium channel blockers increased, Angiotensin Converting Enzyme Inhibitors and thiazides decreased (p < 0.0001). Increased use of statins paralleled with reduction in total cholesterol and LDLc. CONCLUSION Increasing percentages of younger patients and obesity, use of multiple drugs and reduction in HbA1c were the important observations. Rising prevalence of hypertension, increased use of ARB and statins with better control of dyslipidaemia was observed. Achievement of ideal HbA1c and BP were suboptimal.
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Affiliation(s)
- Dhruv Rajesh Nair
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Krishnamoorthy Satheesh
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Arun Raghavan
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Arun Nanditha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ramachandran Vinitha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Priscilla Susairaj
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Chamukuttan Snehalatha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
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Hussein NR, M Saleem ZS, Ibrahim N, Musa DH, Naqid IA. The impact of COVID-19 pandemic on the care of patients with kidney diseases in Duhok City, Kurdistan Region of Iraq. Diabetes Metab Syndr 2020; 14:1551-1553. [PMID: 32846367 PMCID: PMC7434471 DOI: 10.1016/j.dsx.2020.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS The coronavirus disease-2019 (COVID-19) pandemic impacted healthcare services for kidney disease patients. Lockdown and social distancing were mandated in Kurdistan, Iraq to combat the transmission of the infection. The report analyzed the impact of the COVID-19 pandemic on kidney disease patient care in Duhok City, Kurdistan Region of Iraq. METHODS This study took place in the Duhok Kidney Disease and Transplant Center and compared data from February-April 2019 and 2020. RESULTS The average number of patients visiting the consultation unit per week was reduced from 68.67 ± 13.6, to 33.42 ± 29.36 (P = 0.001) during the pandemic. In the dialysis unit, weekly hemodialysis sessions were reduced from 341.5 to 306.42 sessions (P = 0.002). The number of patients visiting the kidney transplant consultation unit was significantly reduced (135.7 ± 37.7 versus 102.5 ± 26.3; P = 0.005). The number of kidney transplant operations per week was reduced from 1.167 to 0.5 (P = 0.025). CONCLUSIONS The COVID-19 pandemic interrupted healthcare services and may continue to impart long-term negative consequences for kidney disease patients.
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Affiliation(s)
- Nawfal R Hussein
- Department of Biomedical Sciences, College of Medicine, University of Zakho, Kurdistan Region of Iraq, Iraq
| | - Zana Sidiq M Saleem
- Department of Medicine, College of Medicine, University of Duhok, Kurdistan Region of Iraq, Iraq
| | - Nashwan Ibrahim
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region of Iraq, Iraq
| | - Dildar H Musa
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region of Iraq, Iraq
| | - Ibrahim A Naqid
- Department of Biomedical Sciences, College of Medicine, University of Zakho, Kurdistan Region of Iraq, Iraq.
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Affiliation(s)
- Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Pin Sym Foong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - C Jason Wang
- Departments of Pediatrics, Medicine, and Health Research and Policy, Stanford University School of Medicine, Stanford, California
- The New School for Leadership in Health Care, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
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15
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Rosti G, Romano F, Secondino S, Caccialanza R, Lobascio F, Carminati O, Pedrazzoli P, Tralongo P. The Role of Nutritional Support in Cured/Chronic Patients. Nutrients 2020; 12:nu12103167. [PMID: 33081215 PMCID: PMC7602732 DOI: 10.3390/nu12103167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/03/2022] Open
Abstract
Improvements in Clinical Oncology, due to earlier diagnoses and more efficient therapeutic strategies, have led to increased numbers of long-term survivors, albeit many with chronic diseases. Dealing with the complex care needs of these survivors is now an important part of Medical Oncology. Suitable diet and physical activity regimes will be important in maintaining their health. This paper will review what we know and what we can do in the near future for these patients.
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Affiliation(s)
- Giovanni Rosti
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (S.S.); (P.P.)
- Correspondence:
| | - Fabrizio Romano
- Medical Oncology Department, Ospedale Umberto 1-RAO-Siracusa, 96100 Syracuse, Italy; (F.R.); (P.T.)
| | - Simona Secondino
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (S.S.); (P.P.)
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (R.C.); (F.L.)
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (R.C.); (F.L.)
| | - Ornella Carminati
- Medical Oncology, Department of Oncology and Hematology, AUSL Romagna, 48100 Ravenna, Italy;
| | - Paolo Pedrazzoli
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (S.S.); (P.P.)
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Paolo Tralongo
- Medical Oncology Department, Ospedale Umberto 1-RAO-Siracusa, 96100 Syracuse, Italy; (F.R.); (P.T.)
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Moore AM, Blades N, Ortiz J, Whitehead H, Villarreal C. What does informal access to misoprostol in Colombia look like? A mystery client methodology in Bogotá and the Coffee Axis. BMJ Sex Reprod Health 2020; 46:294-300. [PMID: 32624479 PMCID: PMC7569367 DOI: 10.1136/bmjsrh-2019-200572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION In 2006, abortion was decriminalised in Colombia under certain circumstances. Yet, women avail themselves of ways to terminate pregnancy outside of the formal health system. This study explored how drug sellers engage with women who attempt to purchase misoprostol from them. METHODS A mapping exercise was undertaken to list small-chain and independent drug stores in two regions in Colombia. A sample (n=558) of drug stores was selected from this list and visited by mystery clients between November and December 2017. Mystery clients sought to obtain a medication to bring back a delayed period, and described the experience, the information obtained and the medications proffered in exit interviews. RESULTS Misoprostol was offered for purchase in 15% of the visits; in half of visits, only information about misoprostol was shared, while no information about misoprostol was provided on the remaining visits. Over half of sellers who refused to sell any medication provided referrals, most commonly to an abortion provider. Among visits which included discussion of misoprostol, two out of five sellers provided dosage instructions with most recommending the minimum adequate dosage. Mystery clients received little information on the physical effects to expect with the use of misoprostol and possible complications. CONCLUSIONS As misoprostol is being obtained from some drug sellers without a prescription, capacitating this cadre with at least a minimum of standardised information on dosage, routes of administration and expected effects and outcomes have the potential to improve reproductive health outcomes for women who choose to terminate pregnancies this way in Colombia.
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Affiliation(s)
- Ann M Moore
- Division of Research, Guttmacher Institute, New York, New York, USA
| | - Nakeisha Blades
- Division of Research, Guttmacher Institute, New York, New York, USA
| | | | - Hannah Whitehead
- Division of Research, Guttmacher Institute, New York, New York, USA
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Tsugawa A, Sakurai S, Inagawa Y, Hirose D, Kaneko Y, Ogawa Y, Serisawa S, Takenoshita N, Sakurai H, Kanetaka H, Hirao K, Shimizu S. Awareness of the COVID-19 Outbreak and Resultant Depressive Tendencies in Patients with Severe Alzheimer's Disease. J Alzheimers Dis 2020; 77:539-541. [PMID: 32925073 DOI: 10.3233/jad-200832] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic has substantially affected patients with dementia and their caregivers. However, we found not all Alzheimer's disease (AD) patients were afraid of COVID-19 infection. Therefore, we investigated the association between rate of awareness of COVID-19 and depressive tendency in AD. 126 consecutive outpatients with AD were enrolled in this study from May 25, on the day when the declaration of emergency was lifted in Japan, through June 30, 2020. In addition to routine psychological tests, the participants were asked the following two questions: "Do you know COVID-19?" and "Why are you wearing a face mask?". Moderate to severe AD patients were found to have a low COVID-19 recognition rate and did not fully understand why they were wearing face masks. In addition, because they did not understand the seriousness of the COVID-19 outbreak, their Geriatric Depression Scale scores were also substantially lower. These results may appear to simply indicate that people with severe dementia are unaware of current events. However, these results provide insights into how to care for patients with dementia and how to allocate the time and support of our limited staff during the COVID-19 outbreak.
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Xiang D, Xiang X, Zhang W, Yi S, Zhang J, Gu X, Xu Y, Huang K, Su X, Yu B, Wang Y, Fang W, Huo Y, Ge J. Management and Outcomes of Patients With STEMI During the COVID-19 Pandemic in China. J Am Coll Cardiol 2020; 76:1318-1324. [PMID: 32828614 PMCID: PMC7438071 DOI: 10.1016/j.jacc.2020.06.039] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [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] [Received: 05/03/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is a fatal cardiovascular emergency requiring rapid reperfusion treatment. During the coronavirus disease-2019 (COVID-19) pandemic, medical professionals need to strike a balance between providing timely treatment for STEMI patients and implementing infection control procedures to prevent nosocomial spread of COVID-19 among health care workers and other vulnerable cardiovascular patients. OBJECTIVES This study evaluates the impact of the COVID-19 outbreak and China Chest Pain Center's modified STEMI protocol on the treatment and prognosis of STEMI patients in China. METHODS Based on the data of 28,189 STEMI patients admitted to 1,372 Chest Pain Centers in China between December 27, 2019 and February 20, 2020, the study analyzed how the COVID-19 outbreak and China Chest Pain Center's modified STEMI protocol influenced the number of admitted STEMI cases, reperfusion strategy, key treatment time points, and in-hospital mortality and heart failure for STEMI patients. RESULTS The COVID-19 outbreak reduced the number of STEMI cases reported to China Chest Pain Centers. Consistent with China Chest Pain Center's modified STEMI protocol, the percentage of patients undergoing primary percutaneous coronary intervention declined while the percentage of patients undergoing thrombolysis increased. With an average delay of approximately 20 min for reperfusion therapy, the rate of in-hospital mortality and in-hospital heart failure increased during the outbreak, but the rate of in-hospital hemorrhage remained stable. CONCLUSIONS There were reductions in STEMI patients' access to care, delays in treatment timelines, changes in reperfusion strategies, and an increase of in-hospital mortality and heart failure during the COVID-19 pandemic in China.
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Affiliation(s)
- Dingcheng Xiang
- Department of Cardiology, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.
| | - Xin Xiang
- Graduate School of Arts and Sciences, Harvard University, Cambridge, Massachusetts
| | - Wei Zhang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Shaodong Yi
- Department of Cardiology, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Jinxia Zhang
- Department of Cardiology, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Xiaolong Gu
- Department of Cardiology, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Yawei Xu
- Department of Cardiology, 10th Hospital of Tongji University, Shanghai, China
| | - Kai Huang
- Department of Cardiology, Union Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Bo Yu
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yan Wang
- Department of Cardiology, Xiamen Heart Center, Xiamen, China
| | - Weiyi Fang
- Department of Cardiology, Shanghai Dongfang Hospital, Shanghai, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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20
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Affiliation(s)
- Amer Harky
- Department of Cardio-thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - Chun Ming Chiu
- Brighton and Sussex Medical School, University of Sussex, East Sussex, UK
| | - Thomas Ho Lai Yau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Abstract
The COVID-19 pandemic has necessitated modifications to pediatric orthopaedic practice to protect patients, families, and healthcare workers and to minimize viral transmission. It is critical to balance the benefits of alterations to current practice to reduce the chances of COVID-19 infection, with the potential long-term impact on patients. Early experiences of the pandemic from orthopaedic surgeons in China, Singapore, and Italy have provided the opportunity to take proactive and preventive measures to protect all involved in pediatric orthopaedic care. These guidelines, based on expert opinion and best available evidence, provide a framework for the management of pediatric orthopaedic patients during the COVID-19 pandemic. General principles include limiting procedures to urgent cases such as traumatic injuries and deferring outpatient visits during the acute phase of the pandemic. Nonsurgical methods should be considered where possible. For patients with developmental or chronic orthopaedic conditions, it may be possible to delay treatment for 2 to 4 months without substantial detrimental long-term impact.
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Affiliation(s)
- Sarah Farrell
- From the Department of Orthopaedics (Dr. Farrell), Children's Hospital Queensland, South Brisbane, Australia, the Department of Orthopaedics (Dr. Schaeffer, Dr. Mulpuri), University of British Columbia, and the Department of Orthopaedic Surgery (Dr. Schaeffer, Dr. Mulpuri), BC Children's Hospital, Vancouver, BC
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22
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Al‐Shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M, Wolff RA, Ibrahim NK, Chua ML, Hotte SJ, Meyers BM, Elfiki T, Curigliano G, Eng C, Grothey A, Xie C. A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group. Oncologist 2020; 25:e936-e945. [PMID: 32243668 PMCID: PMC7288661 DOI: 10.1634/theoncologist.2020-0213] [Citation(s) in RCA: 431] [Impact Index Per Article: 107.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 01/08/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread globally since being identified as a public health emergency of major international concern and has now been declared a pandemic by the World Health Organization (WHO). In December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is characterized by rapid human-to-human transmission. Many cancer patients frequently visit the hospital for treatment and disease surveillance. They may be immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Several factors increase the risk of infection, and cancer patients commonly have multiple risk factors. Cancer patients appear to have an estimated twofold increased risk of contracting SARS-CoV-2 than the general population. With the WHO declaring the novel coronavirus outbreak a pandemic, there is an urgent need to address the impact of such a pandemic on cancer patients. This include changes to resource allocation, clinical care, and the consent process during a pandemic. Currently and due to limited data, there are no international guidelines to address the management of cancer patients in any infectious pandemic. In this review, the potential challenges associated with managing cancer patients during the COVID-19 infection pandemic will be addressed, with suggestions of some practical approaches. IMPLICATIONS FOR PRACTICE: The main management strategies for treating cancer patients during the COVID-19 epidemic include clear communication and education about hand hygiene, infection control measures, high-risk exposure, and the signs and symptoms of COVID-19. Consideration of risk and benefit for active intervention in the cancer population must be individualized. Postponing elective surgery or adjuvant chemotherapy for cancer patients with low risk of progression should be considered on a case-by-case basis. Minimizing outpatient visits can help to mitigate exposure and possible further transmission. Telemedicine may be used to support patients to minimize number of visits and risk of exposure. More research is needed to better understand SARS-CoV-2 virology and epidemiology.
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Affiliation(s)
- Humaid O. Al‐Shamsi
- Medical Oncology Department, Alzahra Hospital DubaiDubaiUnited Arab Emirates
- Department of Medicine, University of SharjahSharjahUnited Arab Emirates
- Emirates Oncology SocietyDubaiUnited Arab Emirates
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, Medicine, McMaster UniversityHamiltonOntarioCanada
- Medicine, McMaster UniversityHamiltonOntarioCanada
| | - Ahmad Alhuraiji
- Department of Hematology, Kuwait Cancer Control CenterKuwait
| | - Eric A. Coomes
- Division of Infectious Disease, Department of Medicine, University of TorontoTorontoOntarioCanada
| | - Roy F. Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Robert A. Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Nuhad K. Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Melvin L.K. Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Center SingaporeSingapore
- Oncology Academic Program, Duke‐NUS Medical SchoolSingapore
- Cong Hua's InstituteSingapore
| | - Sebastien J. Hotte
- Department of Oncology, Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Brandon M. Meyers
- Department of Oncology, Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Tarek Elfiki
- Windsor Regional Cancer CenterWindsorOntarioCanada
- Department of Oncology, Schulich School of Medicine, University of Western OntarioLondonOntarioCanada
| | - Giuseppe Curigliano
- Department of Oncology and Hemato‐Oncology University of MilanMilanItaly
- Division of Early Drug Development for Innovative Therapy, University of MilanMilanItaly
- European Institute of OncologyMilanItaly
- IRCCS, University of MilanoMilanItaly
| | - Cathy Eng
- Vanderbilt‐Ingram Cancer CenterNashvilleTennesseeUSA
| | - Axel Grothey
- West Cancer Center, University of TennesseeMemphisTennesseeUSA
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan UniversityWuhanPeople's Republic of China
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23
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Barnhoorn PC. [Touch in the time of corona]. Ned Tijdschr Geneeskd 2020; 164:D4994. [PMID: 32395956] [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: 06/11/2023]
Abstract
No more shaking hands and keeping your distance to flatten the corona epidemic. The forced distance between doctor and patient in times of corona makes us realize the value of touch in healthcare. The temporary austerity of contacts offers a scope for reflection on the small things that make the difference between care and healing.
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Affiliation(s)
- Pieter C Barnhoorn
- Leids Universitair Medisch Centrum, afd. Public Health en Eerstelijns Geneeskunde, Leiden
- Contact: Pieter C. Barnhoorn
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Hogarty DT, Su JC, Phan K, Attia M, Hossny M, Nahavandi S, Lenane P, Moloney FJ, Yazdabadi A. Artificial Intelligence in Dermatology-Where We Are and the Way to the Future: A Review. Am J Clin Dermatol 2020; 21:41-47. [PMID: 31278649 DOI: 10.1007/s40257-019-00462-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Although artificial intelligence has been available for some time, it has garnered significant interest recently and has been popularized by major companies with its applications in image identification, speech recognition and problem solving. Artificial intelligence is now being increasingly studied for its potential uses in medicine. A sound understanding of the concepts of this emerging field is essential for the dermatologist as dermatology has abundant medical data and images that can be used to train artificial intelligence for patient care. There are already a number of artificial intelligence studies focusing on skin disorders such as skin cancer, psoriasis, atopic dermatitis and onychomycosis. This article aims to present a basic introduction to the concepts of artificial intelligence as well as present an overview of the current research into artificial intelligence in dermatology, examining both its current applications and its future potential.
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Affiliation(s)
- Daniel T Hogarty
- Monash University, Eastern Health, 5 Arnold Street, Box Hill 3128, Melbourne, VIC, Australia.
| | - John C Su
- Monash University, Eastern Health, 5 Arnold Street, Box Hill 3128, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
| | - Mohamed Attia
- Institute for Intelligent Systems Research and Innovation, Geelong, Australia
| | - Mohammed Hossny
- Institute for Intelligent Systems Research and Innovation, Geelong, Australia
| | - Saeid Nahavandi
- Institute for Intelligent Systems Research and Innovation, Geelong, Australia
| | - Patricia Lenane
- Mater Misericordiae University Hospital, Dublin, Ireland
- University College Dublin, School of Medicine and Medical Science, Dublin, Ireland
| | - Fergal J Moloney
- Mater Misericordiae University Hospital, Dublin, Ireland
- University College Dublin, School of Medicine and Medical Science, Dublin, Ireland
| | - Anousha Yazdabadi
- Monash University, Eastern Health, 5 Arnold Street, Box Hill 3128, Melbourne, VIC, Australia
- Department of Dermatology, University of Melbourne, Melbourne, VIC, Australia
- Department of Dermatology, Northern Health, Epping, VIC, Australia
- Department of Dermatology, Deakin University, Melbourne, VIC, Australia
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Abstract
OBJECTIVES This work comes from the interest and need to understand the problems arising from the activity of caring for dependent people, in the world and particularly in the European region. Altogether, it seeks to understand the consequences of informal care on the caregiver adding to the debate a gender perspective. Through a multidisciplinary bibliographic review, the current care crisis becomes clear. The demographic and socio-cultural changes in recent years are causing dependency to increase dramatically, while putting at risk the availability of informal caregivers. Several studies have shown that women are the ones on whom the burden of care mainly falls. Therefore, under the gender perspective, it becomes clear that the consequences of caregiver burden increase gender inequalities worldwide. The study analyzes the current situation and underlines the need to promote alternatives and opportunities so that care is shared and does not fall only on the female gender. Solutions need to be included in public and community health interventions and policies, and to this respect, nurses play an important role in changing the care paradigm.
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Selvaraj A, Redzuan AM, Hatah E. Community pharmacists' perceptions, attitudes and barriers towards pharmacist-led minor ailment services in Malaysia. Int J Clin Pharm 2020; 42:777-785. [PMID: 32006142 DOI: 10.1007/s11096-020-00973-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/18/2020] [Indexed: 11/27/2022]
Abstract
Background Community pharmacists are increasingly recognized to have an important role in providing a convenient and accessible alternative support for patients with minor ailments. In view of the abilities of community pharmacists in managing minor ailments, some countries have started the pharmacy-based minor ailment schemes that offers public access to treatment and advice of minor ailments from their local pharmacist. Nevertheless, there is limited study in Malaysia that explore the current practice of community pharmacists in managing minor ailment. Objective This study aims to evaluate community pharmacists' perceptions, attitudes and barriers of pharmacist-led minor ailment services. Setting Community pharmacists in Malaysia. Methods A cross-sectional survey among community pharmacists practicing in Malaysia was conducted between December 2017 until March 2018. The self-administered survey was distributed online via email, Facebook and WhatsApp's group. Main outcome measure Community pharmacists' perceptions, attitude and barriers towards minor-ailment service in community pharmacy settings. Results A total of 305 community pharmacists had completed the survey. The majority of community pharmacists in Malaysia had positive perceptions and attitudes towards pharmacist-led minor ailment services. The most common perceived barriers were lack of patient's medical information, absence of dispensing separation and lack of support from other healthcare professionals. Ethnicity, position and years of working experience were found to have significant associations with community pharmacists' score of attitudes and barriers related to minor ailment treatment in community pharmacy settings. Conclusion Community pharmacists in Malaysia have positive perceptions and attitudes over benefits of minor ailment services to public, however the barriers towards the service must be overcome to ensure service is sustainable for public's benefits.
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Affiliation(s)
- Amutha Selvaraj
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Adyani Md Redzuan
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
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Garcia D, Guard E, Thumann K. Building an Outdoor Urgent Care Clinic During a Pandemic: One Clinic's Experience. Fam Pract Manag 2020; 27:14-19. [PMID: 32929946] [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: 06/11/2023]
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Abstract
BACKGROUND As digitalization is progressively permeating all aspects of society, how can be it fruitfully employed to sustain the public health goals of quality, accessibility, efficiency and equity in health care and prevention? In this paper, we reflect on the potential of applying digital tools to public health and discuss some key challenges. METHODS We first define 'digitalization' in its broader sense, as well as applied to public health. We then build a conceptual framework where key public health domains are associated to available digital technologies in a matrix that help to identify digital features that bolster public health action. We also provide illustrative data and evidence on the application of digital solutions on selected public health areas. In the second part, we identify the strategic pillars for a successful European strategy for public health digitalization and we outline how the approach being pursued by the European Public Health Association (EUPHA) applies to digital health. RESULTS From a public health perspective, digitalization is being touted as providing several potential benefits and advantages, including support for the transition from cure to prevention, helping to put people and patients at the center of care delivery, supporting patient empowerment and making healthcare system more efficient, safer and cheaper. These benefits are enabled through the following features of digital technologies: (i) Personalization and precision; (ii) Automation; (iii) Prediction; (iv) Data analytics and (v) Interaction. CONCLUSION A successful European strategy for public health digitalization should integrate the following pillars: political commitment, normative frameworks, technical infrastructure, targeted economic investments, education, research, monitoring and evaluation. EUPHA acknowledges digitalization is an asset for public health and is working both to promote the culture of "public health digitalization", as well as to enable its planning, implementation and evaluation at the research, practice and policy level.
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Affiliation(s)
- Anna Odone
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
- European Public Health Association, Utrecht, The Netherlands
| | - Stefan Buttigieg
- European Public Health Association, Utrecht, The Netherlands
- Digital Health Malta, Villetta, Malta
| | - Walter Ricciardi
- European Public Health Association, Utrecht, The Netherlands
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Natasha Azzopardi-Muscat
- European Public Health Association, Utrecht, The Netherlands
- Department of Health Services Management, Faculty of Health Science, University of Malta, Villetta, Malta
| | - Anthony Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland
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Abstract
Digitalization cannot be understood as an off-the-shelf product, bought as a one-time purchase in a warehouse. It rather requires a constantly developing vision, which comes with a continuous transformation process, hand in hand with strategic innovation management. Thus, digitalization means understanding the digital maturity level of an enterprise and the digital skills of the employees. Besides an investment in products, a successful digitalization process also necessitates consideration of the cost to release employees from their obligations in order to contribute to the process as well as for a dedicated and continuing staff training and education program. While digitalization in Germany is underdeveloped regarding both the national health infrastructure and the level of digitalization in hospitals, German clinics are recognizing more and more the importance of digitalization and are initiating digitalization strategies. In this regard, we can learn from our European partners, who have partially established advanced and innovative solutions. Looking into these flagship projects can help to see potentials and to identify valuable building blocks for our own strategy.
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Affiliation(s)
- W Deiters
- Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Deutschland.
| | - A Burmann
- Fraunhofer-Institut für Software- und Systemtechnik, Dortmund, Deutschland
| | - S Meister
- Fraunhofer-Institut für Software- und Systemtechnik, Dortmund, Deutschland
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Hawley CE, Triantafylidis LK, Paik JM. The missing piece: Clinical pharmacists enhancing the interprofessional nephrology clinic model. J Am Pharm Assoc (2003) 2019; 59:727-735. [PMID: 31231002 PMCID: PMC8150925 DOI: 10.1016/j.japh.2019.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To embed pharmacy residents in an interprofessional nephrology clinic to conduct medication reconciliation in targeted high-risk patients with nondialysis kidney disease. SETTING This pilot was a prospective quality improvement initiative conducted in an interprofessional outpatient nephrology clinic. PRACTICE DESCRIPTION The nephrology clinic team includes nephrology providers, a social worker, and a geriatrician. The team is responsible for the management of conditions such as nondialysis kidney disease, resistant hypertension, acute kidney injury, proteinuria, and nephropathy. EVALUATION Primary outcomes included the number and type of medication discrepancies and drug therapy problems identified. Secondary outcomes included the changes in care process directly resulting from the pharmacy residents' recommendations. The perceived value of the pharmacy residents to the interprofessional team was assessed through postintervention anonymous surveys and semistructured interviews. RESULTS The pharmacy residents conducted 118 visits for 87 unique patients (mean age 73 years, 97% male) with nondialysis kidney disease (89% stages III-V), polypharmacy (87% of patients taking > 10 medications), and a heavy comorbidity burden (85% hypertension, 80% dyslipidemia, 59% diabetes mellitus type II) from January to October 2017. Pharmacists identified 344 medication discrepancies and 301 drug therapy problems, resulting in 398 changes in care process. The most frequently identified discrepancies and drug therapy problems were the omission of an active medication from the medication list (86 of 344 discrepancies, 25%) and potentially inappropriate medications (106 of 301 drug therapy problems, 35%). Pharmacists recommended 228 medication changes, provided 76 adherence devices, facilitated 24 consults or referrals, and communicated with the primary care team on 70 occasions. The interprofessional team members all strongly agreed that patients and the team benefited from the pharmacists' involvement. CONCLUSION Pharmacy resident-led medication reconciliation resulted in the identification and resolution of medication discrepancies and drug therapy problems, leading to changes in the care process.
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Affiliation(s)
- Chelsea E. Hawley
- New England Geriatric Research, Education, and Clinical Center
- Department of Pharmacy, VA Boston Healthcare System, Boston, MA
| | | | - Julie M. Paik
- New England Geriatric Research, Education, and Clinical Center
- Renal Section, VA Boston Healthcare System
- Brigham and Women’s Hospital
- Department of Medicine, Harvard Medical School, Boston, MA
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31
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Bloom CI, Ku M, Williams M. Clinical pharmacy specialists' impact in patient aligned care teams for type 2 diabetes management. J Am Pharm Assoc (2003) 2019; 59:717-721. [PMID: 31204200 DOI: 10.1016/j.japh.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 04/12/2019] [Accepted: 05/06/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Clinical pharmacy specialists (CPSs) are a core member of the primary care team, and they have been shown to improve outcomes, decrease overall cost, and increase the availability of primary care providers (PCPs) by assisting with the management of chronic disease states. CPSs have the opportunity to increase access to care if they are used at their full scope of practice. The objective of this study was to compare the reduction in HbA1c between CPSs and PCPs. METHODS This retrospective, chart review study assessed the impact of CPSs on patients with uncontrolled type 2 diabetes who saw a CPS in addition to a PCP compared to those who saw a PCP alone from January 1, 2011, to October 1, 2016. The CPS held prescriptive authority and ordered, interpreted, and monitored laboratory results. Secondary outcomes included the reduction of blood pressure, appropriate statin intensity, weight loss, initiation of insulin, and access to care. RESULTS Seventy-five patients were included in both the CPS and PCP groups. There was a statistically significant decrease in HbA1c in the CPS group (3.02% vs. 0.93%; P < 0.0001), with most patients reaching their HbA1c goal in 6 months or less with an average of 7 clinic visits in that timeframe. In addition, significantly more patients were taking the appropriate intensity statin in the CPS group (90.7% vs. 73.3%; P = 0.006). CONCLUSION The use of CPSs in the management of type 2 diabetes led to similar achievements in HbA1c goal, but over a shorter duration. CPSs provided effective patient care while increasing access to health care.
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Panther SG, Allen RA, Brantner K, Jefferson CG, Murphy NL, Robinson JD. Addressing Unmet Patient Care Needs Through Curricular Development of Student Pharmacist Leadership and Entrepreneurial Skills. Am J Pharm Educ 2019; 83:6764. [PMID: 31333254 PMCID: PMC6630856 DOI: 10.5688/ajpe6764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/21/2017] [Indexed: 06/10/2023]
Abstract
Objective. To develop, deliver, and evaluate an innovative curriculum designed to increase student pharmacists' skills and confidence in addressing unmet patient care needs and the Institute for Healthcare Improvement's (IHI) Triple Aim goals in the community pharmacy setting. Methods. Course modules developed collaboratively between the University of Washington and Washington State University focused on student pharmacist exposure to and direct application of leadership theory in addressing real world challenges. Both programs delivered the curriculum to all second-year student pharmacists during the fall 2015 and fall 2016 semesters. Student teams were asked to identify a new or enhanced service for a community pharmacy based on a needs assessment and the IHI's Triple Aim goals. Students completed precourse, postcourse, and retrospective assessments of their confidence, comfort level in leadership theory application, and project implementation. Effectiveness of the project pitch and team dynamics were assessed. Precourse, postcourse, and retrospective assessments of individual student progress in leadership, innovation, self-awareness, and professionalism also were completed. Results. For all confidence questions, a significant relationship was found between mean precourse and postcourse scores. A comparison of students' postcourse scores and their retrospective reflection scores indicated an increase in confidence to lead. At the conclusion of the course, the students reported improved confidence in their ability to communicate decisions (73%), create a vision (64%), and form a guiding coalition (55%). Conclusion. A five-module curriculum with corresponding project proposal successfully increased the confidence and comfort level of student pharmacists' in their leadership skillset.
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Affiliation(s)
| | - Rachel A. Allen
- University of Washington School of Pharmacy, Seattle, Washington
| | - Kelsey Brantner
- University of Washington School of Pharmacy, Seattle, Washington
| | | | - Nanci L. Murphy
- University of Washington School of Pharmacy, Seattle, Washington
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Epp DA, Kubota T, Yoshida M, Kishimoto J, Kobayashi D, Shimazoe T. Promoting Patient Care Through Communication Training in a Pre-clerkship Pharmacy Education Course in Japan. Am J Pharm Educ 2019; 83:6745. [PMID: 31333251 PMCID: PMC6630866 DOI: 10.5688/ajpe6745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/29/2018] [Indexed: 06/01/2023]
Abstract
Objective. The purpose of this study was to teach communication skills for patient care to pre-clerkship students and observe changes in student perspectives towards communication from pre- to post-training. Methods. Two cohorts of fourth-year pharmacy students completed an eight-week pre-clerkship training course designed to improve their communication skills. The course involved class discussions and in-class research of medications, practicing communication skills, learning to give science-based responses, and developing an awareness of patient education for lifestyle, self-medication, quality of life, and medication adherence. A comparison of students' pre- and post-training responses to a questionnaire were used to assess changes in students' ability and confidence in communicating with patients. An exploratory factor analysis was used to analyze and compare the data results. Results. Students' mean post-training scores for perceived ability to make small talk and confidence to communicate with patients increased compared to pre-training scores. Based on the results of the exploratory factor analysis, the greatest increase in students' scores was in the area of patient education skills. Conclusion. The pre-clerkship communication training improved student understanding of the pharmacy communication skills needed to conduct effective patient education and pharmacist-patient interaction beyond dispensing, affirming the theory that specialized communication training before students' begin a clerkship may be essential.
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Affiliation(s)
- Denise A. Epp
- Center for Advancing Pharmaceutical Education, Daiichi University of Pharmacy, Fukuoka, Japan
- Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshio Kubota
- Center of Pharmaceutical Care for Community Health, Daiichi University of Pharmacy, Fukuoka, Japan
| | - Motofumi Yoshida
- Faculty of Medicine, International University for Health and Welfare, Narita, Japan
| | - Junji Kishimoto
- Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Kobayashi
- Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Takao Shimazoe
- Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
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Melin K, Hilera-Botet CR, Vega-Vélez D, Salgado-Crespo VM, Santiago D, Hernández-Agosto J, Muñoz-Burgos A, Cajigas Z, Martínez-Vélez JJ, Rodríguez-Díaz CE. Readiness to provide pharmaceutical care to transgender patients: Perspectives from pharmacists and transgender individuals. J Am Pharm Assoc (2003) 2019; 59:651-659. [PMID: 31153824 DOI: 10.1016/j.japh.2019.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objectives of this study were (1) to assess pharmacist readiness to provide pharmaceutical care for transgender patients through measuring both pharmacists' knowledge and attitudes towards transgender patients, (2) to assess transgender patients' perception of pharmacist readiness to provide them pharmaceutical care through measuring both pharmacists' knowledge and attitudes toward them, and (3) to compare pharmacist readiness to provide pharmaceutical care for transgender patients and patient perception of this readiness. DESIGN The study used a descriptive, cross-sectional design. The pharmacist's readiness and the transgender patient's perception of their readiness, defined as a combination of knowledge and attitude, were evaluated. Two separate, validated questionnaires with dichotomous, multiple choice, and open-ended questions were used to measure both constructs among both populations. SETTING Community-based research. PARTICIPANTS Pharmacists practicing in Puerto Rico were provided the questionnaire by e-mail or in person. Transgender participants in Puerto Rico were recruited through health clinics and community partners and were surveyed in person. The analysis included responses from 96 pharmacists and 31 transgender participants. RESULTS The majority of the pharmacists' knowledge scores (90%) were found in the low (0-5) and moderate (6-10) ranges, with a mean score of 7.23 out of a total possible score of 16 (SD ±2.36). For the attitude construct, most of the scores (81%) were found in the high (18-26) range, with a mean score of 19.63 out of a total possible score of 26 (SD ±3.65). For both constructs, transgender patient perceptions echoed the results of the pharmacists, indicating several perceived knowledge deficits in combination with mostly positive attitudes. CONCLUSION The majority of pharmacists demonstrated positive attitudes toward caring for transgender patients, and transgender patients also perceived these positive attitudes from pharmacists. However, the measured and perceived knowledge deficits observed in this study suggest the need for educational interventions to improve pharmacist readiness to provide care for transgender patients.
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Schommer JC, Olson AW, Isetts BJ. Transforming community-based pharmacy practice through financially sustainable centers for health and personal care. J Am Pharm Assoc (2003) 2019. [PMID: 30573373 DOI: 10.1016/j.jap.2018.20.009] [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: 05/14/2023]
Abstract
OBJECTIVES To provide a case for transforming community-based pharmacy practice through financially sustainable centers for health and personal care. SUMMARY Macro-level changes in health care laws, markets, technology, organizational systems, and professional education have increased the capacity for pharmacists to competently provide patient care and public health services that surpass the current workflow designs of most community pharmacies. Community-based pharmacy practices have an opportunity to fundamentally transform into financially sustainable centers for health and personal care. This would require changing our objective from connecting products with customers to one that connects practitioners to patients. Rather than inventory generating revenue, patient care generates revenue. Rather than success being measured by number of prescriptions filled, it would be measured by patient outcomes. Physical spaces would no longer be organized to display and sell products; they would be organized for patients to receive services. Finally, this would require that business would change from being sought through the generation of prescriptions to being sought through recruitment of patients. CONCLUSION Community-based pharmacy practice can be transformed through the development of financially sustainable centers for health and personal care that would (1) be focused on optimizing care, (2) use patient care business models, and (3) be conducive to patients "receiving care" rather than "purchasing products."
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Fox BI. Technology in pharmacy practice and patient care: Meeting needs and addressing opportunities. J Am Pharm Assoc (2003) 2019; 59:S5-S6. [PMID: 30853085 DOI: 10.1016/j.japh.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Brent I Fox
- Associate Professor, Director of Student Affairs, Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, AL
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Prusaczyk B, Maki J, Luke DA, Lobb R. Rural Health Networks: How Network Analysis Can Inform Patient Care and Organizational Collaboration in a Rural Breast Cancer Screening Network. J Rural Health 2019; 35:222-228. [PMID: 29656463 PMCID: PMC6188848 DOI: 10.1111/jrh.12302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Rural health networks have the potential to improve health care quality and access. Despite this, the use of network analysis to study rural health networks is limited. The purpose of this study was to use network analysis to understand how a network of rural breast cancer care providers deliver services and to demonstrate the value of this methodology in this research area. METHODS Leaders at 47 Federally Qualified Health Centers and Rural Health Clinics across 10 adjacent rural counties were asked where they refer patients for mammograms or breast biopsies. These clinics and the 22 referral providers that respondents named comprised the network. The network was analyzed graphically and statistically with exponential random graph modeling. FINDINGS Most (96%, n = 45) of the clinics and referral sites (95%, n = 21) are connected to each other. Two clinics of the same type were 62% less likely to refer patients to the same providers as 2 clinics of different types (OR = 0.38, 95% CI = 0.29-0.50). Clinics in the same county have approximately 8 times higher odds of referring patients to the same providers compared to clinics in different counties (OR = 7.80, CI = 4.57-13.31). CONCLUSIONS This study found that geographic location of resources is an important factor in rural health care providers' referral decisions and demonstrated the usefulness of network analysis for understanding rural health networks. These results can be used to guide delivery of patient care and strengthen the network by building resources that take location into account.
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Affiliation(s)
- Beth Prusaczyk
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julia Maki
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Douglas A. Luke
- George Warren Brown School of Social Work, Washington University, St. Louis, Missouri
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Kaewput W, Thongprayoon C, Mungthin M, Jindarat S, Varothai N, Suwannahitatorn P, Rangsin R, Mao MA, Cheungpasitporn W. Temporal trends in optimal diabetic care and complications of elderly type 2 diabetes patients in Thailand: A nationwide study. J Evid Based Med 2019; 12:22-28. [PMID: 30398014 DOI: 10.1111/jebm.12318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/01/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study aimed to assess the nationwide trends in optimal diabetic care and complications of elderly type 2 diabetes mellitus (T2DM) patients over a 6-year period in Thailand. METHODS T2DM patients aged 65 years or older who received medical care at public hospitals in Thailand from 2010 to 2015 were included. The optimal T2DM care in elderly patients was defined as (1) blood pressure (BP) < 140/90, (2) hemoglobin A1C (HbA1c) < 7%, (3) low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, (4) use of antiplatelet medications, and (5) use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in hypertensive patients. T2DM treatment-related complications included hospital admissions due to dysglycemia. RESULTS A total of 54 295 elderly T2DM patients were enrolled in this study. From 2010 to 2015, there was an increasing trend in the achievement of BP control and use of antiplatelet medications (P for trend < 0.01), whereas there was a decreasing trend in the achievement of HbA1c and LDL-C control among elderly T2DM patients (P for trend < 0.001). There was an increasing trend in the use of ACEI/ARB among elderly T2DM patients with hypertension (P for trend < 0.001). Hospital admissions due to dysglycemia decreased over the study period (P for trend < 0.001). CONCLUSION There has been a trend change for diabetic care among elderly T2DM patients in Thailand. Further studies are needed to assess the impact on patient outcomes.
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Affiliation(s)
- Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, New York City, New York, USA
| | - Mathirut Mungthin
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Sarawut Jindarat
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Narittaya Varothai
- Medicine, Geriatric Unit, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Michael A Mao
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology/Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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van de Berg S, Jansen-Aaldring N, de Vries G, van den Hof S. Patient support for tuberculosis patients in low-incidence countries: A systematic review. PLoS One 2018; 13:e0205433. [PMID: 30304052 PMCID: PMC6179254 DOI: 10.1371/journal.pone.0205433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/25/2018] [Indexed: 01/12/2023] Open
Abstract
Background Patient support during tuberculosis treatment is expected to be more often available and more customized in low tuberculosis incidence, high-resource settings than in lower-resource settings. The aim of this systematic review is to provide an overview of tuberculosis patient support interventions implemented in low-incidence countries and an evaluation of their effects on treatment-related outcomes as well as their acceptability by patients and providers. Methods PubMed, Social Science Citation Index and Cumulative Index to Nursing and Allied Health and Literature were searched for the period 01.2006–05.2016 on publications describing tuberculosis patient support interventions in low-incidence countries (<20 patients per 100,000 population). Results Through our search strategy, 1875 unique publications were identified. Forty publications were included: 17 evaluated patient support quantitatively, 9 qualitatively and 14 only described the patient support. Nineteen publications assessed treatment supervision options only, 21 assessed (combinations of) treatment supervision, socio-economic, psycho-emotional, health-educational and other support. Of eight studies quantitatively evaluating the effects of support with a control group, four showed positive effects: two out of three that used combinations of patient support and two out of five that compared treatment supervision options. Heterogeneity of interventions precluded pooling of results. Qualitative and descriptive studies showed that patients appreciated individualized support including treatment supervision, psycho-emotional and socio-economic support; and digital health interventions. Conclusion Our review shows that a variety of patient support interventions is implemented in low-incidence countries. Although only a few interventions were evaluated quantitatively, we identified potential best practices. The scarcity of evidence on effectiveness, however, indicates the need for further research to evaluate potential best practices.
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Affiliation(s)
| | | | - Gerard de Vries
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Susan van den Hof
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
- Dept. of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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Wang T, Molassiotis A, Chung BPM, Tan JY. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care 2018; 17:96. [PMID: 30037346 PMCID: PMC6057056 DOI: 10.1186/s12904-018-0346-9] [Citation(s) in RCA: 319] [Impact Index Per Article: 53.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 06/25/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This systematic review aimed to identify the unmet care needs and their associated variables in patients with advanced cancer and informal caregivers, alongside summarizing the tools used for needs assessment. METHODS Ten electronic databases were searched systematically from inception of each database to December 2016 to determine eligible studies. Studies that considered the unmet care needs of either adult patients with advanced cancer or informal caregivers, regardless of the study design, were included. The Mixed Methods Appraisal Tool was utilized for quality appraisal of the included studies. Content analysis was used to identify unmet needs, and descriptive analysis was adopted to synthesize other outcomes. RESULTS Fifty studies were included, and their methodological quality was generally robust. The prevalence of unmet needs varied across studies. Twelve unmet need domains were identified in patients with advanced cancer, and seven among informal caregivers. The three most commonly reported domains for patients were psychological, physical, and healthcare service and information. The most prominent unmet items of these domains were emotional support (10.1-84.4%), fatigue (18-76.3%), and "being informed about benefits and side-effects of treatment" (4-66.7%). The most commonly identified unmet needs for informal caregivers were information needs, including illness and treatment information (26-100%) and care-related information (21-100%). Unmet needs of patients with advanced cancer were associated with their physical symptoms, anxiety, and quality of life. The most commonly used instruments for needs assessment among patients with advanced cancer were the Supportive Care Needs Survey (N = 8) and Problems and Needs in Palliative Care questionnaire (N = 5). The majority of the included studies investigated unmet needs from the perspectives of either patients or caregivers with a cross-sectional study design using single time-point assessments. Moreover, significant heterogeneity, including differences in study contexts, assessment methods, instruments for measurement, need classifications, and reporting methods, were identified across studies. CONCLUSION Both advanced cancer patients and informal caregivers reported a wide range of context-bound unmet needs. Examining their unmet needs on the basis of viewing patients and their informal caregivers as a whole unit will be highly optimal. Unmet care needs should be comprehensively evaluated from the perspectives of all stakeholders and interpreted by using rigorously designed mixed methods research and longitudinal studies within a given context.
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Affiliation(s)
- Tao Wang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Betty Pui Man Chung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jing-Yu Tan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
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Abstract
Cutaneous melanoma derives from the tumoral transformation of melanocytes. These pigmented cells produce melanin prior transmitting it to the surrounding keratinocytes of the skin, hair and mane. The main function of melanin is to protect cells and their DNA from damage caused by ultraviolet light. Melanoma is the most aggressive skin cancer whose incidence has increased steadily in recent decades. Advances in basic research have resulted in a better understanding of the molecular and cellular events responsible for the initiation and progression of melanomas. In this review, we present an overview of the knowledge gained in recent years and show how recent advances lead to new targeted and more efficient therapeutic approaches.
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Affiliation(s)
- Franck Gesbert
- Institut Curie, Paris Sciences et Lettres (PSL) Research University, Inserm U1021, Développement normal et pathologique des mélanocytes, 91405 Orsay, France - Univ Paris-Sud, Univ Paris-Saclay, CNRS UMR3347, 91405 Orsay, France - Équipe labellisée Ligue contre le cancer, 91405 Orsay, France
| | - Lionel Larue
- Institut Curie, Paris Sciences et Lettres (PSL) Research University, Inserm U1021, Développement normal et pathologique des mélanocytes, 91405 Orsay, France - Univ Paris-Sud, Univ Paris-Saclay, CNRS UMR3347, 91405 Orsay, France - Équipe labellisée Ligue contre le cancer, 91405 Orsay, France
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Safford BH. How Service Agreements Can Improve Referrals and Shrink the Medical Neighborhood. Fam Pract Manag 2018; 25:18-22. [PMID: 30221919] [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: 06/08/2023]
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Zupanic E, Kåreholt I, Norrving B, Secnik J, von Euler M, Winblad B, Religa D, Kramberger MG, Johnell K, Eriksdotter M, Garcia-Ptacek S. Acute Stroke Care in Dementia: A Cohort Study from the Swedish Dementia and Stroke Registries. J Alzheimers Dis 2018; 66:185-194. [PMID: 30248059 PMCID: PMC6294591 DOI: 10.3233/jad-180653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Subscribe] [Scholar Register] [Accepted: 08/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous studies have shown that patients with dementia receive less testing and treatment for stroke. OBJECTIVES Our aim was to investigate hospital management of acute ischemic stroke in patients with and without dementia. METHODS Retrospective analysis of prospectively collected data 2010-2014 from the Swedish national dementia registry (SveDem) and the Swedish national stroke registry (Riksstroke). Patients with dementia who suffered an acute ischemic stroke (AIS) (n = 1,356) were compared with matched non-dementia AIS patients (n = 6,755). Outcomes included length of stay in a stroke unit, total length of hospitalization, and utilization of diagnostic tests and assessments. RESULTS The median age at stroke onset was 83 years. While patients with dementia were equally likely to be directly admitted to a stroke unit as their non-dementia counterparts, their stroke unit and total hospitalization length were shorter (10.5 versus 11.2 days and 11.6 versus 13.5, respectively, p < 0.001). Dementia patients were less likely to receive carotid ultrasound (OR 0.36, 95% CI [0.30-0.42]) or undergo assessments by the interdisciplinary team members (physiotherapists, speech therapists, occupational therapists; p < 0.05 for all adjusted models). However, a similar proportion of patients received CT imaging (97.4% versus 98.6%, p = 0.001) and a swallowing assessment (90.7% versus 91.8%, p = 0.218). CONCLUSIONS Patients with dementia who suffer an ischemic stroke have equal access to direct stroke unit care compared to non-dementia patients; however, on average, their stay in a stroke unit and total hospitalization are shorter. Dementia patients are also less likely to receive specific diagnostic tests and assessments by the interdisciplinary stroke team.
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Affiliation(s)
- Eva Zupanic
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ingemar Kåreholt
- Jönköping University, Institute of Gerontology, School of Health and Welfare, Aging Research network - Jönköping (ARN-J), Jönköping, Sweden
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Juraj Secnik
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - Mia von Euler
- Department of Clinical Science and Education, Södersjukhuset and Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Dorota Religa
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Milica Gregoric Kramberger
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
| | - Kristina Johnell
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
- Department of Internal Medicine, Section for Neurology, Södersjukhuset, Stockholm, Sweden
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Gray G. Next-Era Infusion Management Systems: Inherently Intelligent from the Start. Biomed Instrum Technol 2018; 52:120-124. [PMID: 29558193 DOI: 10.2345/0899-8205-52.2.120] [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: 06/08/2023]
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Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2017. J Am Med Dir Assoc 2017; 18:928-940. [PMID: 29080572 DOI: 10.1016/j.jamda.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/09/2023]
Abstract
This is the 11th annual Clinical Update from the AMDA meeting article. This year the topics covered are hypertension after the Systolic Blood Pressure Intervention Trial; chronic obstructive pulmonary disease risk factors, diagnosis and management including end-of-life planning, and the difficulties with exacerbations such as breathlessness; diagnosis and treatment of cognitive impairment and dementia; and wound care and pressure ulcer management.
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Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Katz IT, Kaplan R, Fitzmaurice G, Leone D, Bangsberg DR, Bekker LG, Orrell C. Treatment guidelines and early loss from care for people living with HIV in Cape Town, South Africa: A retrospective cohort study. PLoS Med 2017; 14:e1002434. [PMID: 29136014 PMCID: PMC5685472 DOI: 10.1371/journal.pmed.1002434] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/10/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl. METHODS AND FINDINGS We performed a retrospective cohort study of 4,025 treatment-eligible, non-pregnant PLWH accessing care in a community health center in Gugulethu Township affiliated with the Desmond Tutu HIV Centre in Cape Town. The median age of participants was 34 years (IQR 28-41 years), almost 62% were female, and the median CD4+ count was 173 cells/μl (IQR 92-254 cells/μl). Participants were stratified into 2 cohorts: an early cohort, enrolled into care at the health center from 1 January 2009 to 31 August 2011, when guidelines mandated that ART initiation required CD4+ ≤ 200 cells/μl, pregnancy, advanced clinical symptoms (World Health Organization [WHO] stage 4), or comorbidity (active tuberculosis); and a later cohort, enrolled into care from 1 September 2011 to 31 December 2013, when the treatment threshold had been expanded to CD4+ ≤ 350 cells/μl. Demographic and clinical factors were compared before and after the policy change using chi-squared tests to identify potentially confounding covariates, and logistic regression models were used to estimate the risk of pre-treatment (pre-ART) loss from care and early loss within the first 16 weeks on treatment, adjusting for age, baseline CD4+, and WHO stage. Compared with participants in the later cohort, participants in the earlier cohort had significantly more advanced disease: median CD4+ 146 cells/μl versus 214 cells/μl (p < 0.001), 61.1% WHO stage 3/4 disease versus 42.8% (p < 0.001), and pre-ART mortality of 34.2% versus 16.7% (p < 0.001). In total, 385 ART-eligible PLWH (9.6%) failed to initiate ART, of whom 25.7% died before ever starting treatment. Of the 3,640 people who started treatment, 58 (1.6%) died within the first 16 weeks in care, and an additional 644 (17.7%) were lost from care within 16 weeks of starting ART. PLWH who did start treatment in the later cohort were significantly more likely to discontinue care in <16 weeks (19.8% versus 15.8%, p = 0.002). After controlling for baseline CD4+, WHO stage, and age, this effect remained significant (adjusted odds ratio [aOR] = 1.30, 95% CI 1.09-1.55). As such, it remains unclear if early attrition from care was due to a "healthy cohort" effect or to overcrowding as programs expanded to accommodate the broader guidelines for treatment. Our findings were limited by a lack of generalizability (given that these data were from a single high-volume site where testing and treatment were available) and an inability to formally investigate the effect of crowding on the main outcome. CONCLUSIONS Over one-quarter of this ART-eligible cohort did not achieve the long-term benefits of treatment due to early mortality, ART non-initiation, or early ART discontinuation. Those who started treatment in the later cohort appeared to be more likely to discontinue care early, and this outcome appeared to be independent of CD4+ count or WHO stage. Future interventions should focus on those most at risk for early loss from care as programs continue to expand in South Africa.
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Affiliation(s)
- Ingrid T. Katz
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Richard Kaplan
- Desmond Tutu HIV Centre, University of Cape Town Medical School, Cape Town, South Africa
| | - Garrett Fitzmaurice
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts, United States of America
| | - Dominick Leone
- Ragon Institute of MGH, MIT and Harvard, Boston, Massachusetts, United States of America
| | - David R. Bangsberg
- Oregon Health & Science University–Portland State University School of Public Health, Portland, Oregon, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town Medical School, Cape Town, South Africa
| | - Catherine Orrell
- Desmond Tutu HIV Centre, University of Cape Town Medical School, Cape Town, South Africa
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Affiliation(s)
- Shane D Morrison
- Resident Physician, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine
| | - Stelios C Wilson
- Resident Physician, Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine
| | - Jesse R Smith
- Resident Physician, Section of Plastic and Reconstructive Surgery, University of Chicago Hospitals
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Affiliation(s)
- Gilbert J Burckart
- Department of Pharmacy, University of Southern California, 1540 Alcazar St., CHP-217E, Los Angeles, CA 90033, USA.
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Abstract
PURPOSE The current state of pharmacogenomics education for pharmacy students and practitioners is discussed, and resources and strategies to address persistent challenges in this area are reviewed. SUMMARY Consensus-based pharmacist competencies and guidelines have been published to guide pharmacogenomics knowledge attainment and application in clinical practice. Pharmacogenomics education is integrated into various pharmacy school courses and, increasingly, into Pharm.D. curricula in the form of required standalone courses. Continuing-education programs and a limited number of postgraduate training opportunities are available to practicing pharmacists. For colleges and schools of pharmacy, identifying the optimal structure and content of pharmacogenomics education remains a challenge; insufficient numbers of faculty members with pharmacogenomics expertise and the inadequate availability of practice settings for experiential education are other limiting factors. Strategies for overcoming those challenges include providing early exposure to pharmacogenomics through foundational courses and incorporating pharmacogenomics into practice-based therapeutics courses and introductory and advanced pharmacy practice experiences. For practitioner education, online resources, clinical decision support-based tools, and certificate programs can be used to supplement structured postgraduate training in pharmacogenomics. Recently published data indicate successful use of "shared curricula" and participatory education models involving opportunities for learners to undergo personal genomic testing. CONCLUSION The pharmacy profession has taken a leadership role in expanding student and practitioner education to meet the demand for increased pharmacist involvement in precision medicine initiatives. Effective approaches to teaching pharmacogenomics knowledge and driving its appropriate application in clinical practice are increasingly available.
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Affiliation(s)
- Kristin Wiisanen Weitzel
- Personalized Medicine Program, UF Health, Gainesville, FL
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO
| | - Samuel Johnson
- Government and Professional Affairs, American College of Clinical Pharmacy, Washington, DC
| | - David F Kisor
- Department of Pharmaceutical Sciences, Manchester University College of Pharmacy, Natural and Health Sciences, Fort Wayne, IN
| | - Philip E Empey
- Department of Pharmacy and Therapeutics, School of Pharmacy and Institute for Precision Medicine, University of Pittsburgh, Pittsburgh, PA.
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