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Burden M, Keniston A, Pell J, Yu A, Dyrbye L, Kannampallil T. Unlocking inpatient workload insights with electronic health record event logs. J Hosp Med 2024. [PMID: 38704753 DOI: 10.1002/jhm.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan Pell
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy Yu
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Liselotte Dyrbye
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine, St Louis, Missouri, USA
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Medeiros P, Koebel J, Yu A, Kazemi M, Nicholson V, Frank P, Persad Y, O'Brien N, Bertozzi B, Smith S, Ndung'u M, Fraleigh A, Gagnier B, Cardinal C, Webster K, Sanchez M, Lee M, Lacombe-Duncan A, Logie CH, Gormley R, de Pokomandy A, Kaida A, Loutfy MR. Experiences and resultant care gaps among women with HIV in Canada: concept mapping the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) findings. BMJ Open 2024; 14:e078833. [PMID: 38569698 DOI: 10.1136/bmjopen-2023-078833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES The community-based, longitudinal, Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) explored the experiences of women with HIV in Canada over the past decade. CHIWOS' high-impact publications document significant gaps in the provision of healthcare to women with HIV. We used concept mapping to analyse and present a summary of CHIWOS findings on women's experiences navigating these gaps. DESIGN Concept mapping procedures were performed in two steps between June 2019 and March 2021. First, two reviewers (AY and PM) independently reviewed CHIWOS manuscripts and conference abstracts written before 1 August 2019 to identify main themes and generate individual concept maps. Next, the preliminary results were presented to national experts, including women with HIV, to consolidate findings into visuals summarising the experiences and care gaps of women with HIV in CHIWOS. SETTING British Columbia, Ontario and Quebec, Canada. PARTICIPANTS A total of 18 individual CHIWOS team members participated in this study including six lead investigators of CHIWOS and 12 community researchers. RESULTS Overall, a total of 60 peer-reviewed manuscripts and conference abstracts met the inclusion criteria. Using concept mapping, themes were generated and structured through online meetings. In total, six composite concept maps were co-developed: quality of life, HIV care, psychosocial and mental health, sexual health, reproductive health, and trans women's health. Two summary diagrams were created encompassing the concept map themes, one for all women and one specific to trans women with HIV. Through our analysis, resilience, social support, positive healthy actions and women-centred HIV care were highlighted as strengths leading to well-being for women with HIV. CONCLUSIONS Concept mapping resulted in a composite summary of 60 peer-reviewed CHIWOS publications. This activity allows for priority setting to optimise care and well-being for women with HIV.
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Affiliation(s)
- Priscilla Medeiros
- Women's College Hospital, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Jill Koebel
- Women's College Hospital, Toronto, Ontario, Canada
| | - Amy Yu
- Women's College Hospital, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Hospital, Toronto, Ontario, Canada
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Peggy Frank
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Nadia O'Brien
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Mary Ndung'u
- Women's College Hospital, Toronto, Ontario, Canada
| | | | | | - Claudette Cardinal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - A Lacombe-Duncan
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Mona R Loutfy
- Medicine, University of Toronto, Toronto, Ontario, Canada
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Yu A, Gao H, Ma Y, Li J, Zhang H. Feasibility study of the multishot gradient-echo planar imaging sequence in non-enhanced and free-breathing whole-heart magnetic resonance coronary angiography. Clin Radiol 2024; 79:e539-e545. [PMID: 38160106 DOI: 10.1016/j.crad.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 11/22/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
AIM To investigate the feasibility of non-enhanced and free-breathing whole-heart magnetic resonance coronary angiography (MRCA) using multishot gradient-echo planar imaging (MSG-EPI). MATERIALS AND METHODS In total, 29 healthy volunteers were recruited for free-breathing whole-heart MRCA acquisition using the MSG-EPI sequence and fast gradient echo (GRE) sequence. After the examination, the actual scanning times, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the left main (LM) coronary artery, subjective quality scores for each segment, and evaluable length of the coronary artery were recorded and statistically analysed. RESULTS There was no significant difference between the SNRLM of the MSG-EPI sequence and fast GRE sequence (p=0.130), but the CNRLM of the MSG-EPI sequence was higher (p=0.001). The subjective quality score of the mid- and distal left anterior descending branch as well as the distal circumflex branch of the coronary artery in the MSG-EPI sequence was higher than that in the fast GRE sequence (p=0.003, 0.001, and 0.003, respectively). The evaluable length of the left anterior descending branch and the circumflex branch was better using the MSG-EPI sequence than that of the fast GRE sequence (p=0.015 and < 0.001, respectively). Moreover, the scanning time of the MSG-EPI sequence was 54.5% less than that of the fast GRE sequence (p<0.001). CONCLUSION The MSG-EPI sequence improves the subjective and objective image quality of MRCA as well as reduces the scanning time.
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Affiliation(s)
- A Yu
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China
| | - H Gao
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China
| | - Y Ma
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China
| | - J Li
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China
| | - H Zhang
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China.
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Levine L, Son J, Yu A, Wesley S, De Jager PL, Moynihan E, Farber RS, Rosser M, Haque H, Riley CS. Inflammatory vaginitis in four B-cell suppressed women with Multiple Sclerosis. Mult Scler Relat Disord 2024; 82:105387. [PMID: 38134606 DOI: 10.1016/j.msard.2023.105387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
B-cell depleting therapies are effective in multiple sclerosis (MS) and are widely used (Hauser et al., 2017). Inflammatory vaginitis (IV), characterized by unexplained vaginal symptoms including mucopurulent discharge, pain, irritation, and dyspareunia, has been reported in one MS patient on ocrelizumab (Filikci and Jensen, 2022), and to be present in 3.5 % of women on rituximab for autoimmune diseases (Yockey et al., 2021). We report here four cases of IV in B cell depleted women with MS. B-cell reconstitution was temporally associated with improvement of IV symptoms. Further investigation and vigilance for this potential treatment emergent adverse event affecting sexual and reproductive health of women with MS is needed.
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Affiliation(s)
- Libby Levine
- Department of Neurology, Columbia University Irving Medical Center, USA
| | - Jiyeon Son
- Department of Neurology, Columbia University Irving Medical Center, USA
| | - Amy Yu
- Baptist Health South Florida, Marcus Neuroscience Institute, USA
| | - Sarah Wesley
- Department of Neurology, Columbia University Irving Medical Center, USA
| | - Philip L De Jager
- Department of Neurology, Columbia University Irving Medical Center, USA
| | - Erin Moynihan
- Department of Neurology, Columbia University Irving Medical Center, USA
| | | | - Mary Rosser
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, USA
| | - Hoosna Haque
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, USA
| | - Claire S Riley
- Department of Neurology, Columbia University Irving Medical Center, USA.
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Yu A, Chopra V, Mueller SK, Wray CM, Jones CD. Engineering safe care journeys: Reenvisioning interhospital transfers. J Hosp Med 2024. [PMID: 38193639 DOI: 10.1002/jhm.13266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Amy Yu
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Vineet Chopra
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stephanie K Mueller
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Charlie M Wray
- Department of Medicine, University of California, San Francisco, California, USA
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Christine D Jones
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado, USA
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Heran M, Lindsay P, Gubitz G, Yu A, Ganesh A, Lund R, Arsenault S, Bickford D, Derbyshire D, Doucette S, Ghrooda E, Harris D, Kanya-Forstner N, Kaplovitch E, Liederman Z, Martiniuk S, McClelland M, Milot G, Minuk J, Otto E, Perry J, Schlamp R, Tampieri D, van Adel B, Volders D, Whelan R, Yip S, Foley N, Smith EE, Dowlatshahi D, Mountain A, Hill MD, Martin C, Shamy M. Canadian Stroke Best Practice Recommendations: Acute Stroke Management, 7 th Edition Practice Guidelines Update, 2022. Can J Neurol Sci 2024; 51:1-31. [PMID: 36529857 DOI: 10.1017/cjn.2022.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The 2022 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for Acute Stroke Management, 7th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by an interdisciplinary team of healthcare providers and system planners caring for persons with an acute stroke or transient ischemic attack. These recommendations are a timely opportunity to reassess current processes to ensure efficient access to acute stroke diagnostics, treatments, and management strategies, proven to reduce mortality and morbidity. The topics covered include prehospital care, emergency department care, intravenous thrombolysis and endovascular thrombectomy (EVT), prevention and management of inhospital complications, vascular risk factor reduction, early rehabilitation, and end-of-life care. These recommendations pertain primarily to an acute ischemic vascular event. Notable changes in the 7th edition include recommendations pertaining the use of tenecteplase, thrombolysis as a bridging therapy prior to mechanical thrombectomy, dual antiplatelet therapy for stroke prevention, the management of symptomatic intracerebral hemorrhage following thrombolysis, acute stroke imaging, care of patients undergoing EVT, medical assistance in dying, and virtual stroke care. An explicit effort was made to address sex and gender differences wherever possible. The theme of the 7th edition of the CSBPR is building connections to optimize individual outcomes, recognizing that many people who present with acute stroke often also have multiple comorbid conditions, are medically more complex, and require a coordinated interdisciplinary approach for optimal recovery. Additional materials to support timely implementation and quality monitoring of these recommendations are available at www.strokebestpractices.ca.
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Affiliation(s)
- Manraj Heran
- Division of Neuroradiology, University of British Columbia, Vancouver, Canada
| | | | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Stroke Program, Halifax, Canada
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - Amy Yu
- Division of Neurology, Department of Medicine, and Regional Stroke Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Aravind Ganesh
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Rebecca Lund
- Heart and Stroke Foundation of Canada, Toronto, Canada
| | - Sacha Arsenault
- Stroke Services BC, Provincial Health Systems Authority, Vancouver, Canada
| | - Doug Bickford
- London Health Sciences Centre, London, Canada (Previous Appointment at Time of Participation)
| | - Donnita Derbyshire
- Saskatchewan College of Paramedics, Paramedic Practice Committee, Saskatoon, Canada
| | - Shannon Doucette
- Enhanced District Stroke Program, Royal Victoria Regional Health Centre, Barrie, Canada (Previous Appointment at Time of Participation)
| | - Esseddeeg Ghrooda
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Devin Harris
- Quality and Patient Safety Division, Interior Health, Kelowna, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Nick Kanya-Forstner
- Northern Ontario School of Medicine, Sudbury, Canada
- Timmins & District Hospital, Timmins, Canada
| | - Eric Kaplovitch
- Faculty of Medicine, University of Toronto, Toronto, Canada
- University Health Network, Department of Medicine (Hematology), Toronto, Canada
| | - Zachary Liederman
- Faculty of Medicine, University of Toronto, Toronto, Canada
- University Health Network, Department of Medicine (Hematology), Toronto, Canada
| | - Shauna Martiniuk
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Schwartz-Reisman Emergency Centre, Mount Sinai Hospital, Toronto, Canada
| | | | - Genevieve Milot
- Department of Surgery, Laval University, Quebec City, Canada
| | - Jeffrey Minuk
- Division of Neurology, The Integrated Health and Social Services, University Network for West Central Montreal, Montreal, Canada
| | - Erica Otto
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Jeffrey Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Rob Schlamp
- British Columbia Emergency Health Services, Vancouver, Canada
| | | | - Brian van Adel
- Department of Neurointerventional Surgery, McMaster University, Hamilton, Canada
| | - David Volders
- Department of Radiology, Dalhousie University, Halifax, Canada
| | - Ruth Whelan
- Royal University Hospital Stroke Program, Saskatoon, Canada
| | - Samuel Yip
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Norine Foley
- WorkHORSE Consulting Group, Epidemiology, London, Canada
| | - Eric E Smith
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Dar Dowlatshahi
- Department of Neurology, University of Ottawa, Ottawa, Canada
| | - Anita Mountain
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Rehabilitation Centre Site, Halifax, Canada
| | - Michael D Hill
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Chelsy Martin
- Heart and Stroke Foundation of Canada, Toronto, Canada
| | - Michel Shamy
- Department of Neurology, University of Ottawa, Ottawa, Canada
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Jones CD, Moss A, Sevick C, Roczen M, Sterling MR, Portz J, Lum HD, Yu A, Urban JA, Khazanie P. Factors Associated With Mortality and Hospice Use Among Medicare Beneficiaries With Heart Failure Who Received Home Health Services. J Card Fail 2023:S1071-9164(23)00921-1. [PMID: 38142043 DOI: 10.1016/j.cardfail.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Although many Medicare beneficiaries with heart failure (HF) are discharged with home health services, little is known about mortality rates and hospice use in this group. OBJECTIVES To identify risk factors for 6-month mortality and hospice use among patients hospitalized due to HF who receive home health care, which could inform efforts to improve palliative and hospice use for these patients. METHODS A retrospective cohort analysis was conducted in a 100% national sample of Medicare fee-for-service beneficiaries with HF who were discharged to home health care between 2017 and 2018. Multivariable Cox regression models examined factors associated with 6-month mortality, and multivariable logistic regression models examined factors associated with hospice use at the time of death. RESULTS A total of 285,359 Medicare beneficiaries were hospitalized with HF and discharged with home health care; 15.5% (44,174) died within 6 months. Variables most strongly associated with mortality included: age > 85 years (hazard ratio [HR] 1.66, 95% CI 1.61-1.71), urgent/emergency hospital admission (HR 1.68, 1.61-1.76), and "serious" condition compared to "stable" condition (HR 1.64, CI 1.52-1.78). Among 44,174 decedents, 48.2% (21,284) received hospice care at the time of death. Those with lower odds of hospice use at death included patients who were: < 65 years (odds ratio [OR] 0.65, CI 0.59-0.72); of Black (OR 0.64, CI 0.59-0.68) or Hispanic race/ethnicity (OR 0.79, CI 0.72-0.88); and Medicaid-eligible (OR 0.80, CI 0.76-0.85). CONCLUSIONS Although many patients hospitalized for HF are at risk of 6-month mortality and may benefit from palliative and/or hospice services, our findings indicate under-use of hospice care and important disparities in hospice use by race/ethnicity and socioeconomic status.
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Affiliation(s)
- Christine D Jones
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO; Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO; Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Division of Geriatrics, Department of Medicine, University of Colorado, Aurora, CO.
| | - Angela Moss
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Carter Sevick
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | | | - Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine at Weill Cornell Medicine, New York, NY
| | - Jennifer Portz
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Hillary D Lum
- Division of Geriatrics, Department of Medicine, University of Colorado, Aurora, CO
| | - Amy Yu
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Jacqueline A Urban
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Prateeti Khazanie
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO
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Murphy MR, Ramadei A, Doymaz A, Varriano S, Natelson D, Yu A, Aktas S, Mazzeo M, Mazzeo M, Zakusilo G, Kleiman F. Long non-coding RNA generated from CDKN1A gene by alternative polyadenylation regulates p21 expression during DNA damage response. Nucleic Acids Res 2023; 51:11911-11926. [PMID: 37870464 PMCID: PMC10681730 DOI: 10.1093/nar/gkad899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 09/21/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023] Open
Abstract
Alternative Polyadenylation (APA) is an emerging mechanism for dynamic changes in gene expression. Previously, we described widespread APA occurrence in introns during the DNA damage response (DDR). Here, we show that a DDR-activated APA event occurs in the first intron of CDKN1A, inducing an alternate last exon-containing lncRNA. We named this lncRNA SPUD (Selective Polyadenylation Upon DNA Damage). SPUD localizes to polysomes in the cytoplasm and is detectable as multiple isoforms in available high-throughput studies. SPUD has low abundance compared to the CDKN1A full-length isoform under non-stress conditions, and SPUD is induced in cancer and normal cells under a variety of DNA damaging conditions in part through p53. The RNA binding protein HuR binds to and promotes the stability of SPUD precursor RNA. SPUD induction increases p21 protein, but not mRNA levels, affecting p21 functions in cell-cycle, CDK2 expression and cell growth. Like CDKN1A full-length isoform, SPUD can bind two competitive p21 translational regulators, the inhibitor calreticulin and the activator CUGBP1; SPUD alters their association with CDKN1A full-length in a DDR-dependent manner, promoting CDKN1A translation. Together, these results show a new regulatory mechanism by which a lncRNA controls p21 expression post-transcriptionally, highlighting lncRNA relevance in DDR progression and cell-cycle.
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Affiliation(s)
- Michael R Murphy
- Chemistry Department, Hunter College, The City University of New York, New York, NY 10021, USA
- Biology Program, The Graduate Center, The City University of New York, New York, NY 10016, USA
| | - Anthony Ramadei
- Chemistry Department, Hunter College, The City University of New York, New York, NY 10021, USA
- Biology Program, The Graduate Center, The City University of New York, New York, NY 10016, USA
| | - Ahmet Doymaz
- Chemistry Department, Hunter College, The City University of New York, New York, NY 10021, USA
| | - Sophia Varriano
- Chemistry Department, Hunter College, The City University of New York, New York, NY 10021, USA
- Biology Program, The Graduate Center, The City University of New York, New York, NY 10016, USA
| | - Devorah M Natelson
- Chemistry Department, Hunter College, The City University of New York, New York, NY 10021, USA
- Biology Program, The Graduate Center, The City University of New York, New York, NY 10016, USA
| | - Amy Yu
- Chemistry Department, Hunter College, The City University of New York, New York, NY 10021, USA
| | - Sera Aktas
- Chemistry Department, Hunter College, The City University of New York, New York, NY 10021, USA
| | - Marie Mazzeo
- Chemistry Department, Hunter College, The City University of New York, New York, NY 10021, USA
| | - Michael Mazzeo
- Chemistry Department, Hunter College, The City University of New York, New York, NY 10021, USA
| | - George Zakusilo
- Chemistry Department, Hunter College, The City University of New York, New York, NY 10021, USA
| | - Frida E Kleiman
- Chemistry Department, Hunter College, The City University of New York, New York, NY 10021, USA
- Biology Program, The Graduate Center, The City University of New York, New York, NY 10016, USA
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Yu A, Ha NB, Shi B, Cheng YW, Mahadevan U, Beck KR. Real-World Experience With Tofacitinib Dose De-Escalation in Patients With Moderate and Severe Ulcerative Colitis. Clin Gastroenterol Hepatol 2023; 21:3115-3124.e3. [PMID: 37187323 DOI: 10.1016/j.cgh.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/20/2023] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND & AIMS Tofacitinib is associated with sustained steroid-free remission in patients with ulcerative colitis (UC), with the lowest effective dose recommended for maintenance therapy. However, there are limited real-world data to guide decisions on the optimal maintenance regimen. We aimed to evaluate predictors and outcomes of disease activity after tofacitinib dose de-escalation in this population. METHODS Included were adults with moderate-severe UC treated with tofacitinib between June 2012 and January 2022. The primary outcome was evidence of UC disease activity-related events: hospitalization/surgery, corticosteroid initiation, tofacitinib dose increase, or therapy switch. RESULTS Among 162 patients, 52% continued 10 mg twice daily while 48% underwent dose de-escalation to 5 mg twice daily. Cumulative incidence rates of UC events at 12 months were similar in patients with and without dose de-escalation (56% vs 58%; P = .81). In univariable Cox regression among patients with dose de-escalation, an induction course with 10 mg twice daily for more than 16 weeks was protective of UC events (hazard ratio [HR], 0.37; 95% CI, 0.16-0.85) while ongoing severe disease (Mayo 3) was associated with UC events (HR, 6.41; 95% 95% CI, 2.23-18.44), which remained significant after adjusting for age, sex, duration of induction course, and corticosteroid use at dose de-escalation (HR, 6.05; 95% CI, 2.00-18.35). Twenty-nine percent of patients with UC events had their dose re-escalated to 10 mg twice daily, with only 63% able to recapture clinical response at 12 months. CONCLUSIONS In this real-world cohort, we observed a 56% cumulative incidence of UC events at 12 months in patients with tofacitinib dose de-escalation. Observed factors associated with UC events after dose de-escalation included induction course for fewer than 16 weeks and active endoscopic disease 6 months after initiation.
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Affiliation(s)
- Amy Yu
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California
| | - Nghiem B Ha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California
| | - Bingyan Shi
- Internal Medicine, Department of Medicine, University of California, San Francisco, California
| | - Yao-Wen Cheng
- Department of Gastroenterology, Santa Clara Homestead Medical Center, The Permanente Medical Group, Santa Clara, California
| | - Uma Mahadevan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California; Colitis and Crohn's Disease Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California
| | - Kendall R Beck
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California; Colitis and Crohn's Disease Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California.
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10
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Barghouth PG, Melemenidis S, Montay-Gruel P, Ollivier J, Viswanathan V, Jorge PG, Soto LA, Lau BC, Sadeghi C, Edlabadkar A, Zhang R, Ru N, Baulch JE, Manjappa R, Wang J, Le Bouteiller M, Surucu M, Yu A, Bush K, Skinner L, Maxim PG, Loo BW, Limoli CL, Vozenin MC, Frock RL. FLASH-RT does not affect chromosome translocations and junction structures beyond that of CONV-RT dose-rates. Radiother Oncol 2023; 188:109906. [PMID: 37690668 PMCID: PMC10591966 DOI: 10.1016/j.radonc.2023.109906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND PURPOSE The impact of radiotherapy (RT) at ultra high vs conventional dose rate (FLASH vs CONV) on the generation and repair of DNA double strand breaks (DSBs) is an important question that remains to be investigated. Here, we tested the hypothesis as to whether FLASH-RT generates decreased chromosomal translocations compared to CONV-RT. MATERIALS AND METHODS We used two FLASH validated electron beams and high-throughput rejoin and genome-wide translocation sequencing (HTGTS-JoinT-seq), employing S. aureus and S. pyogenes Cas9 "bait" DNA double strand breaks (DSBs) in HEK239T cells, to measure differences in bait-proximal repair and their genome-wide translocations to "prey" DSBs generated after various irradiation doses, dose rates and oxygen tensions (normoxic, 21% O2; physiological, 4% O2; hypoxic, 2% and 0.5% O2). Electron irradiation was delivered using a FLASH capable Varian Trilogy and the eRT6/Oriatron at CONV (0.08-0.13 Gy/s) and FLASH (1x102-5x106 Gy/s) dose rates. Related experiments using clonogenic survival and γH2AX foci in the 293T and the U87 glioblastoma lines were also performed to discern FLASH-RT vs CONV-RT DSB effects. RESULTS Normoxic and physioxic irradiation of HEK293T cells increased translocations at the cost of decreasing bait-proximal repair but were indistinguishable between CONV-RT and FLASH-RT. Although no apparent increase in chromosome translocations was observed with hypoxia-induced apoptosis, the combined decrease in oxygen tension with IR dose-rate modulation did not reveal significant differences in the level of translocations nor in their junction structures. Furthermore, RT dose rate modality on U87 cells did not change γH2AX foci numbers at 1- and 24-hours post-irradiation nor did this affect 293T clonogenic survival. CONCLUSION Irrespective of oxygen tension, FLASH-RT produces translocations and junction structures at levels and proportions that are indistinguishable from CONV-RT.
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Affiliation(s)
- Paul G Barghouth
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Stavros Melemenidis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Pierre Montay-Gruel
- Laboratory of Radiation Oncology, Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland; Department of Radiation Oncology, University of California, Irvine, CA 92697-2695, USA
| | - Jonathan Ollivier
- Laboratory of Radiation Oncology, Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Vignesh Viswanathan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Patrik G Jorge
- Institute of Radiation Physics/CHUV, Lausanne University Hospital, Switzerland
| | - Luis A Soto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Brianna C Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Cheyenne Sadeghi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Anushka Edlabadkar
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Richard Zhang
- Department of Radiation Oncology, University of California, Irvine, CA 92697-2695, USA
| | - Ning Ru
- Department of Radiation Oncology, University of California, Irvine, CA 92697-2695, USA
| | - Janet E Baulch
- Department of Radiation Oncology, University of California, Irvine, CA 92697-2695, USA
| | - Rakesh Manjappa
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jinghui Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Marie Le Bouteiller
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Amy Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Karl Bush
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lawrie Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Peter G Maxim
- Department of Radiation Oncology, University of California, Irvine, CA 92697-2695, USA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Charles L Limoli
- Department of Radiation Oncology, University of California, Irvine, CA 92697-2695, USA
| | - Marie-Catherine Vozenin
- Laboratory of Radiation Oncology, Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Richard L Frock
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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11
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Nguyen T, Yu A. Rib Fragility Fractures and Chest Wall Hematoma After Cardiopulmonary Resuscitation Training: A Case Report. Cureus 2023; 15:e47998. [PMID: 38034174 PMCID: PMC10686782 DOI: 10.7759/cureus.47998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Fragility fractures commonly manifest as complications in individuals with diminished bone mineral density and other risk factors. The hip, vertebral body, and wrist are the most documented locations of fragility fractures among patients with osteoporosis or osteopenia. This report presents a rare case of multiple fragility fractures of the right ribs accompanied by an adjacent right chest wall hematoma in an otherwise healthy 60-year-old woman after participating in cardiopulmonary resuscitation (CPR) training. Upon further workup, a diagnosis of osteopenia was established. This report aims to underscore a potential complication in those performing CPR and outline the clinicoradiological presentations, diagnostic workup, and treatment of fragility fractures in patients with no history of prior underlying skeletal conditions or malignancy.
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Affiliation(s)
- Troy Nguyen
- College of Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Amy Yu
- Department of Radiology, Tulane University School of Medicine, New Orleans, USA
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12
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Oh N, Nakashima J, Chadha JS, Kish JA, Manley B, Pow-Sang J, Yu A, Zhang J, Spiess P, Chatwal MS, Jain R, Zemp LW, Poch M, Sexton WJ, Li R, Gilbert SM, Johnstone PAS, Torres-Roca JF, Yamoah K, Grass D. An Analysis of Patients Treated with Stereotactic Body Radiotherapy for Metastatic Urinary Tract Tumors to Identify Predictors of Response. Int J Radiat Oncol Biol Phys 2023; 117:e424-e425. [PMID: 37785392 DOI: 10.1016/j.ijrobp.2023.06.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To identify selection criteria linked to outcomes in patients treated with stereotactic body radiotherapy (SBRT) for metastatic tumors of the urinary tract (UT). MATERIALS/METHODS Single institution retrospective analysis of SBRT treated patients for oligometastatic/progressive UT tumors from 2006-2022. Charts were queried for M1 status at diagnosis or during disease course, treatment details (surgery, SBRT, systemic therapy), metabolic status (diabetes [DM], BMI) and outcomes. A linear quadratic formula was used to calculate the biologically effective dose (BED) using an α/β of 10 for tumor. Descriptive statistics portrayed the cohort, and analyses were done at patient and site level. Time-to-event analyses, including overall survival (OS) and progression-free survival (PFS) from SBRT, were assessed by the Kaplan-Meier method. Cox regression was used for univariable (UVA) and multivariable analyses (MVA) to identify predictors of outcomes. RESULTS A total of 35 patients were treated at 44 metastatic sites, including: bone (25%), node (36.4%), lung (20.5%), soft tissue (13.6%) and liver (4.5%). Most were male (74.3%) with a median age of 70 (range: 51-89), without DM (60%) having a median BMI of 29.8, and ECOG <2 (97.1%) at time of SBRT. Six (17.1%) patients were M1 at diagnosis. Of the 29 non-M1 patients, 86.2% received definitive local therapy (LT), 58.6% had at least T3/N+ disease, 75.8% received systemic therapy with a median of 2 agents (range: 1-6) prior to SBRT. Sixteen (45.7%) received immunotherapy (IO) with most receiving this before (75%) and after (56.2%) SBRT. Six patients had positive PD-L1 status (n = 10). The median RT dose, fractionation and BED was 40 Gy (range: 14-46), 5 fractions, and 72 (range: 28-132), respectively. At a median follow-up of 34.8, the median OS was 18.4 m (range: 9.3-27.4) with a 2-year OS of 35.9%. At patient level, 62.8% recurred after SBRT. The median PFS after SBRT was 5.3 m (range: 1.8-8.7) with a 2-yr PFS of 29.3%. Patient-level PFS was improved with LT (6.7 vs 1.4 m; p = 0.001) and DM (NR vs 2.9 m; p = 0.015), whereas improved OS was related with LT (18.9 vs 6.6 m; p = 0.03), DM (p = 0.04), ECOG (p = 0.004), and no relapse after SBRT (NR vs 9.8 m; p <0.001). Exposure to < 3 systemic agents prior to SBRT portended better PFS (6.7 vs 2.6 m; p = 0.04) without any impact by IO. At site level, 20.4% of sites had local relapse with 4 being the first event. Site was related with PFS (p = 0.009) with order of increased relapse risk being liver > bone > soft tissue > node > lung. No dosimetric feature was related with recurrence risk. On MVA, both DM (p = 0.02) and LT (p = 0.002) were predictive for PFS. Only recurrence after SBRT predicted for OS on MVA (HR: 6.7, 95% CI: 1.4-31; p = 0.014). In the IO subset, median PFS was 5.3 m and OS was 9.4 m, with no difference seen with IO-SBRT sequence or PDL1 status. CONCLUSION Optimized selection criteria for metastasis-directed therapy in patients with UT tumors is unclear, notably with IO. Future studies may benefit by assessing circulating tumor markers prior to SBRT.
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Affiliation(s)
- N Oh
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - J Nakashima
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - J S Chadha
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - J A Kish
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - B Manley
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - J Pow-Sang
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - A Yu
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - J Zhang
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - P Spiess
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - M S Chatwal
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - R Jain
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - L W Zemp
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - M Poch
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - W J Sexton
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - R Li
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - S M Gilbert
- H. Lee Moffitt Cancer Center and Research Institute, Department of Genitourinary Oncology, Tampa, FL
| | - P A S Johnstone
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - J F Torres-Roca
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - K Yamoah
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - D Grass
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
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Liu EY, Lin EY, Lee A, Venkat PS, Shiao JC, Wong A, Yu A, Hagio MA, Park SJ, Demanes J, Chang AJ. High-Dose Rate Brachytherapy Alone for Treatment of Unfavorable Intermediate Risk Prostate Cancer: A Propensity-Score Matched Analysis. Int J Radiat Oncol Biol Phys 2023; 117:e408-e409. [PMID: 37785355 DOI: 10.1016/j.ijrobp.2023.06.1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To demonstrate the feasibility of high-dose rate brachytherapy (HDR BT) as monotherapy for unfavorable intermediate risk (UIR) prostate cancer by comparing survival outcomes of HDR BT alone against external beam radiation therapy (EBRT) + HDR BT boost, +/- androgen deprivation therapy (ADT) using propensity-score matched (PSM) data. MATERIALS/METHODS This retrospective study queried two data registries collecting patient data from 1991 to present. 633 patients with UIR prostate cancer treated with HDR BT alone, HDR BT+EBRT or HDR+EBRT+ADT were included. HDR BT patients received 42-45Gy/6 fractions (fx) or 27 Gy/2 fx. For HDR BT+EBRT, the HDR dose was 20-24 Gy/2 fx, 24 Gy/4 fx, or 15 Gy/1 fx. EBRT patients received 45 Gy/25 fx to the prostate +/- pelvic nodes. GU/GI toxicities were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Time-to-event analyses were carried out to evaluate the relationship between treatments and five primary endpoints of interest: freedom from biochemical recurrence (FFBC), freedom from distant metastasis (FFDM), freedom from local failure (FFLF), cancer specific survival (CSS), and overall survival (OS) at 5 years. PSM was performed with one-to-n matching. Logistic regression was used to estimate the respective propensity scores. The five potential confounders identified were T-stage, Gleason score, pre-treatment PSA, age, and percent positive cores. Balance was checked using the standardized mean difference of covariates. Univariate and multivariate analyses were conducted on the matched data. Toxicity analysis was performed via association between a change in pre- and post-treatment GU/GI toxicity status and the treatment group, as well as incidence of post-treatment severe GI/GU toxicity (grade 3 or higher) and the treatment group. RESULTS Univariate analysis with Kaplan-Meier method and log rank test comparison between the three cohorts demonstrated no significant difference in all survival outcomes FFBC, FFDM, FFLF, CSS, OS (p = 0.15, 0.19, 0.29, 0.57, 0.28, respectively). Multivariate analysis with Cox proportional hazard regression showed no differences in HR for FFBC and OS (p = 0.95, 0.11) with addition of EBRT, or with EBRT+ADT (p = 0.17, 0.24); no fit was obtainable for FFDM, CSS, FFLF. Toxicities between the three cohorts were not significantly different when comparing post-treatment and baseline GI/GU symptoms (p = 0.53/1). No Grade 2 or 3 GI toxicities were identified, while 8%/1% HDR patients, 10%/1% HDR+EBRT patients, and 12%/2% HDR+EBRT+ADT patients experienced Grade 2/3 GU toxicities. The incidence of grade 3 or higher GU toxicities between the three groups was not significantly different (p = 0.91). CONCLUSION This propensity-score matched study demonstrates the feasibility of HDR BT alone for effective treatment of UIR prostate cancer when compared to HDR+EBRT or HDR+EBRT+ADT, while potentially minimizing the added toxicities of EBRT and the undesirable side effect profile of ADT.
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Affiliation(s)
- E Y Liu
- Department of Radiation Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - E Y Lin
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - A Lee
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - P S Venkat
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - J C Shiao
- The University of Kansas Cancer Center, Kansas City, KS
| | - A Wong
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - A Yu
- University of California, Los Angeles, Los Angeles, CA
| | - M A Hagio
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - S J Park
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - J Demanes
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - A J Chang
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
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14
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Barghouth PG, Melemenidis S, Montay-Gruel P, Ollivier J, Viswanathan V, Jorge PG, Soto LA, Lau BC, Sadeghi C, Edlabadkar A, Manjappa R, Wang J, Le Bouteiller M, Surucu M, Yu A, Bush K, Skinner L, Maxim PG, Loo BW, Limoli CL, Vozenin MC, Frock RL. FLASH-RT does not affect chromosome translocations and junction structures beyond that of CONV-RT dose-rates. bioRxiv 2023:2023.03.27.534408. [PMID: 37034651 PMCID: PMC10081175 DOI: 10.1101/2023.03.27.534408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The molecular and cellular mechanisms driving the enhanced therapeutic ratio of ultra-high dose-rate radiotherapy (FLASH-RT) over slower conventional (CONV-RT) radiotherapy dose-rate remain to be elucidated. However, attenuated DNA damage and transient oxygen depletion are among several proposed models. Here, we tested whether FLASH-RT under physioxic (4% O 2 ) and hypoxic conditions (≤2% O 2 ) reduces genome-wide translocations relative to CONV-RT and whether any differences identified revert under normoxic (21% O 2 ) conditions. We employed high-throughput rejoin and genome-wide translocation sequencing ( HTGTS-JoinT-seq ), using S. aureus and S. pyogenes Cas9 "bait" DNA double strand breaks (DSBs), to measure differences in bait-proximal repair and their genome-wide translocations to "prey" DSBs generated by electron beam CONV-RT (0.08-0.13Gy/s) and FLASH-RT (1×10 2 -5×10 6 Gy/s), under varying ionizing radiation (IR) doses and oxygen tensions. Normoxic and physioxic irradiation of HEK293T cells increased translocations at the cost of decreasing bait-proximal repair but were indistinguishable between CONV-RT and FLASH-RT. Although no apparent increase in chromosome translocations was observed with hypoxia-induced apoptosis, the combined decrease in oxygen tension with IR dose-rate modulation did not reveal significant differences in the level of translocations nor in their junction structures. Thus, Irrespective of oxygen tension, FLASH-RT produces translocations and junction structures at levels and proportions that are indistinguishable from CONV-RT.
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Affiliation(s)
- Paul G. Barghouth
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Stavros Melemenidis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Pierre Montay-Gruel
- Laboratory of Radiation Oncology, Department of Radiation Oncology. Lausanne University Hospital and University of Lausanne, Switzerland
- Department of Radiation Oncology, University of California, Irvine, CA 92697-2695, USA
| | - Jonathan Ollivier
- Laboratory of Radiation Oncology, Department of Radiation Oncology. Lausanne University Hospital and University of Lausanne, Switzerland
| | - Vignesh Viswanathan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Patrik G. Jorge
- Institute of Radiation Physics/CHUV, Lausanne University Hospital, Switzerland
| | - Luis A. Soto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Brianna C. Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Cheyenne Sadeghi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Anushka Edlabadkar
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Rakesh Manjappa
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jinghui Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Marie Le Bouteiller
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Amy Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Karl Bush
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lawrie Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Peter G. Maxim
- Department of Radiation Oncology, University of California, Irvine, CA 92697-2695, USA
| | - Billy W. Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Charles L. Limoli
- Department of Radiation Oncology, University of California, Irvine, CA 92697-2695, USA
| | - Marie-Catherine Vozenin
- Laboratory of Radiation Oncology, Department of Radiation Oncology. Lausanne University Hospital and University of Lausanne, Switzerland
| | - Richard L. Frock
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
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15
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Dirbas F, Melemenidis S, Loo B, Horst K, Graves EE, Dutt S, Viswanathan V, Lau B, Yu A. Abstract P1-10-02: FLASH-RT, ultra-high dose rate rate radiotherapy, is as effective as conventional dose rate radiotherapy in eradicating tumor in a preclinical model of breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p1-10-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Problem Statement: Radiation therapy (RT) for breast cancer (BC) can induce skin and soft tissue fibrosis, raises concerns over cardiac and pulmonary injury, is associated with higher rates of lymphedema and shoulder dysfunction with regional nodal irradiation, and significantly increases complication rates in women undergoing implant-based reconstruction due to radiation toxicity. Although these toxicities are not generally associated with higher mortality, in general, they can represent significant setbacks with respect to quality of life. These toxicities dissuade some patients from breast conservation leading to unnecessary mastectomy and can lead patients to omit reconstruction after mastectomy or choose more extensive autologous breast reconstruction. Women with implant-based reconstruction and radiotherapy have known higher rates of reconstruction failure. Purpose: Ultra-high dose rate radiation (FLASH) has been shown to induce less normal tissue toxicity, therefore if tumor control of FLASH-RT would be comparable to conventional radiotherapy (CONV) then it has the potential to lower morbidity associated with radiotherapy for breast cancer and allow overall improved outcomes. At first, we aimed to determine the effectiveness of FLASH-RT compared to CONV in eradicating small breast tumors in an orthotopic BC model using single-fraction 20 or 30Gy RT to compare effectiveness of FLASH-RT vs CONV. Methods: Radiation sensitive, syngeneic mammary tumor cell line Py117, that efficiently forms non-metastatic orthotopic tumors in C57BL/6 mice, were injected (106 cells) into the left 4th mammary fat pad. 30mm3 tumors or a range of greater volumes (200-800mm3) were irradiated with single-fraction 20 or 30Gy with a 2x2cm radiation field (~17MeV beams), exposing only 5mm of the surrounding tissue. FLASH RT was delivered with 2Gy per pulse at dose rate ~200Gy/s compared to CONV dose rate of 0.13Gy/s Results: Single-fraction 20Gy suppressed 30mm3 tumor growth until ~day 15 post-RT then regrew for both FLASH and CONV, while 30mm3 tumors were eradicated with both FLASH and CONV at 30Gy. Larger tumors irradiated with 30Gy regressed until ~day 12 post-RT then regrew for both FLASH and CONV. There was no significant difference in growth suppression or tumor eradication between FLASH and CONV in any cohort. Conclusion: In this murine model of breast cancer, FLASH is as effective as CONV in controlling tumor growth. Future studies will extend the evaluation of the tumor control using clinically relevant fractionated dose schedules to be followed by comparisons of tumor control in xenograft models. Additional studies will assess normal tissue toxicity of FLASH vs CONV in murine models of implant-based breast reconstruction. We have established collaborations to understand differences in molecular pathways activated by FLASH vs CONV in tumor and normal tissue to explain the observed experimental differences in normal tissue, tumor, and cancer stem cells.
Citation Format: Frederick Dirbas, Stavros Melemenidis, Bill Loo, Kathleen Horst, Edward E. Graves, Suparna Dutt, Vignesh Viswanathan, Brianna Lau, Amy Yu. FLASH-RT, ultra-high dose rate rate radiotherapy, is as effective as conventional dose rate radiotherapy in eradicating tumor in a preclinical model of breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-10-02.
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Affiliation(s)
| | | | - Bill Loo
- 3Stanford University School of Medicine, Stanford, California
| | | | | | - Suparna Dutt
- 6Stanford University School of Medicine, Stanford, California
| | | | - Brianna Lau
- 8Stanford University School of Medicine, Stanford, California
| | - Amy Yu
- 9Stanford University, Palo Alto, California
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Yue F, Yu B, Zhang L, Yu A, Wang C, Xu Z, Wei K. A controlled forearm washing ex vivo method for assessing the impact of personal cleansing products on skin's acid mantle properties and antimicrobial defense against transient bacteria. Int J Cosmet Sci 2023. [PMID: 36756663 DOI: 10.1111/ics.12840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND An important trend in the personal care industry involves the development of advanced personal cleaning products that not only provide skin mildness but support skin's acid mantle properties and skin's natural antimicrobial defense function. OBJECTIVE The objective of this study was to develop a controlled forearm washing ex vivo method for assessing the impact of personal cleansing products on skin's acid mantle properties and antimicrobial defense against transient bacteria. METHODS We developed a controlled forearm washing ex vivo method (ex vivo NET method) to compare the impact of two representative personal cleansing products on skin's acid mantle properties and antimicrobial defense against transient bacteria: one was a low pH skin cleanser, and the other was a high pH soap cleanser. Skin pH was measured at baseline and four hours after the product application. Concurrently, D-squame tape stripping procedure was followed to sample the stratum corneum surface layers. Then, two selected transient bacteria: S.aureus and E.coli, were inoculated onto the D-Squame tapes and incubated under controlled conditions, respectively. The residual bacteria counts can provide an objective measure of skin's acid mantle properties against transient bacteria. Results from the ex vivo NET method were compared with the traditional in vivo cup-scrub RET method. RESULTS The skin pH was significantly lower four hours after washing the forearm with the low pH cleanser vs. the high pH soap, consistent with literatures. Interestingly, the skin surface washed by the low pH cleanser showed significantly higher hostility against representative transient bacteria as demonstrated by the lower counts of S. aureus by 1.09log and E. coli by 0.6log vs. the high pH soap based on the ex vivo NET method. Results from the ex vivo NET method was further supported by the traditional in vivo RET method which also showed the skin washed by the low pH cleanser had significantly lower counts of S. aureus and E. coli vs. the high pH soap. CONCLUSIONS The skin's acid mantle properties and antimicrobial defense can be directly impacted by the personal cleansing products. The low pH skin cleanser works better than the high pH soap for supporting skin's acid mantle properties and antimicrobial defense against transient bacteria. Results from the ex vivo NET method are consistent with the in vivo RET method. It is important that the ex vivo NET method offers many advantages since it is quicker to run with higher throughput and has better safety without the constraint of inoculating harmful microorganisms onto the human subjects.
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Affiliation(s)
- Feng Yue
- Procter and Gamble, Beijing Innovation Center, China
| | - Betty Yu
- Procter and Gamble, Beijing Innovation Center, China
| | - Lesheng Zhang
- Procter and Gamble, Beijing Innovation Center, China
| | - Amy Yu
- Procter and Gamble, Beijing Innovation Center, China
| | - Caroline Wang
- Procter and Gamble, Singapore Innovation Center, Singapore
| | - Zigang Xu
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, China
| | - Karl Wei
- Procter and Gamble, Mason Business Center, Mason, Ohio, USA
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Todd CM, Yu A, Lay C, Lagman-Bartolome AM. Effect of testosterone therapy on migraine frequency and disability in two transgender patients: a case report. BMJ Case Rep 2023; 16:e251895. [PMID: 36693705 PMCID: PMC9884870 DOI: 10.1136/bcr-2022-251895] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
With an increasing number of patients seeking gender-affirming hormone therapy (GAHT), the clinical impact of testosterone treatments on headache needs to be determined. Our case report looks at the potential effect of testosterone on migraine among transgender patients. We present two transmasculine patients who used masculinising hormone therapy with testosterone. Both patients described their headache as moderate-to-severe pain with features that fulfilled the criteria for chronic migraine without aura. Following GAHT, one patient improved in both frequency and intensity of headache symptoms while the other noted improvement in headache intensity alone. Our report postulates that testosterone therapy may have a positive impact on headaches in individuals participating in GAHT, highlighting the need for further research on the role of testosterone therapy on headache in transmasculine individuals.
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Affiliation(s)
- Candice Marie Todd
- Centre for Headache, Women's College Hospital, Toronto, Ontario, Canada
- Division of Neurology, Adult Neurology Fellowship Program, University of Toronto, Toronto, Ontario, Canada
| | - Amy Yu
- Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Lay
- Centre for Headache, Women's College Hospital, Toronto, Ontario, Canada
| | - Ana Marissa Lagman-Bartolome
- Centre for Headache, Women's College Hospital, Toronto, Ontario, Canada
- Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
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18
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Murphy MR, Ramadei A, Doymaz A, Varriano S, Natelson D, Yu A, Aktas S, Mazzeo M, Mazzeo M, Zakusilo G, Kleiman FE. Long Non-Coding RNA Generated from CDKN1A Gene by Alternative Polyadenylation Regulates p21 Expression during DNA Damage Response. bioRxiv 2023:2023.01.10.523318. [PMID: 36711808 PMCID: PMC9882041 DOI: 10.1101/2023.01.10.523318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Alternative Polyadenylation (APA) is an emerging mechanism for dynamic changes in gene expression. Previously, we described widespread APA occurrence in introns during the DNA damage response (DDR). Here, we show that a DNA damage activated APA event occurs in the first intron of CDKN1A , inducing an alternate last exon (ALE)-containing lncRNA. We named this lncRNA SPUD (Selective Polyadenylation Upon Damage). SPUD localizes to polysomes in the cytoplasm and is detectable as multiple isoforms in available high throughput studies. SPUD has low abundance compared to the CDKN1A full-length isoform and is induced in cancer and normal cells under a variety of DNA damaging conditions in part through p53 transcriptional activation. RNA binding protein (RBP) HuR and the transcriptional repressor CTCF regulate SPUD levels. SPUD induction increases p21 protein, but not CDKN1A full-length levels, affecting p21 functions in cell-cycle, CDK2 expression, and cell viability. Like CDKN1A full-length isoform, SPUD can bind two competitive p21 translational regulators, the inhibitor calreticulin and the activator CUGBP1; SPUD can change their association with CDKN1A full-length in a DDR-dependent manner. Together, these results show a new regulatory mechanism by which a lncRNA controls p21 expression post-transcriptionally, highlighting lncRNA relevance in DDR progression and cellcycle.
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Lawandi A, Mishuk AU, Yek C, Yu A, Li X, Strich JR, Sarzynski S, Warner S, Kadri SS. 1649. Ceftolozane-Tazobactam or Ceftazidime-Avibactam Versus Best Available Therapy in the Treatment of Difficult-to-Treat Pseudomonas aeruginosa Infections: a Retrospective Comparative Effectiveness Analysis of 195 U.S. Hospitals, 2016–2020. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Infections due to Pseudomonas aeruginosa displaying difficult-to-treat resistance (DTR-PA) necessitate the use of sub-efficacious and/or toxic “reserve” antibiotics and are associated with considerable morbidity and mortality. Ceftazidime-avibactam (CAZ-AVY) and ceftolozane-tazobactam (CEF-TAZO) are novel ß-lactam/ß-lactamase inhibitors (BLBLI) that tend to retain in vitro activity against DTR-PA. However, little is known about their in vivo effectiveness compared to reserve agents.
Methods
Inpatients aged ≥ 18 years with ≥1 blood, urine, respiratory, or body fluid culture growing DTR-PA who received targeted therapy with either CAZ-AVY, CEF-TAZO, or Best-Available Therapy (BAT) were identified in the Premier Healthcare Database. Primary outcome was in-hospital mortality or discharge to hospice and secondary outcome was length of hospital stay (LOS) for survivors. The primary outcome was compared for CAZ-AVY vs CEF-TAZO and novel agents (CAZ-AVY or CEF-TAZO) vs BAT using overlap weighting and binomial regression with downstream adjustment controlling for patient and treatment characteristics. The secondary outcomes were compared using overlap weighting and poisson regression with downstream adjustment controlling for patient and treatment characteristics.
Results
Between 2016 and 2020, 1,552 patients with DTR-PA infections were identified at 105 hospitals, of which 202 (13.0%) were treated with CAZ-AVY, 906 (58.4%) with CEF-TAZO, and 444 (28.6%) with BAT. Patient characteristics were similar among treatment groups (Table 1, Table 2). Overall crude mortality was 15.5%. The adjusted risk of mortality was lower in patients treated with CAZ-AVI (12.5%, 95% CI 7.9–17.1) vs CEF-TAZO (18.8%, 95% CI 15.9–21.8) for a risk difference of 6.3% (95% 1.1–11.5, p = 0.02). The novel agents were not associated with a reduced mortality risk when collectively compared to BAT (risk difference -1.1%, 95% CI -5.4; 3.2%). LOS favoured novel agents and were comparable for CAZ-AVY and CEF-TAZO.
Conclusion
In this real-world observational study of patients with DTR-PA infections, the novel ß-lactam/ß-lactamase inhibitors were comparably effective against BAT, though the use of CAZ-AVY was associated with a reduced mortality compared to CEF-TAZO.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | - Ahmed Ullah Mishuk
- Critical Care Medicine Department, National Institutes of Health Clinical Center , Bethesda, MD
| | - Christina Yek
- National Institute of Allergy and Infectious Diseases , Bethesda, Maryland
| | - Amy Yu
- Critical Care Medicine, National Institutes of Health , Bethesda, Maryland
| | | | - Jeffrey R Strich
- Critical Care Medicine, National Institutes of Health Clinical Center , Bethesda, Maryland
| | - Sadia Sarzynski
- Critical Care Medicine, National Institutes of Health Clinical Center , Bethesda, Maryland
| | - Sarah Warner
- Critical Care Medicine, National Institutes of Health Clinical Center , Bethesda, Maryland
| | - Sameer S Kadri
- Critical Care Medicine, National Institutes of Health Clinical Center , Bethesda, Maryland
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Yu A, Cable C, Sharma S, Shihan MH, Mattis AN, Mileva I, Hannun YA, Duwaerts CC, Chen JY. Targeting acid ceramidase ameliorates fibrosis in mouse models of non-alcoholic steatohepatitis. Front Med (Lausanne) 2022; 9:881848. [PMID: 36275798 PMCID: PMC9582277 DOI: 10.3389/fmed.2022.881848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a common cause of liver disease worldwide, and is characterized by the accumulation of fat in the liver. Non-alcoholic steatohepatitis (NASH), an advanced form of NAFLD, is a leading cause of liver transplantation. Fibrosis is the histologic feature most associated with liver-related morbidity and mortality in patients with NASH, and treatment options remain limited. In previous studies, we discovered that acid ceramidase (aCDase) is a potent antifibrotic target using human hepatic stellate cells (HSCs) and models of hepatic fibrogenesis. Using two dietary mouse models, we demonstrate that depletion of aCDase in HSC reduces fibrosis without worsening metabolic features of NASH, including steatosis, inflammation, and insulin resistance. Consistently, pharmacologic inhibition of aCDase ameliorates fibrosis but does not alter metabolic parameters. The findings suggest that targeting aCDase is a viable therapeutic option to reduce fibrosis in patients with NASH.
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Affiliation(s)
- Amy Yu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Carson Cable
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Sachin Sharma
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Mahbubul H. Shihan
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Aras N. Mattis
- Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
- The Liver Center, University of California, San Francisco, San Francisco, CA, United States
| | - Izolda Mileva
- Department of Medicine and Biochemistry and the Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, United States
| | - Yusuf A. Hannun
- Department of Medicine and Biochemistry and the Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, United States
| | - Caroline C. Duwaerts
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- The Liver Center, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Y. Chen
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- The Liver Center, University of California, San Francisco, San Francisco, CA, United States
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21
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Yu A, Dupont G, Nerva J, Anadkat SN, D'Antoni AV, Wang A, Iwanaga J, Dumont AS, Tubbs RS. The petrosal artery and its variations: a comprehensive review and anatomical study with application to skull base surgery and neurointerventional procedures. Folia Morphol (Warsz) 2022; 82:568-579. [PMID: 35692114 DOI: 10.5603/fm.a2022.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The petrosal artery supplies several structures at the skull base and is often the focus of various neurointerventional procedures. Therefore, knowledge of its anatomy and variations is important to surgeons and interventionalists. MATERIALS AND METHODS Twenty latex injected cadaveric heads (40 sides) underwent microsurgical dissection of the petrosal artery. Documentation of the course of the artery and its branches were made. Measurements of the petrosal artery's length and diameter were performed using microcallipers. RESULTS A petrosal artery was identified on all sides. The mean length and diameter of the artery within the middle cranial fossa was 2.4 cm and 0.38 mm, respectively. Branches included the following: dural, ganglionic, V3 branches, branches extending through the foramen ovale, branches directly to the greater petrosal and lesser petrosal nerves, branches to the floor of the hiatus of the greater and lesser petrosal nerves, branch to the arcuate eminence, and superior tympanic artery. No statistically significant differences were noted between male and female specimens, but right-sided petrosal arteries were in general, larger in diameter than left sides. CONCLUSIONS A thorough anatomical knowledge of the petrosal artery and to its relationship to the facial nerve and other neurovascular structures is necessary to facilitate effective endovascular treatment and to preclude facial nerve complications.
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Affiliation(s)
- A Yu
- Tulane University School of Medicine, New Orleans, LA, United States
| | - G Dupont
- Tulane University School of Medicine, New Orleans, LA, United States
| | - J Nerva
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - S N Anadkat
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, United States
| | - A V D'Antoni
- Physician Assistant Programme, Wagner College, Staten Island, New York, United States
- Division of Anatomy, Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - A Wang
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
| | - J Iwanaga
- Department of Neurosurgery, Tulane Centre for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States.
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States.
| | - A S Dumont
- Department of Neurosurgery, Tulane Centre for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
| | - R S Tubbs
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Neurosurgery, Tulane Centre for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, United States
- University of Queensland, Brisbane, Australia
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22
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Yu A, Jordan SR, Gilmartin H, Mueller SK, Holliman BD, Jones CD. "Our Hands Are Tied Until Your Doctor Gets Here": Nursing Perspectives on Inter-hospital Transfers. J Gen Intern Med 2022; 37:1729-1736. [PMID: 34993869 PMCID: PMC8735724 DOI: 10.1007/s11606-021-07276-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND The transfer of patients between hospitals (inter-hospital transfer, or IHT) is a common occurrence for patients, but guidelines to ensure safe and effective IHTs are lacking. Poor IHTs result in higher rates of mortality, longer lengths of stay, and higher hospitalization costs compared to admissions from the emergency department. Nurses are often the first point of contact for IHT patients and can provide valuable insights on key challenges to IHT processes. OBJECTIVE To characterize the experiences of inpatient floor-level bedside nurses caring for IHT patients and identify care coordination challenges and solutions. DESIGN/PARTICIPANTS/APPROACH Qualitative study using semi-structured focus groups and interviews conducted from October 2019 to July 2020 with 21 inpatient floor-level nurses caring for adult medicine patients at an academic hospital. Nurses were recruited using a purposive convenience sampling approach. A combined inductive and deductive coding approach guided by thematic analysis was used for data analysis. KEY RESULTS Results from this study are mapped to the Agency for Healthcare Research and Quality Care Coordination Measurement Framework domains of communication, assessing needs and goals, and negotiating accountability. The following key themes characterize nurses' experiences with IHT related to these domains: (1) challenges with information exchange and team communication during IHT, (2) environmental and information preparation needed to anticipate transfers, and (3) determining responsibility and care plans after the IHT patient has arrived at the accepting facility. CONCLUSIONS Nurses described the absence of standardized processes to coordinate care before or at the time of patient arrival. Challenges to communication and coordination during IHTs negatively impacted patient care and nursing professional satisfaction. To streamline care for IHT patients and reduce nursing stress, future IHT interventions should include standardized handoff reports, timely identification and easy access to admitting clinicians, and timely clinician evaluation and orders.
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Affiliation(s)
- Amy Yu
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12401 E. 17th Avenue Mailstop F-782, Aurora, CO, 80045, USA.
| | - Sarah R Jordan
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Heather Gilmartin
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stephanie K Mueller
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brooke Dorsey Holliman
- Department of Family Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12401 E. 17th Avenue Mailstop F-782, Aurora, CO, 80045, USA
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA
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23
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Buhari H, Han L, Austin P, Dorian P, Jackevicius C, Kapral M, Singh SM, Tu K, Yu A, Ko DT, Abdel-Qadir HM. THE RELATIONSHIP BETWEEN FEMALE SEX AND STROKE RATE IN ELDERLY PATIENTS WITH ATRIAL FIBRILLATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Adu P, Binka M, Mahmood B, Jeong D, Buller-Tylor T, Damascene MJ, Iyaniwura S, Ringa N, Velasquez H, Wong S, Yu A, Bartlett S, Wilton J, Irvine M, Otterstatter M, Janjua N. Quantifying Contact Patterns: Development and Characteristics of the British Columbia COVID-19 Population Mixing Patterns Survey. Int J Infect Dis 2022. [PMCID: PMC8884815 DOI: 10.1016/j.ijid.2021.12.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Several non-pharmaceutical interventions such as physical distancing, self-isolation, a stay-at-home order, hand washing, and schools and businesses closures were implemented in British Columbia (BC) following the first lab-tested case of COVID-19 on January 26, 2020. These interventions were aimed at minimizing in-person contacts that could potentially lead to new COVID-19 infections. The BC COVID-19 Population Mixing Patterns survey (BC-Mix) was established as a surveillance system to measure behaviour and contact patterns in BC over time to inform the timing of the easing/re-imposition of control measures. We describe the BC-Mix survey design and the demographic characteristics of respondents. Methods & Materials The ongoing repeated online survey was launched in September 2020. Participants are recruited through a variety of social media platforms including Instagram, Facebook, YouTube, and community group mailing lists. A follow up survey is sent to participants two to four weeks after completing the first iteration. Survey responses are weighted to BC's population by age, sex, geography, and ethnicity to obtain generalizable estimates. A survey completion rate of at least 33% AND a valid response for the sex questionnaire item AND a valid response for age questionnaire item were required for inclusion in weighting and further analysis. Additional indices such as material and social deprivation index, and residential instability are generated using census and location data. Results As of June 14, 2021, over 58,000 residents of BC had participated in the survey of which 31,007 survey responses were eligible for analysis. Of the eligible participants, about 60% provided consent for monthly follow up and about 26% provided their personal health numbers for linkage with other healthcare utilization databases. Approximately 51% were females 39% were 55 years or older, 63% identified as white or not a visible minority and 48% had at least a university degree. Conclusion The pandemic response is best informed by surveillance systems capable of timely assessment of behaviour patterns. BC-Mix survey respondents represented a large cohort of British Columbians providing near real-time information on behavioural and contact patterns in BC. Data from the BC-Mix survey continues to inform provincial COVID-19-related control measures.
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Dworkin M, No HJ, Wu Y, Binkley M, Rieger K, Graves E, Barcellos-Hoff M, Von Eyben R, Ashraf R, Manjappa R, Yu A, Skinner L, Surucu M, Kim Y, Loo B, Hoppe R. A RANDOMIZED SPLIT-BODY FEASIBILITY TRIAL OF SINGLE-FRACTION FLASH VS CONVENTIONAL ELECTRON RADIOTHERAPY USING A STANDARD CLINICAL LINEAR ACCELERATOR FOR ADULTS WITH MULTILESIONAL PRIMARY CUTANEOUS LYMPHOMAS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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26
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Beman JM, Vargas SM, Wilson JM, Perez-Coronel E, Karolewski JS, Vazquez S, Yu A, Cairo AE, White ME, Koester I, Aluwihare LI, Wankel SD. Substantial oxygen consumption by aerobic nitrite oxidation in oceanic oxygen minimum zones. Nat Commun 2021; 12:7043. [PMID: 34857761 PMCID: PMC8639706 DOI: 10.1038/s41467-021-27381-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/15/2021] [Indexed: 01/04/2023] Open
Abstract
Oceanic oxygen minimum zones (OMZs) are globally significant sites of biogeochemical cycling where microorganisms deplete dissolved oxygen (DO) to concentrations <20 µM. Amid intense competition for DO in these metabolically challenging environments, aerobic nitrite oxidation may consume significant amounts of DO and help maintain low DO concentrations, but this remains unquantified. Using parallel measurements of oxygen consumption rates and 15N-nitrite oxidation rates applied to both water column profiles and oxygen manipulation experiments, we show that the contribution of nitrite oxidation to overall DO consumption systematically increases as DO declines below 2 µM. Nitrite oxidation can account for all DO consumption only under DO concentrations <393 nM found in and below the secondary chlorophyll maximum. These patterns are consistent across sampling stations and experiments, reflecting coupling between nitrate reduction and nitrite-oxidizing Nitrospina with high oxygen affinity (based on isotopic and omic data). Collectively our results demonstrate that nitrite oxidation plays a pivotal role in the maintenance and biogeochemical dynamics of OMZs.
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Affiliation(s)
- J. M. Beman
- grid.266096.d0000 0001 0049 1282Life and Environmental Sciences, University of California, Merced, Merced, CA USA
| | - S. M. Vargas
- grid.266096.d0000 0001 0049 1282Life and Environmental Sciences, University of California, Merced, Merced, CA USA
| | - J. M. Wilson
- grid.266096.d0000 0001 0049 1282Life and Environmental Sciences, University of California, Merced, Merced, CA USA ,grid.266100.30000 0001 2107 4242Scripps Institution of Oceanography, University of California, San Diego, CA USA
| | - E. Perez-Coronel
- grid.266096.d0000 0001 0049 1282Life and Environmental Sciences, University of California, Merced, Merced, CA USA
| | - J. S. Karolewski
- grid.56466.370000 0004 0504 7510Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution, Woods Hole, MA USA
| | - S. Vazquez
- grid.266096.d0000 0001 0049 1282Life and Environmental Sciences, University of California, Merced, Merced, CA USA
| | - A. Yu
- grid.266096.d0000 0001 0049 1282Life and Environmental Sciences, University of California, Merced, Merced, CA USA
| | - A. E. Cairo
- grid.266096.d0000 0001 0049 1282Life and Environmental Sciences, University of California, Merced, Merced, CA USA
| | - M. E. White
- grid.266100.30000 0001 2107 4242Scripps Institution of Oceanography, University of California, San Diego, CA USA
| | - I. Koester
- grid.266100.30000 0001 2107 4242Scripps Institution of Oceanography, University of California, San Diego, CA USA
| | - L. I. Aluwihare
- grid.266100.30000 0001 2107 4242Scripps Institution of Oceanography, University of California, San Diego, CA USA
| | - S. D. Wankel
- grid.56466.370000 0004 0504 7510Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution, Woods Hole, MA USA
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Kirubarajan A, Lam A, Yu A, Taheri C, Khan S, Sethuram C, Mehta V, Olivieri N. Knowledge, Information Sources, and Institutional Trust of Patients Regarding Medication Use in Pregnancy: A Systematic Review. J Family Reprod Health 2021; 15:160-171. [PMID: 34721607 PMCID: PMC8536826 DOI: 10.18502/jfrh.v15i3.7133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: The objective of our study is to characterize the knowledge, information sources, and institutional trust of patients regarding medication use in pregnancy. Materials and methods: We conducted a review of three databases: MEDLINE, EMBASE, and CINAHL. We included observational studies and knowledge assessments that examined the knowledge, attitudes, beliefs or information sources of pregnant patients related to medication use during pregnancy. Extraction was completed by two independent reviewers, outcomes were summarized descriptively, and appraisal was conducted. Results: Of the 1359 search results, 34 studies met inclusion criteria. Thus, our systematic review encompasses the beliefs of 11,757 pregnant participants. In most studies, participants described apprehension regarding potential risks to the fetus and the inadequacy of safety information. Across the 23 knowledge assessments, the majority of studies reported patient misconceptions about prescription medication in pregnancy. The most preferred information source was a healthcare provider. However, many participants expressed frustration, mistrust, and skepticism regarding physician knowledge. A common source of mistrust was due to perceived physician self-interest as well as a lack of education tailored to pregnancy. Consequently, informal sources of information were also popular. Conclusion: There is a need to improve the health literacy and trust among pregnant patients regarding drug prescribing. There are modifiable risk factors for mistrust that require further attention.
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Affiliation(s)
- Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Lam
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Yu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cameron Taheri
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Claire Sethuram
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vikita Mehta
- Arts and Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Olivieri
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Rijal H, Kapral M, Yu A, Chu A, Yu B, Fang J, Austin P, Vyas M. IMMIGRATION STATUS AND SEX DIFFERENCES IN PRIMARY CARDIOVASCULAR DISEASE PREVENTION: A RETROSPECTIVE STUDY OF 5 MILLION ADULTS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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29
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Haseltine J, Apte A, Jackson A, Yorke E, Yu A, Wu A, Peleg A, Al-Sadawi M, Iocolano M, Gelblum D, Shaverdian N, Simone, Ii C, Rimner A, Gomez D, Shepherd A. P27.02 Associating Cardiac Plaque Accumulation With Cardiac Toxicity and Overall Survival In Locally Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yu A, Cheng ZQ, Bi DS, Yan ZB. Polymer-ligating clips used as line stoppers during closing the peritoneum of the pelvic floor. Tech Coloproctol 2021; 26:147-148. [PMID: 34545515 DOI: 10.1007/s10151-021-02528-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- A Yu
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Z Q Cheng
- Department of Colorectal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107, Wenhua West Road, Jinan, 250012, Shandong, China
| | - D S Bi
- Department of Colorectal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107, Wenhua West Road, Jinan, 250012, Shandong, China
| | - Z B Yan
- Department of Colorectal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107, Wenhua West Road, Jinan, 250012, Shandong, China.
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Abstract
Purpose The goal of this work was to develop and test nontoxic electron collimation technologies for clinical use. Methods Two novel technologies were investigated: tungsten‐silicone composite and 3D printed electron cutouts. Transmission, dose uniformity, and profiles were measured for the tungsten‐silicone. Surface dose, relative dose output, and field size were measured for the 3D printed cutouts and compared with the standard cerrobend cutouts in current clinical use. Quality assurance tests including mass measurements, Megavoltage (MV) imaging, and drop testing were developed for the 3D printed cutouts as a guide to safe clinical implementation. Results Dose profiles of the flexible tungsten‐silicone skin shields had an 80–20 penumbra values of 2–3 mm compared to 7–8 mm for cerrobend. In MV transmission image measurements of the tungsten‐silicone, 80% of the pixels had a transmission value within 2% of the mean. An ∼90% reduction in electron intensity was measured for 6 MeV and a 6.4 mm thickness of tungsten‐silicone and 12.7 mm thickness for 16 MeV. The maximum difference in 3D printed cutout versus cerrobend output, surface dose, and full width at half‐maximum (FWHM) was 1.7%, 1.2%, and 1.5%, respectively, for the 10 cm × 10 cm cutouts. Conclusions Both flexible tungsten‐silicone and 3D printed cutouts were found to be feasible for clinical use. The flexible tungsten‐silicone was of adequate density, flexibility, and uniformity to serve as skin shields for electron therapy. The 3D printed cutouts were dosimetrically equivalent to standard cerrobend cutouts and were robust enough for handling in the clinical environment.
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Affiliation(s)
| | - Lawrie Skinner
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Stephanie Lo
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Amy Yu
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
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Han Y, Xiang C, Guo L, Zhao R, Yu A. 1148P Identification and validation of RET fusions in lung adenocarcinoma through DNA and RNA sequencing. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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33
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Gupta A, Yu A, Peyrin-Biroulet L, Ananthakrishnan AN. Treat to Target: The Role of Histologic Healing in Inflammatory Bowel Diseases: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2021; 19:1800-1813.e4. [PMID: 33010406 DOI: 10.1016/j.cgh.2020.09.046] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic remission is a recognized therapeutic endpoint in inflammatory bowel disease (IBD; Crohn's disease (CD), ulcerative colitis (UC)). The impact of persistent histologic activity on long-term outcomes is less clear and limited by small studies. METHODS We performed a systematic search of PubMed and Embase to identify eligible studies examining the association between histologic activity and relapse in patients with CD or UC in endoscopic remission. Studies were pooled together using random effects meta-analysis per the DerSimonian and Laird inverse variance method. The impact of different histologic scales, cut-offs, and individual features were examined. FINDINGS Our meta-analysis included 28 studies contributing 2,806 patients (2677 UC; 129 CD). In UC, histologically active disease was associated with an overall increased risk of relapse (OR, 2.41; 95% CI, 1.91-3.04), with a similar effect noted in the subgroup with endoscopic Mayo endoscopic score of 0 vs 0 or 1. More rigorous Geboes cut-offs demonstrated numerically stronger impact on relapse rates-Geboes <3.1 (OR, 2.40; 95% CI, 1.57-3.65), Geboes <2.1 (OR, 3.91; 95% CI, 2.21-6.91) and Geboes 0 (OR, 7.40; 95% CI, 2.00-18.27). Among individual histologic features, basal plasmacytosis (OR, 1.94), neutrophilic infiltrations (OR, 2.30), mucin depletion (OR, 2.05), and crypt architectural irregularities (OR, 2.22) predicted relapse. There was no association between histologic activity and relapse in CD. CONCLUSIONS In patients with UC in endoscopic remission, persistent histologic activity is associated with higher rates of relapse. Greater degree of normalization may have a stronger impact.
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Affiliation(s)
- Akshita Gupta
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Yu
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandoeuvre-les-Nancy, France; French Institute of Health and Medical Research U1256 NGERE, University of Lorraine, Vandoeuvre-les-Nancy, France
| | - Ashwin N Ananthakrishnan
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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34
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Alsamman S, Christenson SA, Yu A, Ayad NME, Mooring MS, Segal JM, Hu JKH, Schaub JR, Ho SS, Rao V, Marlow MM, Turner SM, Sedki M, Pantano L, Ghoshal S, Ferreira DDS, Ma HY, Duwaerts CC, Espanol-Suner R, Wei L, Newcomb B, Mileva I, Canals D, Hannun YA, Chung RT, Mattis AN, Fuchs BC, Tager AM, Yimlamai D, Weaver VM, Mullen AC, Sheppard D, Chen JY. Targeting acid ceramidase inhibits YAP/TAZ signaling to reduce fibrosis in mice. Sci Transl Med 2021; 12:12/557/eaay8798. [PMID: 32817366 DOI: 10.1126/scitranslmed.aay8798] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/11/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022]
Abstract
Hepatic stellate cells (HSCs) drive hepatic fibrosis. Therapies that inactivate HSCs have clinical potential as antifibrotic agents. We previously identified acid ceramidase (aCDase) as an antifibrotic target. We showed that tricyclic antidepressants (TCAs) reduce hepatic fibrosis by inhibiting aCDase and increasing the bioactive sphingolipid ceramide. We now demonstrate that targeting aCDase inhibits YAP/TAZ activity by potentiating its phosphorylation-mediated proteasomal degradation via the ubiquitin ligase adaptor protein β-TrCP. In mouse models of fibrosis, pharmacologic inhibition of aCDase or genetic knockout of aCDase in HSCs reduces fibrosis, stromal stiffness, and YAP/TAZ activity. In patients with advanced fibrosis, aCDase expression in HSCs is increased. Consistently, a signature of the genes most down-regulated by ceramide identifies patients with advanced fibrosis who could benefit from aCDase targeting. The findings implicate ceramide as a critical regulator of YAP/TAZ signaling and HSC activation and highlight aCDase as a therapeutic target for the treatment of fibrosis.
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Affiliation(s)
- Sarah Alsamman
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Amy Yu
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Nadia M E Ayad
- Center for Bioengineering and Tissue Regeneration, Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA.,UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA 94143, USA
| | - Meghan S Mooring
- Division of Pediatric Gastroenterology and Hepatology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Joe M Segal
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Jimmy Kuang-Hsien Hu
- Division of Oral Biology & Medicine, School of Dentistry, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | | | - Steve S Ho
- Pliant Therapeutics, South San Francisco, CA 94080, USA
| | - Vikram Rao
- Pliant Therapeutics, South San Francisco, CA 94080, USA
| | | | | | - Mai Sedki
- Internal Medicine, Kaiser Permanente, San Francisco, CA 94115, USA
| | - Lorena Pantano
- Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA
| | - Sarani Ghoshal
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114, USA
| | - Diego Dos Santos Ferreira
- Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Hsiao-Yen Ma
- Lung Biology Center, Department of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Caroline C Duwaerts
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94115, USA.,Liver Center, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Regina Espanol-Suner
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Lan Wei
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114, USA
| | - Benjamin Newcomb
- Departments of Medicine and Biochemistry and Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA
| | - Izolda Mileva
- Departments of Medicine and Biochemistry and Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA
| | - Daniel Canals
- Departments of Medicine and Biochemistry and Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA
| | - Yusuf A Hannun
- Departments of Medicine and Biochemistry and Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA
| | - Raymond T Chung
- Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Aras N Mattis
- Liver Center, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Pathology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Bryan C Fuchs
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114, USA
| | - Andrew M Tager
- Division of Pulmonary and Critical Care Medicine, Fibrosis Research Center, and Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dean Yimlamai
- Division of Pediatric Gastroenterology and Hepatology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Valerie M Weaver
- Center for Bioengineering and Tissue Regeneration, Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA.,UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA 94143, USA.,Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA 94143, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA.,Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA 94158, USA.,Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Alan C Mullen
- Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dean Sheppard
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA. .,Lung Biology Center, Department of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Jennifer Y Chen
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94115, USA. .,Liver Center, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
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35
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Chan AS, Rout A, D 'Adamo CR, Lev I, Yu A, Miller K. Palliative Referrals in Advanced Cancer Patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index. Am J Hosp Palliat Care 2021; 39:164-168. [PMID: 34002623 DOI: 10.1177/10499091211017873] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Timely identification of palliative care needs can reduce hospitalizations and improve quality of life. The Supportive & Palliative Care Indicators Tool (SPICT) identifies patients with advanced medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting. SPICT and RI among cancer patients were utilized in this study to evaluate their potential roles in palliative care referrals. METHODS Advanced cancer patients admitted to an institution in Baltimore, Maryland in 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), palliative care referrals, RI scores, and SPICT scores were obtained. Patients were divided into SPICT positive or negative and RI > 60 or RI < 60.Unpaired t-tests and chi-square tests were utilized to determine the associations between SPICT and RI and early palliative care needs and mortality. RESULTS 227 patients were included, with a mean age of 68 years, 63% Black, 59% female, with the majority having lung and GI malignancies. Sixty percent were SPICT +, 21% had RI < 60. SPICT + patients were more likely to have RI < 60 (p = 0.001). SPICT + and RI < 60 patients were more likely to have longer LOS, change in code status, more palliative/hospice referrals, and increased mortality (p <0.05). CONCLUSIONS SPICT and RI are valuable tools in predicting mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer.
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Affiliation(s)
- Abigail Sy Chan
- Department of Medicine, Sinai Hospital of Baltimore, MD, USA.,Department of Hematology/Oncology, University of Louisville, KY, USA
| | - Amit Rout
- Department of Medicine, Sinai Hospital of Baltimore, MD, USA
| | - Christopher R D 'Adamo
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Irina Lev
- Department of Medicine, Sinai Hospital of Baltimore, MD, USA
| | - Amy Yu
- Department of Medicine, Sinai Hospital of Baltimore, MD, USA
| | - Kenneth Miller
- Department of Hematology/Oncology, Sinai Hospital of Baltimore, Baltimore, MD, USA
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Gottenborg E, Yu A, Naderi R, Keniston A, McBeth L, Morrison K, Schwartz D, Burden M. COVID-19's impact on faculty and staff at a School of Medicine in the US: what is the blueprint for the future? BMC Health Serv Res 2021; 21:395. [PMID: 33910541 PMCID: PMC8079230 DOI: 10.1186/s12913-021-06411-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background The Coronavirus Disease 2019 (COVID-19) caused unprecedented challenges within medical centers, revealing inequities embedded in the medical community and exposing fragile social support systems. While faculty and staff faced extraordinary demands in workplace duties, personal responsibilities also increased. The goal of this study was to understand the impact of the COVID-19 pandemic on personal and professional activities of faculty and staff in order to illuminate current challenges and explore solutions. Methods Qualitative, semi-structured group interviews involved faculty and staff at four affiliate sites within the Department of Medicine at the University of Colorado, School of Medicine. Focus groups addressed the impact of COVID-19 on (1) Changes to roles and responsibilities at work and at home, (2) Resources utilized to manage these changes and, (3) Potential strategies for how the Department could assist faculty and staff. Thematic analysis was conducted using an inductive method at the semantic level to form themes and subthemes. Results Qualitative analysis of focus group transcripts revealed themes of: (1) Challenges and disparities experienced during the pandemic, (2) Disproportionate impact on women personally and professionally, (3) Institutional factors that contributed to wellness and burnout, and (4) Solutions and strategies to support faculty and staff. Within each of these themes were multiple subthemes including increased professional and personal demands, concern for personal safety, a sense of internal guilt, financial uncertainty, missed professional opportunities, and a negative impact on mentoring. Solutions were offered and included an emphasis on addressing preexisting inequities, the importance of community, and workplace flexibility. Conclusions The COVID-19 pandemic created burdens for already challenged faculty and staff in both their personal and professional lives. Swift action and advocacy by academic institutions is needed to support the lives and careers of our colleagues now and in the future.
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Affiliation(s)
- Emily Gottenborg
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA. .,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA.
| | - Amy Yu
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Roxana Naderi
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Angela Keniston
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Lauren McBeth
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Katherine Morrison
- Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, Division of General Internal Medicine, University of Colorado, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - David Schwartz
- Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA.,Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Marisha Burden
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
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Stevenson L, Yu A, Haughey S, Barry H. Delivery of the Dementia Friends programme on the MPharm degree course: a qualitative exploration of pharmacy students’ perspectives. International Journal of Pharmacy Practice 2021. [DOI: 10.1093/ijpp/riab015.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
A person-centred approach to dementia care has been advocated1, but limited literature exists on integration of this into pharmacist undergraduate education. The Alzheimer’s Society Dementia Friends programme was developed to change peoples’ perceptions and promote understanding of living with dementia. In 2019, the School piloted provision of Dementia Friends training; Level 3 MPharm students (n=102) were invited by email to participate as an optional part of a Clinical Therapeutics module. Sixty-three students (61.8%) attended the workshop, which combined Dementia Friends training with an interactive session facilitated by a person living with dementia (PLWD).
Aim
To explore undergraduate pharmacy students’ views and experiences of the Dementia Friends pilot.
Methods
All students who had attended the workshop were invited by email to participate in a focus group during February 2020. Participants provided written informed consent. The topic guide focused on students’ views of workshop delivery, improvements that could be made, their understanding of person-centred care, and the impact of the workshop on their clinical practice. The focus group was audio-recorded, transcribed verbatim, and analysed using thematic analysis.
Results
One focus group was conducted with eight students. Three overarching themes were identified: learning from an expert patient; importance of person-centred care; and dementia education during MPharm degree. Students valued the opportunity to learn from a PLWD and felt it allowed them to relate the condition to a real person: “it felt more personal so you could really connect with them [PLWD] and understand their experience”. Hearing about the ‘lived experience’ helped to contextualise learning from other methods of delivery, e.g. lectures: “you don’t know what’s going on in someone else’s life, and sometimes we’re all a bit quick to judge, I think [the workshop] put that into perspective”. Students described having greater understanding of person-centred care and taking a holistic approach to pharmaceutical care provision for PLWD: “it’s very important to take into account their quality of life…we can focus on the clinical but looking at the person as a whole actually helps their treatment” and “one of the things I found most interesting was that they might not remember the interaction but they will [retain] the feeling or emotion”. Students reported feeling more confident in engaging with PLWD following the workshop, which is something they would not have had the opportunity to learn from lectures alone: “If we hadn’t had that dementia training, I feel like I would still have no confidence chatting to dementia patients”. Students suggested that future Dementia Friends training should be delivered earlier in the MPharm degree course.
Conclusion
This study has shown that Dementia Friends training complemented students’ existing knowledge of dementia and increased their confidence to communicate with PLWD. The use of an expert patient was an effective way of supporting MPharm students to develop a person-centred approach to their professional practice. The study was limited to one university so findings may not be generalisable. However, these data provide a good basis for future development and evaluation of Dementia Friends training provision to MPharm students.
References
1. Kitwood, T. M. Dementia reconsidered: the person comes first. 1997. Buckingham [England], Open University Press
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Affiliation(s)
- L Stevenson
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - A Yu
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - S Haughey
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - H Barry
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
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Shepherd A, Yu A, Al-Sadawi M, Peleg A, Iocolano M, Leeman J, Imber B, Wild A, Offin M, Chaft J, Huang J, Rimner A, Wu A, Gelblum D, Shaverdian N, Gomez D, Simone Ii C, Yorke E, Jackson A. FP04.01 Heart Dose is a Dosimetric Predictor of Overall Survival in Patients with NSCLC Undergoing Post-Operative Radiation Therapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Leeman J, Gelb E, Michaliski M, Yu A, Powell S, Cahlon O, Braunstein L, Jones L, McCormick B. Cardiorespiratory Fitness is a Strong, Independent Predictor of Radiation Induced Fatigue in Breast Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abel S, Karlovits S, Yu A, Renz P, Xu L, Wegner R. Patterns Of Care In The Non-Operative Management Of Elderly Patients With NSCLC Brain Metastases. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pymar H, Poliquin V, Morris M, Yu A, Mohadeb J, Liu M, Mulhall F. P22 Using transabdominal ultrasound for first trimester pregnancy dating in an office setting: A comparison of a wifi and portable machine. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shmuylovich L, Mishra D, Hurbon H, Yu A, Du T, Wang T, Berezin M. 843 Seeing water in the skin: Hyperspectral imaging in the short-wave infrared. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lambert RF, Yu A, Orrell C, Haberer JE. Perceived oral health interventions by medical providers in Gugulethu, South Africa. PLoS One 2020; 15:e0233437. [PMID: 32453785 PMCID: PMC7250410 DOI: 10.1371/journal.pone.0233437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/05/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction The purpose of this study was to explore factors that impact patients’ ability to access high quality, expeditious oral health care by understanding medical professionals’ knowledge of oral health, the care they provide to patients presenting with oral health complaints, and their perceptions of potential interventions to improve oral health care delivery. Methods We conducted in depth qualitative interviews, which were analyzed using an inductive content analytical approach. The study was conducted in Gugulethu, a community located outside of Cape Town, South Africa. Local public sector health services provided free-of-charge are the main source of primary health and dental care for this population. Participants included the following medical providers: doctors, clinical nurse practitioners, professional nurses, and health promoters. Results Identified themes fell within the three broad subject areas: oral health knowledge, patient care, and potential interventions. Themes within oral health knowledge included (1) personal responsibility for hygiene, (2) routine oral health care, (3) lack of knowledge among medical professionals, (4) poverty, and (5) an oral-systemic connection. Participants cited both ‘clinical care knowledge’ and/or ‘uncertainty’ about patient care for oral health complaints. Participants independently suggested interventions in three broad areas: (1) education, (2) expanded provider roles, and (3) colocation of services. Conclusions Our findings suggest that a variety of interventions, ranging from high to low resource investment, may impact access to and utilization of oral health services and thereby result in improved patient care. Future studies should develop and evaluate the suggested interventions in a range of care settings.
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Affiliation(s)
- R. Frederick Lambert
- Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, United States of America
| | - Amy Yu
- Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, United States of America
| | - Catherine Orrell
- Desmond Tutu HIV Foundation, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
- * E-mail:
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Chan AS, Rout A, Lev I, Yu A, D'Adamo C, Miller KD. Palliative referrals in advanced cancer patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12102 Backgroun1d: Timely identification of palliative care needs have the ability to reduce hospitalizations and improve QOL. The Supportive & Palliative Care Indicators Tool (SPICT) is used to identify patients with advanced stage medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting and has been validated to assess 24-hour mortality risk. We used SPICT and RI in cancer patients admitted to the hospital and evaluated their roles in recognizing early palliative care needs and 6-month mortality. Methods: Advanced/metastatic cancer patients admitted to our institution from Jan 1, 2019 to June 30, 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), comorbidities, palliative/hospice care referrals, vital status, initial RI score, and computed SPICT scores were obtained. Worse clinical indicators were defined as SPICT positive if it met > 2 clinical indicators or RI < 60. Univariate and bivariate analyses were performed. Results: A total of 227 patients were included, mean age 68, 34% Caucasians, 63% Blacks, 59% female, median comorbidities of 3, with majority having lung and GI malignancies. A total of 137 (60%) were SPICT +, 47 (21%) had RI < 60, and 38 (17%) concurrent SPICT + and RI < 60. SPICT + patients were more likely to have longer hospital stay, change in code status, more palliative/hospice referrals, and increased mortality. Those with RI < 60 had similar results (Table). SPICT + patients are more likely to have RI < 60 (p = 0.0013). Conclusions: SPICT and RI are valuable tools in predicting 6-month mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer. [Table: see text]
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Affiliation(s)
| | - Amit Rout
- Sinai Hospital of Baltimore, Baltimore, MD
| | - Irina Lev
- Sinai Hospital of Baltimore, Baltimore, MD
| | - Amy Yu
- Sinai Hospital of Baltimore, Baltimore, MD
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Yu A, Friedman S, Ananthakrishnan AN. Characteristics and Long-Term Outcomes of Pregnancy-Onset Inflammatory Bowel Disease: A Case-Control Study. Inflamm Bowel Dis 2020; 27:476-481. [PMID: 32426824 PMCID: PMC7957219 DOI: 10.1093/ibd/izaa096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Although the impact of pregnancy in patients with established IBD has been widely studied, the characteristics and outcomes of patients who develop a new diagnosis of IBD during pregnancy or the postpartum year ("pregnancy-onset") is not well characterized. METHODS We identified all patients with pregnancy-onset IBD between 2006 and 2018 at 2 major academic referral centers. Patient and disease characteristics were abstracted and compared to those of control patients with IBD not diagnosed during pregnancy or postpartum. Diagnostic and therapeutic interventions were noted, as were long-term outcomes including disease treatment course, hospitalizations, and surgery. RESULTS We identified 50 patients with pregnancy-onset IBD and 100 control patients matched for year of diagnosis. The mean age of diagnosis and duration of follow-up was similar among both patients and control patients (aged 30.4 vs 28.5 years). Among patients with pregnancy-onset disease, 30% noted symptom onset in the first trimester, 22% in the second, 24% in the third, and 24% in the postpartum year. Patients with pregnancy-onset IBD were more likely to be diagnosed with ulcerative colitis compared with control patients (76% vs 56%; P = 0.02). On multivariable analysis, pregnancy onset-disease had a 4-fold increase in the risk of hospitalization (28% vs 13%; adjusted odds ratio 4.18; 95% confidence interval, 1.26-13.91). This increased risk persisted even after excluding any index hospitalizations during pregnancy. CONCLUSIONS Patients with pregnancy-onset IBD more commonly develop ulcerative colitis and have a higher risk of disease-related hospitalizations.
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Affiliation(s)
- Amy Yu
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, USA
| | - Sonia Friedman
- Division of Gastroenterology, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, USA
| | - Ashwin N Ananthakrishnan
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, USA,Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA,Address correspondence to: Ashwin N. Ananthakrishnan, MD, MPH, Division of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, 9th Floor, Boston, MA 02114 ()
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Vigen R, Diercks DB, Hashim IA, Pandey A, Zhong L, Kutscher P, Fernandez F, Yu A, Bertulfo B, Molberg K, Metzger JC, Soto J, Alzubaidy D, Thibodeaux L, Joglar JA, Das SR, de Lemos JA. Association of a Novel Protocol for Rapid Exclusion of Myocardial Infarction With Resource Use in a US Safety Net Hospital. JAMA Netw Open 2020; 3:e203359. [PMID: 32320036 PMCID: PMC7177202 DOI: 10.1001/jamanetworkopen.2020.3359] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE High-sensitivity cardiac troponin T (hs-cTnT) protocols for the evaluation of chest pain in the emergency department (ED) may reduce unnecessary resource use and overcrowding. OBJECTIVE To determine whether the implementation of a novel hs-cTnT protocol, which incorporated troponin values drawn at 0, 1, and 3 hours after ED presentation and the modified HEART score (history, electrocardiogram, age, risk factors), was associated with improvements in resource use while maintaining safety. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study from Parkland Health and Hospital System, a large safety net hospital in Dallas, Texas, included data on 31 543 unique ED encounters in which patients underwent electrocardiographic and troponin testing from January 1, 2017, to October 16, 2018. The hs-cTnT protocol was implemented in December 2017. MAIN OUTCOMES AND MEASURES Resource use outcomes included trends in ED dwell time, troponin to disposition decision time (the difference between the first troponin draw time and the time an order was placed for inpatient admission, admission to observation, or discharge), and final patient disposition. Safety outcomes included readmission for myocardial infarction and death. RESULTS In 31 543 encounters, mean (SD) patient age was 54 (14.4) years and 14 675 patients (48%) were female. Department dwell time decreased by a mean of -1.09 (95% CI, -2.81 to 0.64) minutes per month in the preintervention period. The decline was steeper after the intervention (-4.69 [95% CI, -9.05 to -0.33] minutes per month) (P for interaction = .007). The troponin to disposition time was increasing in the preintervention period by 1.72 (95% CI, 1.08 to 2.36) minutes per month; postintervention, the mean difference increased more slowly (0.37 [95% CI, -1.25 to 1.99 minutes per month; P value for interaction = .007]). The proportion of patients discharged from the ED increased after the intervention (48% vs 54%, P < .001). Thirty-day major adverse cardiac event rates were low and did not differ before and after the intervention. CONCLUSIONS AND RELEVANCE Implementation of a novel protocol incorporating serial hs-cTnT measurements over 3 hours with the Modified HEART Score was associated with reduction in ED dwell times and attenuation of temporal increases in time from troponin measurement to disposition. This or similar protocols to rule out myocardial infarction have the potential to reduce ED overcrowding and improve health care quality while maintaining safety.
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Affiliation(s)
- Rebecca Vigen
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Deborah B. Diercks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ibrahim A. Hashim
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Lin Zhong
- Department of Population and Data Science, University of Texas Southwestern Medical Center, Dallas
| | - Patricia Kutscher
- Rapid Response Lab, Parkland Health and Hospital System, Dallas, Texas
| | | | - Amy Yu
- Rapid Response Lab, Parkland Health and Hospital System, Dallas, Texas
| | - Bryan Bertulfo
- Rapid Response Lab, Parkland Health and Hospital System, Dallas, Texas
| | - Kyle Molberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas
| | - Jeffery C. Metzger
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jose Soto
- Division of Hospitalist Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Dergham Alzubaidy
- Division of Hospitalist Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Lorie Thibodeaux
- Quality Safety Division, Performance Improvement Department, Parkland Health and Hospital System, Dallas, Texas
| | - Jose A. Joglar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sandeep R. Das
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Center for Innovation and Value at Parkland, Parkland Health and Hospital System, Dallas, Texas
| | - James A. de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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Yu A, Lambert RF, Alvarado JA, Guzman CAF, Seymour B. Integrating Competency-Based Didactic and Experiential Global Health Learning for Dental Students: The Global Health Learning Helix Model. J Dent Educ 2020; 84:438-448. [PMID: 32314384 DOI: 10.21815/jde.019.186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/04/2019] [Indexed: 11/20/2022]
Abstract
The aim of this study was to evaluate the feasibility and preliminary outcomes of immersive integrated experiential and didactic courses in strengthening competency-based global health learning in dental education. To address global inequities in oral health and student interest in global health, the Harvard School of Dental Medicine introduced two global health courses in 2017-18. The first was a didactic course in the core predoctoral curriculum, and the second, in collaboration with the Inter-American Center for Global Health, was a five-day elective experiential learning course in rural Costa Rica. The experiential course was an extension of the didactic course. All 33 second-year dental students completed the didactic course, and three of those students completed the experiential course. A pre-post survey and a six-month follow-up survey on self-reported knowledge based on course learning objectives were administered. The experiential course students also completed journals and interviews for qualitative analysis. Thirty-two students completed the pre-post didactic course surveys, for a response rate of 94%. There was a 100% response rate on the pre-post didactic surveys by those students who participated in the experiential learning course. While the experiential learning group scored similarly to the class average before the didactic course, they had higher scores than the class averages both immediately after and at the six-month follow-up. All three students reported that the experiential learning course was "extremely effective" in building on what they learned in the didactic course. Qualitative analysis of the journals and interviews suggested enhanced learning from the combination of didactic and experiential methods. These preliminary results support the Global Health Learning Helix Model, a theoretical competency-based teaching model for ethical student global health engagement to better prepare the future generation in tackling oral health disparities both locally and worldwide.
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Chan A, Lev I, Yu A, Rout A, D'Adamo C, Judson P, Miller K. QIM20-122: Use of Supportive and Palliative Care Indicators Tool in Cancer Patients: A Validity Study. J Natl Compr Canc Netw 2020. [DOI: 10.6004/jnccn.2019.7504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Irina Lev
- aSinai Hospital of Baltimore, Baltimore, MD
| | - Amy Yu
- aSinai Hospital of Baltimore, Baltimore, MD
| | - Amit Rout
- aSinai Hospital of Baltimore, Baltimore, MD
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Liu ZA, Mamdani M, Aviv R, Pou-Prom C, Yu A. Abstract 165: Automated Stroke-Related Information Extraction From Diagnostic Imaging Reports Using Natural Language Processing. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Diagnostic imaging reports contain important data for stroke surveillance and clinical research but converting a large amount of free-text data into structured data with manual chart abstraction is resource-intensive. We determined the accuracy of CHARTextract, a natural language processing (NLP) tool, to extract relevant stroke-related attributes from full reports of computed tomograms (CT), CT angiograms (CTA), and CT perfusion (CTP) performed at a tertiary stroke centre.
Methods:
We manually extracted data from full reports of 1,320 consecutive CT/CTA/CTP performed between October 2017 and January 2019 in patients presenting with acute stroke. Trained chart abstractors collected data on the presence of anterior proximal occlusion, basilar occlusion, distal intracranial occlusion, established ischemia, haemorrhage, the laterality of these lesions, and ASPECT scores, all of which were used as a reference standard. Reports were then randomly split into a training set (n= 921) and validation set (n= 399). We used CHARTextract to extract the same attributes by creating rule-based information extraction pipelines. The rules were human-defined and created through an iterative process in the training sample and then validated in the validation set.
Results:
The prevalence of anterior proximal occlusion was 12.3% in the dataset (n=86 left, n=72 right, and n=4 bilateral). In the training sample, CHARTextract identified this attribute with an overall accuracy of 97.3% (PPV 84.1% and NPV 99.4%, sensitivity 95.5% and specificity 97.5%). In the validation set, the overall accuracy was 95.2% (PPV 76.3% and NPV 98.5%, sensitivity 90.0% and specificity 96.0%).
Conclusions:
We showed that CHARTextract can identify the presence of anterior proximal vessel occlusion with high accuracy, suggesting that NLP can be used to automate the process of data collection for stroke research. We will present the accuracy of CHARTextract for the remaining neurological attributes at ISC 2020.
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Affiliation(s)
| | | | - Richard Aviv
- Sunnybrook Health Sciences Cntr, Toronto, Canada
| | | | - Amy Yu
- Sunnybrook Health Sciences Cntr, Toronto, Canada
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Yu A, Pagni SE, Park SE, Karimbux N. Early Clinical Exposure in U.S. Dental Schools and Correlation with Earlier Competencies Evaluation. J Dent Educ 2020; 84:151-156. [PMID: 32043584 DOI: 10.21815/jde.019.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2019] [Indexed: 11/20/2022]
Abstract
Early clinical exposure (ECE), defined as any interaction with patients prior to the portion of the curriculum when den- tal students spend most of their time at school as a primary provider, is a growing trend in curriculum reform across U.S. dental schools in the 21st century. The aims of this study were to characterize the types of ECE implementation in U.S. dental schools and determine if ECE correlated with earlier clinical competency assessments. In September 2018, the academic deans of all 66 U.S. dental schools were invited to respond to an eight-item electronic survey about ECE at their schools. Representatives of 40 schools submitted complete responses, for a response rate of 60.6%. Among the respondents, 85% reported their schools started their principal clinical experience (PCE), the portion of the curriculum when students spend most of their time as the primary provider for patients, during the last quarter of Year 2 or the first quarter of Year 3. Respondents at all 40 schools reported offering some form of ECE as part of the formal curriculum, with shadowing and performing dental prophylaxis the most commonly of- fered types. No statistically significant associations were found between specific types of ECE and related Commission on Dental Accreditation (CODA) clinical standards for both formative and summative assessments. Although U.S. dental schools have been incorporating more ECE into their curricula over the past decade, these findings suggest that it has not led to earlier clinical competency assessments.
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