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Pasricha SR, Rogers L, Branca F, Garcia-Casal MN. Measuring haemoglobin concentration to define anaemia: WHO guidelines. Lancet 2024; 403:1963-1966. [PMID: 38493792 DOI: 10.1016/s0140-6736(24)00502-6] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Sant-Rayn Pasricha
- Population Health and Immunity Division and World Health Organization Collaborating Centre for Anaemia Detection and Control, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Diagnostic Haematology, The Royal Melbourne Hospital, Parkville, VIC, Australia; Clinical Haematology, The Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Lisa Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva 1202, Switzerland
| | - Francesco Branca
- Department of Nutrition and Food Safety, World Health Organization, Geneva 1202, Switzerland
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2
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Hammoud S, Alsabek L, Rogers L, McAuliffe E. Systematic review on the frequency and quality of reporting patient and public involvement in patient safety research. BMC Health Serv Res 2024; 24:532. [PMID: 38671476 PMCID: PMC11046929 DOI: 10.1186/s12913-024-11021-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND In recent years, patient and public involvement (PPI) in research has significantly increased; however, the reporting of PPI remains poor. The Guidance for Reporting Involvement of Patients and the Public (GRIPP2) was developed to enhance the quality and consistency of PPI reporting. The objective of this systematic review is to identify the frequency and quality of PPI reporting in patient safety (PS) research using the GRIPP2 checklist. METHODS Searches were performed in Ovid MEDLINE, EMBASE, PsycINFO, and CINAHL from 2018 to December, 2023. Studies on PPI in PS research were included. We included empirical qualitative, quantitative, mixed methods, and case studies. Only articles published in peer-reviewed journals in English were included. The quality of PPI reporting was assessed using the short form of the (GRIPP2-SF) checklist. RESULTS A total of 8561 studies were retrieved from database searches, updates, and reference checks, of which 82 met the eligibility criteria and were included in this review. Major PS topics were related to medication safety, general PS, and fall prevention. Patient representatives, advocates, patient advisory groups, patients, service users, and health consumers were the most involved. The main involvement across the studies was in commenting on or developing research materials. Only 6.1% (n = 5) of the studies reported PPI as per the GRIPP2 checklist. Regarding the quality of reporting following the GRIPP2-SF criteria, our findings show sub-optimal reporting mainly due to failures in: critically reflecting on PPI in the study; reporting the aim of PPI in the study; and reporting the extent to which PPI influenced the study overall. CONCLUSIONS Our review shows a low frequency of PPI reporting in PS research using the GRIPP2 checklist. Furthermore, it reveals a sub-optimal quality in PPI reporting following GRIPP2-SF items. Researchers, funders, publishers, and journals need to promote consistent and transparent PPI reporting following internationally developed reporting guidelines such as the GRIPP2. Evidence-based guidelines for reporting PPI should be encouraged and supported as it helps future researchers to plan and report PPI more effectively. TRIAL REGISTRATION The review protocol is registered with PROSPERO (CRD42023450715).
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Affiliation(s)
- Sahar Hammoud
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland.
| | - Laith Alsabek
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
- Department of Oral and Maxillofacial Surgery, University Hospital Galway, Galway, Ireland
| | - Lisa Rogers
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
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3
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Rogers L, Hughes Spence S, Aivalli P, De Brún A, McAuliffe E. A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings. J Interprof Care 2024; 38:156-171. [PMID: 36708308 DOI: 10.1080/13561820.2023.2168632] [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: 07/22/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Shannon Hughes Spence
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
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Urdova V, Rogers L, Jesenak M, Seys SF. Real-life studies and registries of severe asthma: The advent of digital technology. Respir Med 2023; 220:107429. [PMID: 37926182 DOI: 10.1016/j.rmed.2023.107429] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Abstract
Severe asthma is a chronic and heterogeneous disease that negatively affects the quality of life of our patients and health care utilization. Given the remaining burden of uncontrolled disease in many of these patients, better understanding of its epidemiology, disease mechanisms, effectiveness of novel therapies such as biologics are still highly needed. Asthma treatment guidelines are largely informed by randomized controlled trials (RCTs) and meta analyses of RCTs, however inclusion criteria of many efficacy RCTs of asthma treatments often exclude a high number of patients with asthma in the community. Data from real-life studies and registries of severe asthma can complement efficacy studies by not only providing evidence on how a treatment performs in everyday clinical practice, post marketing safety information, data to support subsequent clinical trial design, but also helping to delineate the natural history of a disease and supporting important translational research endeavors. In the current review, we summarise available national and international collaborative studies and registries, the variables studies and the novel data and insights they provide. The key source of information for most asthma registries are real-life data from patient's electronic health records. Advent of digital technology in collecting data and their analysis is obvious and we draw attention to generation of new knowledge from registries of severe asthma to improve current diagnostic and therapeutic guidelines and asthma control.
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Affiliation(s)
- V Urdova
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Institute of Clinical Immunology and Allergology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia.
| | - L Rogers
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Jesenak
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Institute of Clinical Immunology and Allergology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
| | - S F Seys
- Research Unit, Galenus Health, Hasselt, Belgium
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Tanner J, Brierley Jones L, Rochon M, Westwood N, Wloch C, Vaja R, Rogers L, Dearling J, Wilson K, Magboo R, Aujla H, Page S, Whiting P, Murphy G, Brown C, Lamagni T, Harrington P. Barriers and facilitators for surgical site infection surveillance for adult cardiac surgery in a high-income setting: an in-depth exploration. J Hosp Infect 2023; 141:112-118. [PMID: 37734675 DOI: 10.1016/j.jhin.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Surgical site infection (SSI) surveillance aims to facilitate a reduction in SSIs through identifying infection rates, benchmarking, triggering clinical review and instituting infection control measures. Participation in surveillance is, however, variable suggesting opportunities to improve wider adoption. AIM To gain an in-depth understanding of the barriers and facilitators for SSI surveillance in a high-income European setting. METHODS Key informant interviews with 16 surveillance staff, infection prevention staff, nurses and surgeons from nine cardiac hospitals in England. Data were analysed thematically. FINDINGS SSI surveillance was reported to be resource intensive. Barriers to surveillance included challenges associated with data collection: data being located in numerous places, multiple SSI data reporting schemes, difficulty in finding denominator data, lack of interface between computerized systems, 'labour intensive' or 'antiquated' methods to collect data (e.g., using postal systems for patient questionnaires). Additional reported concerns included: relevance of definitions, perceived variability in data reporting, lack of surgeon engagement, unsupportive managers, low priority of SSIs among staff, and a 'blame culture' around high SSI rates. Facilitators were increased resources, better use of digital technologies (e.g., remote digital wound monitoring), integrating surveillance within routine clinical work, having champions, mandating surveillance, ensuring a closer relationship between surveillance and improved patient outcomes, increasing the focus on post-discharge surveillance, and integration with primary care data. CONCLUSION Using novel interviews with 'front-line' staff, identified opportunities for improving participation in SSI surveillance. Translating these findings into action will increase surveillance activity and bring patient safety benefits to a larger pool of surgical patients.
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Affiliation(s)
- J Tanner
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - L Brierley Jones
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - M Rochon
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - C Wloch
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - R Vaja
- Department of Cardiothoracic Surgery, Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Rogers
- Department of Cardiothoracic Surgery, University Hospitals of Bristol and Weston NHS Foundation Trust
| | | | - K Wilson
- Patient and Public Representative, UK
| | - R Magboo
- Critical Care, Barts Health NHS Trust, London, UK
| | - H Aujla
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - S Page
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - P Whiting
- Bristol Medical School, University of Bristol, Bristol, UK
| | - G Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - C Brown
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - T Lamagni
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
| | - P Harrington
- HCAI Fungal AMR AMU & Sepsis Division, UKHSA, London, UK
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Moore G, Khurshid Z, McDonnell T, Rogers L, Healy O. A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in Ireland. BMC Health Serv Res 2023; 23:1112. [PMID: 37848947 PMCID: PMC10583305 DOI: 10.1186/s12913-023-10076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND In May 2021, the Irish public health service was the target of a cyber-attack. The response by the health service resulted in the widespread removal of access to ICT systems. While services including radiology, diagnostics, maternity, and oncology were prioritised for reinstatement, recovery efforts continued for over four months. This study describes the response of health service staff to the loss of ICT systems, and the risk mitigation measures introduced to safely continue health services. The resilience displayed by frontline staff whose rapid and innovative response ensured continuity of safe patient care is explored. METHODS To gain an in-depth understanding of staff experiences of the cyber-attack, eight focus groups (n = 36) were conducted. Participants from a diverse range of health services were recruited, including staff from radiology, pathology/laboratories, radiotherapy, maternity, primary care dental services, health and wellbeing, COVID testing, older person's care, and disability services. Thematic Analysis was applied to the data to identify key themes. RESULTS The impact of the cyber-attack varied across services depending on the type of care being offered, the reliance on IT systems, and the extent of local IT support. Staff stepped-up to the challenges and quickly developed and implemented innovative solutions, exhibiting great resilience, teamwork and adaptability, with a sharp focus on ensuring patient safety. The cyber-attack resulted in a flattening of the healthcare hierarchy, with shared decision-making at local levels leading to an empowered frontline workforce. However, participants in this study felt the stress placed on staff by the attack was more severe than the cumulative effect of the COVID-19 pandemic. CONCLUSIONS Limited contingencies within the health system IT infrastructure - what we call a lack of system resilience - was compensated for by a resilient workforce. Within the context of the prevailing COVID-19 pandemic, this was an enormous burden on a dedicated workforce. The adverse impact of this attack may have long-term and far-reaching consequences for staff wellbeing. Design and investment in a resilient health system must be prioritised.
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Affiliation(s)
- Gemma Moore
- Health Service Executive, National Quality and Patient Safety Directorate, Dublin, Ireland
| | - Zuneera Khurshid
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- Improvement Academy, Bradford Institute for Health Research, National Health Service, Bradford, England
| | - Thérèse McDonnell
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - Lisa Rogers
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Orla Healy
- Health Service Executive, National Quality and Patient Safety Directorate, Dublin, Ireland
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Drury A, O'Brien A, O'Connell L, Cosgrave S, Hannan M, Smyth C, Fessele K, Harkin M, Rogers L. Setting a Patient-Driven Agenda for Cancer Research Priorities in Geriatric Oncology: A Qualitative Study. Semin Oncol Nurs 2023; 39:151463. [PMID: 37419848 DOI: 10.1016/j.soncn.2023.151463] [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: 03/15/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES This study aims to explore older adults' perceptions of priorities for research in cancer and hematological malignancies and proposes an agenda of patient-driven priorities for cancer care research in the field of geriatric oncology. DATA SOURCES Sixteen older adults (≥65 years) living with or after a diagnosis of cancer participated in a descriptive qualitative study. Participants were purposively recruited via a regional cancer center and cancer advocacy organizations. Semistructured telephone interviews explored participants' experiences of cancer and perceptions of priorities for future cancer-related research. CONCLUSION Participants reported positive experiences of cancer care. However, positive and negative experiences of information, symptoms, and support both within and beyond the hospital setting were highlighted. Forty-two research priorities in six thematic areas were identified: 1) recognition of the signs and symptoms of cancer; 2) research about cancer treatment; 3) assessment and management of comorbidities; 4) unmet needs of older adults living with and after cancer; 5) impact of COVID-19; and 6) impact on caregivers and family members of people living with and after cancer. IMPLICATIONS FOR NURSING PRACTICE The results of this study provide a basis for future priority-setting activities that are culturally and contextually sensitive to health care systems, resources, and needs of older adults living with and after cancer. Based on the findings of this study, we make recommendations for the development of interventions that can build awareness, capacity, and competence in geriatric oncology among cancer care professionals and consideration of the diverse needs of older adults in the development of interventions to address unmet information and supportive care needs.
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Affiliation(s)
- Amanda Drury
- Associate Professor in General Nursing, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland.
| | - Aoife O'Brien
- Research Assistant, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Liz O'Connell
- Haematology Advanced Nurse Practitioner, Haematology Department, Tallaght University Hospital, Dublin, Ireland
| | - Sarah Cosgrave
- Registered Advanced Nurse Practitioner, Caritas Day Hospital, St Vincent's Hospital, Dublin, Ireland
| | - Michelle Hannan
- Advanced Nurse Practitioner in Geriatric Oncology, Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Caroline Smyth
- Advanced Nurse Practitioner, Community Intervention Team, Anam Cara, Dublin, Ireland
| | - Kristen Fessele
- Nurse Scientist, Memorial Sloan Kettering Office of Nursing Research, New York, New York
| | - Mary Harkin
- Research & Evaluation Manager, Age & Opportunity Lisa Rogers, Assistant Professor, School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Lisa Rogers
- Research Assistant, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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Nizar R, Cazacu S, Xiang C, Krasner M, Barbiro-Michaely E, Gerber D, Schwartz J, Fried I, Yuval S, Brodie A, Kazimirsky G, Amos N, Unger R, Brown S, Rogers L, Penning DH, Brodie C. Propofol Inhibits Glioma Stem Cell Growth and Migration and Their Interaction with Microglia via BDNF-AS and Extracellular Vesicles. Cells 2023; 12:1921. [PMID: 37566001 PMCID: PMC10417602 DOI: 10.3390/cells12151921] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/24/2023] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 08/12/2023] Open
Abstract
Glioblastoma (GBM) is the most common and aggressive primary brain tumor. GBM contains a small subpopulation of glioma stem cells (GSCs) that are implicated in treatment resistance, tumor infiltration, and recurrence, and are thereby considered important therapeutic targets. Recent clinical studies have suggested that the choice of general anesthetic (GA), particularly propofol, during tumor resection, affects subsequent tumor response to treatments and patient prognosis. In this study, we investigated the molecular mechanisms underlying propofol's anti-tumor effects on GSCs and their interaction with microglia cells. Propofol exerted a dose-dependent inhibitory effect on the self-renewal, expression of mesenchymal markers, and migration of GSCs and sensitized them to both temozolomide (TMZ) and radiation. At higher concentrations, propofol induced a large degree of cell death, as demonstrated using microfluid chip technology. Propofol increased the expression of the lncRNA BDNF-AS, which acts as a tumor suppressor in GBM, and silencing of this lncRNA partially abrogated propofol's effects. Propofol also inhibited the pro-tumorigenic GSC-microglia crosstalk via extracellular vesicles (EVs) and delivery of BDNF-AS. In conclusion, propofol exerted anti-tumor effects on GSCs, sensitized these cells to radiation and TMZ, and inhibited their pro-tumorigenic interactions with microglia via transfer of BDNF-AS by EVs.
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Affiliation(s)
- Rephael Nizar
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 52900, Israel; (R.N.); (M.K.); (E.B.-M.); (D.G.); (J.S.); (G.K.); (N.A.); (R.U.)
| | - Simona Cazacu
- Davidson Laboratory of Cell Signaling and Tumorigenesis, Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Health, Detroit, MI 48202, USA; (S.C.); (C.X.); (D.H.P.)
| | - Cunli Xiang
- Davidson Laboratory of Cell Signaling and Tumorigenesis, Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Health, Detroit, MI 48202, USA; (S.C.); (C.X.); (D.H.P.)
| | - Matan Krasner
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 52900, Israel; (R.N.); (M.K.); (E.B.-M.); (D.G.); (J.S.); (G.K.); (N.A.); (R.U.)
| | - Efrat Barbiro-Michaely
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 52900, Israel; (R.N.); (M.K.); (E.B.-M.); (D.G.); (J.S.); (G.K.); (N.A.); (R.U.)
| | - Doron Gerber
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 52900, Israel; (R.N.); (M.K.); (E.B.-M.); (D.G.); (J.S.); (G.K.); (N.A.); (R.U.)
| | - Jonathan Schwartz
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 52900, Israel; (R.N.); (M.K.); (E.B.-M.); (D.G.); (J.S.); (G.K.); (N.A.); (R.U.)
| | - Iris Fried
- Pediatric Hematology Oncology Unit, Shaare Zedek Hospital, Jerusalem 9103102, Israel; (I.F.); (S.Y.)
| | - Shira Yuval
- Pediatric Hematology Oncology Unit, Shaare Zedek Hospital, Jerusalem 9103102, Israel; (I.F.); (S.Y.)
| | | | - Gila Kazimirsky
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 52900, Israel; (R.N.); (M.K.); (E.B.-M.); (D.G.); (J.S.); (G.K.); (N.A.); (R.U.)
| | - Naama Amos
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 52900, Israel; (R.N.); (M.K.); (E.B.-M.); (D.G.); (J.S.); (G.K.); (N.A.); (R.U.)
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 52900, Israel; (R.N.); (M.K.); (E.B.-M.); (D.G.); (J.S.); (G.K.); (N.A.); (R.U.)
| | - Stephen Brown
- Radiation Oncology, Henry Ford Health, Detroit, MI 48202, USA;
| | - Lisa Rogers
- Department of Neurosurgery, Henry Ford Health, Detroit, MI 48202, USA;
| | - Donald H. Penning
- Davidson Laboratory of Cell Signaling and Tumorigenesis, Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Health, Detroit, MI 48202, USA; (S.C.); (C.X.); (D.H.P.)
- Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health, Detroit, MI 48202, USA
| | - Chaya Brodie
- The Mina and Everard Goodman Faculty of Life Sciences, Institute of Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan 52900, Israel; (R.N.); (M.K.); (E.B.-M.); (D.G.); (J.S.); (G.K.); (N.A.); (R.U.)
- Davidson Laboratory of Cell Signaling and Tumorigenesis, Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Health, Detroit, MI 48202, USA; (S.C.); (C.X.); (D.H.P.)
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Rogers L, De Brún A, McAuliffe E. Exploring healthcare staff narratives to gain an in-depth understanding of changing multidisciplinary team power dynamics during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:419. [PMID: 37127626 PMCID: PMC10150666 DOI: 10.1186/s12913-023-09406-7] [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: 08/24/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Multidisciplinary teams (MDTs) are integral to healthcare provision. However, healthcare has historically adopted a hierarchical power structure meaning some voices within the MDT have more influence than others. While power dynamics can influence interprofessional communication and care coordination, the field's understanding of these power structures during the COVID-19 pandemic is limited. METHODS Adopting a narrative inquiry methodology, this research addresses this knowledge gap and provides an in-depth understanding of MDT power dynamics during COVID-19. Using semi-structured interviews (n = 35) and inductive thematic analysis, this research explores staff perspectives of changing power dynamics in MDTs during the pandemic response. RESULTS An in-depth analysis generated three overarching themes: (1) Healthcare: a deeply embedded hierarchy reveals that while a hierarchical culture prevails within the Irish health system, staff perceptions of influence in MDTs and 'real' experiences of autonomy differ significantly. (2) Team characteristics: the influence of team structure on MDT power dynamics highlights the impact of organisational structures (e.g., staff rotations) and local processes (e.g., MDT meeting structure) on collaborative practice. (3) Ongoing effort to stimulate true collaboration underscores the importance of ongoing interprofessional education to support collaborative care. CONCLUSION By offering a greater understanding of MDT power dynamics throughout the COVID-19 pandemic, this research supports the development of more appropriate strategies to promote the provision of interprofessional care in practice.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Dublin, Ireland.
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Dublin, Ireland
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Van Tine B, Panda P, Rogers L, Oyama T. 97P Bcl-xL prevents the arginine starvation induced by PEGylated arginine deiminase (ADI-PEG20) from inducing apoptosis. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100955] [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: 04/05/2023] Open
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11
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Lukowski JK, Olson H, Velickovic M, Wang J, Kyle JE, Kim YM, Williams SM, Zhu Y, Huyck HL, McGraw MD, Poole C, Rogers L, Misra R, Alexandrov T, Ansong C, Pryhuber GS, Clair G, Adkins JN, Carson JP, Anderton CR. An optimized approach and inflation media for obtaining complimentary mass spectrometry-based omics data from human lung tissue. Front Mol Biosci 2022; 9:1022775. [PMID: 36465564 PMCID: PMC9709465 DOI: 10.3389/fmolb.2022.1022775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/18/2022] [Accepted: 11/02/2022] [Indexed: 04/23/2024] Open
Abstract
Human disease states are biomolecularly multifaceted and can span across phenotypic states, therefore it is important to understand diseases on all levels, across cell types, and within and across microanatomical tissue compartments. To obtain an accurate and representative view of the molecular landscape within human lungs, this fragile tissue must be inflated and embedded to maintain spatial fidelity of the location of molecules and minimize molecular degradation for molecular imaging experiments. Here, we evaluated agarose inflation and carboxymethyl cellulose embedding media and determined effective tissue preparation protocols for performing bulk and spatial mass spectrometry-based omics measurements. Mass spectrometry imaging methods were optimized to boost the number of annotatable molecules in agarose inflated lung samples. This optimized protocol permitted the observation of unique lipid distributions within several airway regions in the lung tissue block. Laser capture microdissection of these airway regions followed by high-resolution proteomic analysis allowed us to begin linking the lipidome with the proteome in a spatially resolved manner, where we observed proteins with high abundance specifically localized to the airway regions. We also compared our mass spectrometry results to lung tissue samples preserved using two other inflation/embedding media, but we identified several pitfalls with the sample preparation steps using this preservation method. Overall, we demonstrated the versatility of the inflation method, and we can start to reveal how the metabolome, lipidome, and proteome are connected spatially in human lungs and across disease states through a variety of different experiments.
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Affiliation(s)
| | - Heather Olson
- Pacific Northwest National Laboratory (PNNL), Richland, WA, United States
| | - Marija Velickovic
- Pacific Northwest National Laboratory (PNNL), Richland, WA, United States
| | - Juan Wang
- Pacific Northwest National Laboratory (PNNL), Richland, WA, United States
| | - Jennifer E. Kyle
- Pacific Northwest National Laboratory (PNNL), Richland, WA, United States
| | - Young-Mo Kim
- Pacific Northwest National Laboratory (PNNL), Richland, WA, United States
| | - Sarah M. Williams
- Pacific Northwest National Laboratory (PNNL), Richland, WA, United States
| | - Ying Zhu
- Pacific Northwest National Laboratory (PNNL), Richland, WA, United States
| | - Heidi L. Huyck
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Matthew D. McGraw
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Cory Poole
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Lisa Rogers
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Ravi Misra
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Theodore Alexandrov
- Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Charles Ansong
- Pacific Northwest National Laboratory (PNNL), Richland, WA, United States
| | - Gloria S. Pryhuber
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Geremy Clair
- Pacific Northwest National Laboratory (PNNL), Richland, WA, United States
| | - Joshua N. Adkins
- Pacific Northwest National Laboratory (PNNL), Richland, WA, United States
| | - James P. Carson
- Texas Advanced Computing Center (TACC), University of Texas at Austin, Austin, TX, United States
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12
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Akbari H, Mohan S, Garcia J, Kazerooni AF, Sako C, Bakas S, Bilello M, Bagley S, Baid U, Brem S, Lustig R, Nasrallah M, O'Rourke D, Barnholtz-Sloan J, Badve C, Sloan A, Jain R, Lee M, Chakravarti A, Palmer J, Taylor W, Cepeda S, Dicker A, Flanders A, Shi W, Shukla G, Calabrese E, Rudie J, Villanueva-Meyer J, LaMontagne P, Marcus D, Balana C, Capellades J, Puig J, Ak M, Colen R, Ahn SS, Chang JH, Choi YS, Lee SK, Griffith B, Poisson L, Rogers L, Booth T, Mahajan A, Wiestler B, Davatzikos C. NIMG-67. MULTI-PARAMETRIC MRI-BASED MACHINE LEARNING ANALYSIS FOR PREDICTION OF NEOPLASTIC INFILTRATION AND RECURRENCE IN PATIENTS WITH GLIOBLASTOMA: UPDATES FROM THE MULTI-INSTITUTIONAL RESPOND CONSORTIUM. Neuro Oncol 2022. [PMCID: PMC9661087 DOI: 10.1093/neuonc/noac209.685] [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] Open
Abstract
Abstract
PURPOSE
Glioblastoma is extremely infiltrative with malignant cells extending beyond the enhancing rim where recurrence inevitably occurs, despite aggressive multimodal therapy. We hypothesize that important characteristics of peritumoral tissue heterogeneity captured and analyzed by multi-parametric MRI and artificial intelligence (AI) methods are generalizable in the updated multi-institutional ReSPOND (Radiomics Signatures for PrecisiON Diagnostics) consortium and predictive of neoplastic infiltration and future recurrence.
METHODS
We used the most recent update of the ReSPOND consortium to evaluate and further refine generalizability of our methods with different scanners and acquisition settings. 179 de novo glioblastoma patients with available T1, T1Gd, T2, T2-FLAIR, and ADC sequences at pre-resection baseline and after complete resection with subsequent pathology-confirmed recurrence were included. To establish generalizability of the predictive models, training and testing of the refined AI model was performed through Leave-One-Institution-Out-Cross-Validation schema. The multi-institutional cohort consisted of the Hospital of the University of Pennsylvania (UPenn, 124), Case Western Reserve University/University Hospitals (CWRU/UH, 27), New York University (NYU, 13), Ohio State University (OSU, 13), and University Hospital Río Hortega (RH, 2). Features extracted from pre-resection MRI were used to build the model predicting the spatial pattern of subsequent tumor recurrence. These predictions were evaluated against regions of pathology-confirmed post-resection recurrence.
RESULTS
Our model predicted the locations that later harbored tumor recurrence with overall odds ratio (99% CI)/AUC (99% CI), 12.0(11.8-12.2)/0.80(0.76-0.85), and per institute, CWRU/UH, 11.0(10.7-11.3)/0.80 (0.64-0.97); NYU, 7.0(6.7-7.3)/0.78(0.56-1.00); OSU, 18.3(17.5-19.1)/0.83(0.54-1.00); RH, 40.0(35.3-45.5)/0.93(0.00-1.00); UPenn, 8.00(7.7-8.3)/0.80(0.75-0.84).
CONCLUSION
This study provides extensive multi-institutional validated evidence that machine learning tools can identify peritumoral neoplastic infiltration and predict location of future recurrence, by decrypting the MRI signal heterogeneity in peritumoral tissue. Our analyses leveraged the unique dataset of the ReSPOND consortium, which aims to develop and validate AI-based biomarkers for individualized prediction and prognostication and establish generalizability in a multi-institutional setting.
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Affiliation(s)
- Hamed Akbari
- University of Pennsylvania , Philadelphia, PA , USA
| | - Suyash Mohan
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Jose Garcia
- University of Pennsylvania , Philadelphia , USA
| | | | - Chiharu Sako
- Center for Biomedical Image Computing and Analytics and Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
| | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics, Department of Radiology, and Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | | | - Stephen Bagley
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | - Ujjwal Baid
- University of Pennsylvania , Philadelphia , USA
| | - Steven Brem
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Robert Lustig
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - MacLean Nasrallah
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Donald O'Rourke
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
| | - Jill Barnholtz-Sloan
- Center for Biomedical Informatics and Information Technology and Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, MD , USA
| | - Chaitra Badve
- Department of Radiology, Case Western Reserve University and University Hospitals Cleveland Medical Center , Cleveland , USA
| | - Andrew Sloan
- Department of Pathology and Department of Neurosurgery, Case Western Reserve University and University Hospitals Cleveland Medical Center; Seidman Cancer Center and Case Comprehensive Cancer Center , Cleveland , USA
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine , New York, NY , USA
| | - Matthew Lee
- Department of Radiology, NYU Grossman School of Medicine , New York, NY , USA
| | - Arnab Chakravarti
- Department of Radiation Oncology, Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Joshua Palmer
- The Department of Radiation Oncology, The James Cancer Hospital, Ohio State University Wexner Medical Center , Columbus, OH , USA
| | | | | | - Adam Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University , Philadelphia, PA , USA
| | - Adam Flanders
- Department of Radiology, Sidney Kimmel Cancer Center, Thomas Jefferson University , Philadelphia, PA , USA
| | - Wenyin Shi
- Department of Radiation Oncology, Thomas Jefferson University Hospital , Philadelphia, PA , USA
| | - Gaurav Shukla
- Department of Radiation Oncology, Christiana Care Health System , Philadelphia , USA
| | - Evan Calabrese
- University of California, San Francisco , San Francisco , USA
| | - Jeffrey Rudie
- University of California, San Francisco , San Francisco , USA
| | | | | | - Daniel Marcus
- Department of Radiology, Washington University School of Medicine , St. Louis, MO , USA
| | - Carmen Balana
- Medical Oncology Department, Catalan Institute of Oncology , Barcelona , Spain
| | - Jaume Capellades
- Department of Medical Imaging Consorci MAR Parc de Salut , Barcelona , Spain
| | - Josep Puig
- Department of Radiology (IDI) and Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, , Girona , Spain
| | - Murat Ak
- University of Pittsburgh , Pittsburgh , USA
| | - Rivka Colen
- Department of Radiology, University of Pittsburgh , Pittsburgh, PA , USA
| | - Sung Soo Ahn
- Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Jong Hee Chang
- Severance Hospital, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Yoon Seong Choi
- Department of Radiology, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Seung-Koo Lee
- Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Brent Griffith
- Department of Radiology, Henry Ford Health System , Detroit, MI , USA
| | - Laila Poisson
- Department of Public Health Sciences, Center for Bioinformatics, Henry Ford Health System , Detroit, MI , USA
| | - Lisa Rogers
- Department of Neurosurgery, Henry Ford Health , Detroit , USA
| | - Thomas Booth
- School of Biomedical Engineering and Imaging Sciences, King’s College , London , United Kingdom
| | - Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust , London , United Kingdom
| | - Benedikt Wiestler
- Department of Neuroradiology, Technical University of Munich , Munich , Germany
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics and Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
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Akbari H, Bakas S, Sako C, Kazerooni AF, Villanueva-Meyer J, Garcia J, Bagley S, Baid U, Bilello M, Brem S, Lustig R, Mohan S, Nasrallah M, O'Rourke D, Calabrese E, Rudie J, LaMontagne P, Marcus D, Balana C, Capellades J, Puig J, Barnholtz-Sloan J, Badve C, Sloan A, Ak M, Colen R, Ahn SS, Chang JH, Choi YS, Lee SK, Dicker A, Flanders A, Shi W, Shukla G, Griffith B, Poisson L, Rogers L, Booth T, Jain R, Lee M, Mahajan A, Chakravarti A, Palmer J, Taylor W, Cepeda S, Wiestler B, Davatzikos C. NIMG-33. PROGNOSTIC STRATIFICATION OF DE NOVO GLIOBLASTOMA PATIENTS ACROSS 22 GEOGRAPHICALLY DISTINCT INSTITUTIONS: UPDATES FROM THE RESPOND CONSORTIUM. Neuro Oncol 2022. [PMCID: PMC9661084 DOI: 10.1093/neuonc/noac209.651] [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] Open
Abstract
Abstract
PURPOSE
Glioblastoma, IDH-wildtype, is the most common primary malignant adult brain tumor with median overall survival (OS) of ~14 months, with little improvement over the last 20 years. We hypothesize that AI-based integration of quantitative tumor characteristics, independent of acquisition protocol and equipment, can reveal accurate generalizable prognostic stratification. We seek an AI-based OS predictor using routine clinically acquired MRI sequences, quantitatively evaluated across institutions of the ReSPOND (Radiomics Signatures for PrecisiON Diagnostics) consortium.
METHODS
We identified a retrospective cohort of 2,293 diffuse glioma (IDH-wildtype/-NOS/-NEC) patients from 22 geographically distinct institutions across 3 continents, with preoperative structural MRI scans. The entire tumor burden was automatically segmented into 3 sub-compartments, i.e., enhancing, necrotic, peritumoral T2-FLAIR abnormality. We developed our AI predictor by multivariate integration of i)patient age, ii)tumor sub-compartment volume normalized to brain volume, iii)spatial distribution characteristics (tumor location, distance to the ventricles, and laterality), and iv)morphologic descriptors (major axes’ length, axes’ ratio, extent, and number of tumors). The AI predictor returns a continuous value between 0-1, defining short-, intermediate-, and long-survivors based on thresholds on the 25th and 75th percentiles. Leave-One-Site-Out-Cross-Validation was used to assess the generalizability of our stratification. Kaplan-Meier survival curves were computed for OS analysis and evaluated by a Cox proportional hazards model for statistical significance and hazard ratios.
RESULTS
Survival analysis yielded a hazard ratio of 2.07 (95%CI, 2.06-2.08, p-value= 4.8e-102) for patient stratification into short-, intermediate-, and long-survivors. Pearson correlation between the predicted and actual OS yielded an R= 0.49.
CONCLUSION
Multivariate integration of visually quantified tumor characteristics, agnostic to acquisition protocol/equipment, yields an accurate OS surrogate index. Validation of our AI model in the largest centralized glioblastoma imaging dataset, from the ReSPOND consortium, supports its generalizability across diverse patient populations and acquisition settings, potentially contributing to equitable improvements of personalized patient care.
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Affiliation(s)
- Hamed Akbari
- University of Pennsylvania , Philadelphia, PA , USA
| | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics, Department of Radiology, and Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Chiharu Sako
- Center for Biomedical Image Computing and Analytics and Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
| | | | | | - Jose Garcia
- University of Pennsylvania , Philadelphia , USA
| | - Stephen Bagley
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | - Ujjwal Baid
- University of Pennsylvania , Philadelphia , USA
| | | | - Steven Brem
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Robert Lustig
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Suyash Mohan
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - MacLean Nasrallah
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Donald O'Rourke
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
| | - Evan Calabrese
- University of California, San Francisco , San Francisco , USA
| | - Jeffrey Rudie
- University of California, San Francisco , San Francisco , USA
| | | | - Daniel Marcus
- Department of Radiology, Washington University School of Medicine , St. Louis, MO , USA
| | - Carmen Balana
- Medical Oncology Department, Catalan Institute of Oncology , Barcelona , Spain
| | - Jaume Capellades
- Department of Medical Imaging Consorci MAR Parc de Salut , Barcelona , Spain
| | - Josep Puig
- Department of Radiology (IDI) and Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, , Girona , Spain
| | - Jill Barnholtz-Sloan
- Center for Biomedical Informatics and Information Technology and Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, MD , USA
| | - Chaitra Badve
- Department of Radiology, Case Western Reserve University and University Hospitals Cleveland Medical Center , Cleveland , USA
| | - Andrew Sloan
- Department of Pathology and Department of Neurosurgery, Case Western Reserve University and University Hospitals Cleveland Medical Center; Seidman Cancer Center and Case Comprehensive Cancer Center , Cleveland , USA
| | - Murat Ak
- University of Pittsburgh , Pittsburgh , USA
| | - Rivka Colen
- Department of Radiology, University of Pittsburgh , Pittsburgh, PA , USA
| | - Sung Soo Ahn
- Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Jong Hee Chang
- Severance Hospital, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Yoon Seong Choi
- Department of Radiology, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Seung-Koo Lee
- Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Adam Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University , Philadelphia, PA , USA
| | - Adam Flanders
- Department of Radiology, Sidney Kimmel Cancer Center, Thomas Jefferson University , Philadelphia, PA , USA
| | - Wenyin Shi
- Department of Radiation Oncology, Thomas Jefferson University Hospital , Philadelphia, PA , USA
| | - Gaurav Shukla
- Department of Radiation Oncology, Christiana Care Health System , Philadelphia , USA
| | - Brent Griffith
- Department of Radiology, Henry Ford Health System , Detroit, MI , USA
| | - Laila Poisson
- Department of Public Health Sciences, Center for Bioinformatics, Henry Ford Health System , Detroit, MI , USA
| | - Lisa Rogers
- Department of Neurosurgery, Henry Ford Health , Detroit , USA
| | - Thomas Booth
- School of Biomedical Engineering and Imaging Sciences, King’s College , London , United Kingdom
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine , New York, NY , USA
| | - Matthew Lee
- Department of Radiology, NYU Grossman School of Medicine , New York, NY , USA
| | - Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust , London , United Kingdom
| | - Arnab Chakravarti
- Department of Radiation Oncology, Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Joshua Palmer
- The Department of Radiation Oncology, The James Cancer Hospital, Ohio State University Wexner Medical Center , Columbus, OH , USA
| | | | | | - Benedikt Wiestler
- Department of Neuroradiology, Technical University of Munich , Munich , Germany
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics and Department of Radiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
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McAuliffe E, Mulcahy Symmons S, Conlon C, Rogers L, De Brún A, Mannion M, Keane N, Glynn L, Ryan J, Quinlan D. COVID-19 community assessment hubs in Ireland: A study of staff and patient perceptions of their value. Health Expect 2022; 26:119-131. [PMID: 36333948 PMCID: PMC9854303 DOI: 10.1111/hex.13603] [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: 12/21/2021] [Revised: 06/14/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Critical care bed capacity per capita in Ireland is among the lowest in Europe. The COVID-19 pandemic has put additional strain on an over-stretched healthcare system. COVID-19 community assessment hubs (CAHs) were established to prevent unnecessary admission to acute hospitals and to reduce infection spread. OBJECTIVE The aim of this study was to assess the effectiveness and acceptability of CAHs and identify how the service might be improved or adapted for possible future use. DESIGN This was a mixed methods study, incorporating co-design with clinical stakeholders. Data collection was via an online survey and semistructured telephone interviews with staff and patients conducted between January and May 2021. SETTING AND PARTICIPANTS Thirty-one patients completed the survey and nine were interviewed. Twenty interviews were conducted with staff. RESULTS The findings suggest that the CAH model was successful in providing a dedicated pathway for assessing patients with COVID-19 symptoms, whilst mitigating the risk of infection. Patients were particularly positive about the timely, comprehensive and holistic care they received, as well as the accessibility of the clinics and the friendly attitudes of the staff. Staff welcomed the training and clinical protocols which contributed to their feelings of safety and competency in delivering care to this cohort of patients. They also highlighted the benefits of working in a multidisciplinary environment. Both staff and patients felt that the hubs could be repurposed for alternative use, including the treatment of chronic diseases. DISCUSSION This study describes staff and patients' experiences of these hubs. An unexpected outcome of this study is its demonstration of the true value of effective multidisciplinary working, not only for the staff who were deployed to this service but also for the patients in receipt of care in these hubs. CONCLUSION This multidisciplinary patient-centred service may provide a useful model for the delivery of other services currently delivered in hospital settings. PATIENT OR PUBLIC CONTRIBUTION An earlier phase of this study involved interviews with COVID-19-positive patients on a remote monitoring programme. The data informed this phase. Several of the authors had worked in the CAHs and provided valuable input into the design of the staff and patient interviews.
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Affiliation(s)
- Eilish McAuliffe
- IRIS Centre, School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
| | - Sophie Mulcahy Symmons
- IRIS Centre, School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
| | - Ciara Conlon
- Academic AffairsTrinity College DublinDublinIreland
| | - Lisa Rogers
- IRIS Centre, School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
| | - Aoife De Brún
- IRIS Centre, School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
| | | | - Niamh Keane
- Midwest Community Healthcare Organisation (CHO3)LimerickIreland
| | - Liam Glynn
- School of Medicine, University of Limerick & HRB Prmary Care Clinical Trials Network IrelandGalawyIreland
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O’Connor L, McAuliffe E, Casey M, Rogers L, Gallen A, Finnegan L, Glasgow ME, White M, White C, Kavanagh P, Bell M, Killeen A, Barnard M. Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care. J Res Nurs 2022; 27:655-676. [PMID: 36405804 PMCID: PMC9669935 DOI: 10.1177/17449871211021138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Background Despite representing the largest occupational group within the healthcare workforce, evidence suggests that due to the complexity of nursing practice, nurses' contribution remains 'invisible'. Quality Care Metrics aligned to standards can offer valuable numerical information that quantify input, output and dimensions of nursing care processes in complex clinical and interprofessional milieus. Aims and objectives Progress an evidence-based metric system to measure the quality and clinical safety of nursing care within acute care in Ireland. The objectives were to: classify quality care process nursing metrics and corresponding indicators pertinent to acute care; reach agreement on a selected set of robust metrics and corresponding indicators; and implement the findings of the study. Design A modified four-round Delphi study. Methods The modified Delphi study integrated a four-round survey of 422 nurses, face-to-face meetings with a patient representative and key stakeholders within acute services with a final consensus meeting inclusive of a panel of 26 expert nurse clinicians. Results There was consensus on 11 quality care process nursing metrics and 53 corresponding indicators for the acute care setting. Despite the rating of 'critical' in the Delphi rounds, a concern was reported by participants on the subjective nature of three of the developed metrics: 'patient experience', 'patient engagement' and 'professional and ethical approach to care' based on the absence of objective measurement tools that include patient input. Conversely, this led to the conundrum for the panel of experts at the final consensus meeting who were divided in their views on objectively observing, recording and subsequent auditing of those three developed metrics in real-time clinical practice. Conclusion This paper describes the operationalisation of a modified Delphi technique that progressed a set of 11 quality care process metrics and 53 corresponding indicators. The challenge now is the implementation of these quality care process metrics so that nurses' contribution to patient-centred care is tangible in acute care.
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Affiliation(s)
- Laserina O’Connor
- Professor, UCD School of Nursing Midwifery
& Health Systems, University College Dublin, Ireland
| | - Eilish McAuliffe
- Full Professor, UCD School of Nursing Midwifery
& Health Systems, University College Dublin, Ireland
| | - Mary Casey
- Associate Professor, UCD School of Nursing
Midwifery & Health Systems, University College Dublin, Ireland
| | - Lisa Rogers
- Lecturer, UCD School of Nursing Midwifery &
Health Systems, University College Dublin, Ireland
| | - Anne Gallen
- Director, Nursing & Midwifery Planning
Development Unit, Health Service Executive, Ireland
| | - Leonie Finnegan
- Quality Care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | | | - Mark White
- Vice-President, Department of Nursing,
Waterford Institute of Technology, Ireland
| | - Ciara White
- Assistant Lecturer, School of Nursing,
Psychotherapy, and Community Health, Dublin City University, Ireland
| | - Paula Kavanagh
- Quality care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | - Miriam Bell
- Quality Care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | - Angela Killeen
- Quality Care Metrics Project Officer, Nursing
& Midwifery Planning Development Unit, Health Service Executive,
Ireland
| | - Marlize Barnard
- Research Assistant, UCD School of Nursing
Midwifery & Health Systems, University College Dublin, Ireland
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16
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Rycroft-Malone J, Rogers L, Burton CR. Optimising the Conceptualisation of Context Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-country Analysis". Int J Health Policy Manag 2022; 11:2365-2367. [PMID: 37579347 PMCID: PMC9808282 DOI: 10.34172/ijhpm.2022.6900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/27/2022] [Indexed: 08/02/2023] Open
Abstract
Context matters. Therefore, efforts to develop greater conceptual clarity are important for science and practice. In this commentary, we outline some key issues that were prompted by Squire's et al.'s contribution. Specifically, we reinforce context as an interactive concept and therefore something that is hard to 'pin down', the problematic nature of conceptualising context in implementation and de-implementation, and a requirement for the development of culturally sensitive understandings. Finally, we suggest it is vital that continued investment into providing a more comprehensive list of determinants needs to be accompanied by an equal effort in developing practical methods and tools to support use and application.
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Affiliation(s)
| | - Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), Health Sciences Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
- Health Sciences Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland
| | - Christopher R. Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
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Drury A, O'Connell L, O'Brien A, Harkin M, Rogers L. CN62 Patient and public involvement in cancer research: The needs and perceptions of older adults living with and after cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.385] [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: 11/24/2022] Open
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Penning D, Cazacu S, Nizar R, Goldstein H, Kazimirsky G, Brown S, Rogers L, Brodie C. BSCI-05 REPURPOSING PROPOFOL FOR THE TREATMENT OF BRAIN METASTASES. Neurooncol Adv 2022. [PMCID: PMC9354200 DOI: 10.1093/noajnl/vdac078.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent clinical studies suggest beneficial effects of propofol anesthesia on tumor progression and patient survival in solid tumors but reported benefits are modest. One potential reason is the relatively short, single exposure to propofol, limited to the surgical period. Brain metastases (BM) are the most common brain tumors in adults. Metastatic tumors develop following infiltration of the brain from primary tumors such as lung, breast, melanoma, and colorectal cancers. BM are treated with combination therapies, including surgery, radiotherapy, chemotherapy, and immunotherapy, however the prognosis of most patients with BM remains dismal. In this report we investigated the effects of propofol plus radiation on cancer stem cells derived from human lung cancer brain metastases (BM-CSCs) and their cross-talk with microglia. OBJECTIVES Our hypothesis is that propofol can be repurposed as a treatment of BM in addition to its anesthetic uses. To test this, we first examined the cytotoxic effects of propofol on cancer stem cells established from BM-CSCs alone and with radiation. Also, we studied the effects of propofol on the cross-talk of BM-CSCs and microglia. RESULTS We found that propofol 1) exerted inhibitory effect on BM-CSCs self-renewal, stemness and cell proliferation; 2) increased cell death of cancer cells but not normal neural elements; 3) sensitized BM-CSCs to radiation; 4) inhibited the pro-tumorigenic BM-CSCs/ microglia cross-talk by promoting M1 phenotypes of co-cultured microglia. CONCLUSIONS Propofol exerted anti-tumor effects on BM-CSCs including inhibition of cell renewal, proliferation, and mesenchymal transition. Propofol at sensitized BM-GSCs to radiation and at higher concentrations induced cell death. Propofol exerted anti-tumor cytotoxicity also by inhibiting the pro-tumorigenic CSC-microglia cross-talk via secreted extracellular vesicles (EVs). Propofol effects can be exploited as a general anesthetic of choice during tumor resection and should be examined as an anti-tumor agent in sub-anesthetic doses either alone or in combination with radiation.
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Affiliation(s)
- Donald Penning
- Henry Ford Health Anesthesiology , Detroit, MI , USA
- Henry Ford Health Neurosurgery , Detroit, MI , USA
| | - Simona Cazacu
- Henry Ford Health Anesthesiology , Detroit, MI , USA
- Henry Ford Health Neurosurgery , Detroit, MI , USA
| | - Raphael Nizar
- Bar-Ilan University Faculty of Life Sciences , Ramat Gan , Israel
| | - Hodaya Goldstein
- Bar-Ilan University Faculty of Life Sciences , Ramat Gan , Israel
| | - Gila Kazimirsky
- Bar-Ilan University Faculty of Life Sciences , Ramat Gan , Israel
| | - Stephen Brown
- Henry Ford Health Department of Radiation-Oncology , Detroit, MI , USA
| | - Lisa Rogers
- Henry Ford Health Neurosurgery , Detroit, MI , USA
| | - Chaya Brodie
- Henry Ford Health Neurosurgery , Detroit, MI , USA
- Bar-Ilan University Faculty of Life Sciences , Ramat Gan , Israel
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Robin AM, Pawloski JA, Snyder JM, Walbert T, Rogers L, Mikkelsen T, Noushmehr H, Lee I, Rock J, Kalkanis SN, Rosenblum ML. Neurosurgery's Impact on Neuro-Oncology—“Can We Do Better?”—Lessons Learned Over 50 Years. Neurosurgery 2022; 68:17-26. [DOI: 10.1227/neu.0000000000001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 11/19/2022] Open
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Brannon J, Nguyen L, Eastman A, Rogers L, Hadjifrangiskou M, Aronoff D. Escherichia coli Forms Intracellular Bacterial Communities Within the Gestational Membranes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P. Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. Cochrane Database Syst Rev 2022; 2:CD014217. [PMID: 36321557 PMCID: PMC8805585 DOI: 10.1002/14651858.cd014217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Description of the condition Malaria, an infectious disease transmitted by the bite of female mosquitoes from several Anopheles species, occurs in 87 countries with ongoing transmission (WHO 2020). The World Health Organization (WHO) estimated that, in 2019, approximately 229 million cases of malaria occurred worldwide, with 94% occurring in the WHO's African region (WHO 2020). Of these malaria cases, an estimated 409,000 deaths occurred globally, with 67% occurring in children under five years of age (WHO 2020). Malaria also negatively impacts the health of women during pregnancy, childbirth, and the postnatal period (WHO 2020). Sulfadoxine/pyrimethamine (SP), an antifolate antimalarial, has been widely used across sub-Saharan Africa as the first-line treatment for uncomplicated malaria since it was first introduced in Malawi in 1993 (Filler 2006). Due to increasing resistance to SP, in 2000 the WHO recommended that one of several artemisinin-based combination therapies (ACTs) be used instead of SP for the treatment of uncomplicated malaria caused by Plasmodium falciparum (Global Partnership to Roll Back Malaria 2001). However, despite these recommendations, SP continues to be advised for intermittent preventive treatment in pregnancy (IPTp) and intermittent preventive treatment in infants (IPTi), whether the person has malaria or not (WHO 2013). Description of the intervention Folate (vitamin B9) includes both naturally occurring folates and folic acid, the fully oxidized monoglutamic form of the vitamin, used in dietary supplements and fortified food. Folate deficiency (e.g. red blood cell (RBC) folate concentrations of less than 305 nanomoles per litre (nmol/L); serum or plasma concentrations of less than 7 nmol/L) is common in many parts of the world and often presents as megaloblastic anaemia, resulting from inadequate intake, increased requirements, reduced absorption, or abnormal metabolism of folate (Bailey 2015; WHO 2015a). Pregnant women have greater folate requirements; inadequate folate intake (evidenced by RBC folate concentrations of less than 400 nanograms per millilitre (ng/mL), or 906 nmol/L) prior to and during the first month of pregnancy increases the risk of neural tube defects, preterm delivery, low birthweight, and fetal growth restriction (Bourassa 2019). The WHO recommends that all women who are trying to conceive consume 400 micrograms (µg) of folic acid daily from the time they begin trying to conceive through to 12 weeks of gestation (WHO 2017). In 2015, the WHO added the dosage of 0.4 mg of folic acid to the essential drug list (WHO 2015c). Alongside daily oral iron (30 mg to 60 mg elemental iron), folic acid supplementation is recommended for pregnant women to prevent neural tube defects, maternal anaemia, puerperal sepsis, low birthweight, and preterm birth in settings where anaemia in pregnant women is a severe public health problem (i.e. where at least 40% of pregnant women have a blood haemoglobin (Hb) concentration of less than 110 g/L). How the intervention might work Potential interactions between folate status and malaria infection The malaria parasite requires folate for survival and growth; this has led to the hypothesis that folate status may influence malaria risk and severity. In rhesus monkeys, folate deficiency has been found to be protective against Plasmodium cynomolgi malaria infection, compared to folate-replete animals (Metz 2007). Alternatively, malaria may induce or exacerbate folate deficiency due to increased folate utilization from haemolysis and fever. Further, folate status measured via RBC folate is not an appropriate biomarker of folate status in malaria-infected individuals since RBC folate values in these individuals are indicative of both the person's stores and the parasite's folate synthesis. A study in Nigeria found that children with malaria infection had significantly higher RBC folate concentrations compared to children without malaria infection, but plasma folate levels were similar (Bradley-Moore 1985). Why it is important to do this review The malaria parasite needs folate for survival and growth in humans. For individuals, adequate folate levels are critical for health and well-being, and for the prevention of anaemia and neural tube defects. Many countries rely on folic acid supplementation to ensure adequate folate status in at-risk populations. Different formulations for folic acid supplements are available in many international settings, with dosages ranging from 400 µg to 5 mg. Evaluating folic acid dosage levels used in supplementation efforts may increase public health understanding of its potential impacts on malaria risk and severity and on treatment failures. Examining folic acid interactions with antifolate antimalarial medications and with malaria disease progression may help countries in malaria-endemic areas determine what are the most appropriate lower dose folic acid formulations for at-risk populations. The WHO has highlighted the limited evidence available and has indicated the need for further research on biomarkers of folate status, particularly interactions between RBC folate concentrations and tuberculosis, human immunodeficiency virus (HIV), and antifolate antimalarial drugs (WHO 2015b). An earlier Cochrane Review assessed the effects and safety of iron supplementation, with or without folic acid, in children living in hyperendemic or holoendemic malaria areas; it demonstrated that iron supplementation did not increase the risk of malaria, as indicated by fever and the presence of parasites in the blood (Neuberger 2016). Further, this review stated that folic acid may interfere with the efficacy of SP; however, the efficacy and safety of folic acid supplementation on these outcomes has not been established. This review will provide evidence on the effectiveness of daily folic acid supplementation in healthy and malaria-infected individuals living in malaria-endemic areas. Additionally, it will contribute to achieving both the WHO Global Technical Strategy for Malaria 2016-2030 (WHO 2015d), and United Nations Sustainable Development Goal 3 (to ensure healthy lives and to promote well-being for all of all ages) (United Nations 2021), and evaluating whether the potential effects of folic acid supplementation, at different doses (e.g. 0.4 mg, 1 mg, 5 mg daily), interferes with the effect of drugs used for prevention or treatment of malaria. OBJECTIVES To examine the effects of folic acid supplementation, at various doses, on malaria susceptibility (risk of infection) and severity among people living in areas with various degrees of malaria endemicity. We will examine the interaction between folic acid supplements and antifolate antimalarial drugs. Specifically, we will aim to answer the following. Among uninfected people living in malaria endemic areas, who are taking or not taking antifolate antimalarials for malaria prophylaxis, does taking a folic acid-containing supplement increase susceptibility to or severity of malaria infection? Among people with malaria infection who are being treated with antifolate antimalarials, does folic acid supplementation increase the risk of treatment failure? METHODS Criteria for considering studies for this review Types of studies Inclusion criteria Randomized controlled trials (RCTs) Quasi-RCTs with randomization at the individual or cluster level conducted in malaria-endemic areas (areas with ongoing, local malaria transmission, including areas approaching elimination, as listed in the World Malaria Report 2020) (WHO 2020) Exclusion criteria Ecological studies Observational studies In vivo/in vitro studies Economic studies Systematic literature reviews and meta-analyses (relevant systematic literature reviews and meta-analyses will be excluded but flagged for grey literature screening) Types of participants Inclusion criteria Individuals of any age or gender, living in a malaria endemic area, who are taking antifolate antimalarial medications (including but not limited to sulfadoxine/pyrimethamine (SP), pyrimethamine-dapsone, pyrimethamine, chloroquine and proguanil, cotrimoxazole) for the prevention or treatment of malaria (studies will be included if more than 70% of the participants live in malaria-endemic regions) Studies assessing participants with or without anaemia and with or without malaria parasitaemia at baseline will be included Exclusion criteria Individuals not taking antifolate antimalarial medications for prevention or treatment of malaria Individuals living in non-malaria endemic areas Types of interventions Inclusion criteria Folic acid supplementation Form: in tablet, capsule, dispersible tablet at any dose, during administration, or periodically Timing: during, before, or after (within a period of four to six weeks) administration of antifolate antimalarials Iron-folic acid supplementation Folic acid supplementation in combination with co-interventions that are identical between the intervention and control groups. Co-interventions include: anthelminthic treatment; multivitamin or multiple micronutrient supplementation; 5-methyltetrahydrofolate supplementation. Exclusion criteria Folate through folate-fortified water Folic acid administered through large-scale fortification of rice, wheat, or maize Comparators Placebo No treatment No folic acid/different doses of folic acid Iron Types of outcome measures Primary outcomes Uncomplicated malaria (defined as a history of fever with parasitological confirmation; acceptable parasitological confirmation will include rapid diagnostic tests (RDTs), malaria smears, or nucleic acid detection (i.e. polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP), etc.)) (WHO 2010). This outcome is relevant for patients without malaria, given antifolate antimalarials for malaria prophylaxis. Severe malaria (defined as any case with cerebral malaria or acute P. falciparum malaria, with signs of severity or evidence of vital organ dysfunction, or both) (WHO 2010). This outcome is relevant for patients without malaria, given antifolate antimalarials for malaria prophylaxis. Parasite clearance (any Plasmodium species), defined as the time it takes for a patient who tests positive at enrolment and is treated to become smear-negative or PCR negative. This outcome is relevant for patients with malaria, treated with antifolate antimalarials. Treatment failure (defined as the inability to clear malaria parasitaemia or prevent recrudescence after administration of antimalarial medicine, regardless of whether clinical symptoms are resolved) (WHO 2019). This outcome is relevant for patients with malaria, treated with antifolate antimalarials. Secondary outcomes Duration of parasitaemia Parasite density Haemoglobin (Hb) concentrations (g/L) Anaemia: severe anaemia (defined as Hb less than 70 g/L in pregnant women and children aged six to 59 months; and Hb less than 80 g/L in other populations); moderate anaemia (defined as Hb less than 100 g/L in pregnant women and children aged six to 59 months; and less than 110 g/L in others) Death from any cause Among pregnant women: stillbirth (at less than 28 weeks gestation); low birthweight (less than 2500 g); active placental malaria (defined as Plasmodium detected in placental blood by smear or PCR, or by Plasmodium detected on impression smear or placental histology). Search methods for identification of studies A search will be conducted to identify completed and ongoing studies, without date or language restrictions. Electronic searches A search strategy will be designed to include the appropriate subject headings and text word terms related to each intervention of interest and study design of interest (see Appendix 1). Searches will be broken down by these two criteria (intervention of interest and study design of interest) to allow for ease of prioritization, if necessary. The study design filters recommended by the Scottish Intercollegiate Guidelines Network (SIGN), and those designed by Cochrane for identifying clinical trials for MEDLINE and Embase, will be used (SIGN 2020). There will be no date or language restrictions. Non-English articles identified for inclusion will be translated into English. If translations are not possible, advice will be requested from the Cochrane Infectious Diseases Group and the record will be stored in the "Awaiting assessment" section of the review until a translation is available. The following electronic databases will be searched for primary studies. Cochrane Central Register of Controlled Trials. Cumulative Index to Nursing and Allied Health Literature (CINAHL). Embase. MEDLINE. Scopus. Web of Science (both the Social Science Citation Index and the Science Citation Index). We will conduct manual searches of ClinicalTrials.gov, the International Clinical Trials Registry Platform (ICTRP), and the United Nations Children's Fund (UNICEF) Evaluation and Research Database (ERD), in order to identify relevant ongoing or planned trials, abstracts, and full-text reports of evaluations, studies, and surveys related to programmes on folic acid supplementation in malaria-endemic areas. Additionally, manual searches of grey literature to identify RCTs that have not yet been published but are potentially eligible for inclusion will be conducted in the following sources. Global Index Medicus (GIM). African Index Medicus (AIM). Index Medicus for the Eastern Mediterranean Region (IMEMR). Latin American & Caribbean Health Sciences Literature (LILACS). Pan American Health Organization (PAHO). Western Pacific Region Index Medicus (WPRO). Index Medicus for the South-East Asian Region (IMSEAR). The Spanish Bibliographic Index in Health Sciences (IBECS) (ibecs.isciii.es/). Indian Journal of Medical Research (IJMR) (journals.lww.com/ijmr/pages/default.aspx). Native Health Database (nativehealthdatabase.net/). Scielo (www.scielo.br/). Searching other resources Handsearches of the five journals with the highest number of included studies in the last 12 months will be conducted to capture any relevant articles that may not have been indexed in the databases at the time of the search. We will contact the authors of included studies and will check reference lists of included papers for the identification of additional records. For assistance in identifying ongoing or unpublished studies, we will contact the Division of Nutrition, Physical Activity, and Obesity (DNPAO) and the Division of Parasitic Diseases and Malaria (DPDM) of the CDC, the United Nations World Food Programme (WFP), Nutrition International (NI), Global Alliance for Improved Nutrition (GAIN), and Hellen Keller International (HKI). Data collection and analysis Selection of studies Two review authors will independently screen the titles and abstracts of articles retrieved by each search to assess eligibility, as determined by the inclusion and exclusion criteria. Studies deemed eligible for inclusion by both review authors in the abstract screening phase will advance to the full-text screening phase, and full-text copies of all eligible papers will be retrieved. If full articles cannot be obtained, we will attempt to contact the authors to obtain further details of the studies. If such information is not obtained, we will classify the study as "awaiting assessment" until further information is published or made available to us. The same two review authors will independently assess the eligibility of full-text articles for inclusion in the systematic review. If any discrepancies occur between the studies selected by the two review authors, a third review author will provide arbitration. Each trial will be scrutinized to identify multiple publications from the same data set, and the justification for excluded trials will be documented. A PRISMA flow diagram of the study selection process will be presented to provide information on the number of records identified in the literature searches, the number of studies included and excluded, and the reasons for exclusion (Moher 2009). The list of excluded studies, along with their reasons for exclusion at the full-text screening phase, will also be created. Data extraction and management Two review authors will independently extract data for the final list of included studies using a standardized data specification form. Discrepancies observed between the data extracted by the two authors will be resolved by involving a third review author and reaching a consensus. Information will be extracted on study design components, baseline participant characteristics, intervention characteristics, and outcomes. For individually randomized trials, we will record the number of participants experiencing the event and the number analyzed in each treatment group or the effect estimate reported (e.g. risk ratio (RR)) for dichotomous outcome measures. For count data, we will record the number of events and the number of person-months of follow-up in each group. If the number of person-months is not reported, the product of the duration of follow-up and the number of children evaluated will be used to estimate this figure. We will calculate the rate ratio and standard error (SE) for each study. Zero events will be replaced by 0.5. We will extract both adjusted and unadjusted covariate incidence rate ratios if they are reported in the original studies. For continuous data, we will extract means (arithmetic or geometric) and a measure of variance (standard deviation (SD), SE, or confidence interval (CI)), percentage or mean change from baseline, and the numbers analyzed in each group. SDs will be computed from SEs or 95% CIs, assuming a normal distribution of the values. Haemoglobin values in g/dL will be calculated by multiplying haematocrit or packed cell volume values by 0.34, and studies reporting haemoglobin values in g/dL will be converted to g/L. In cluster-randomized trials, we will record the unit of randomization (e.g. household, compound, sector, or village), the number of clusters in the trial, and the average cluster size. The statistical methods used to analyze the trials will be documented, along with details describing whether these methods adjusted for clustering or other covariates. We plan to extract estimates of the intra-cluster correlation coefficient (ICC) for each outcome. Where results are adjusted for clustering, we will extract the treatment effect estimate and the SD or CI. If the results are not adjusted for clustering, we will extract the data reported. Assessment of risk of bias in included studies Two review authors (KSC, LFY) will independently assess the risk of bias for each included trial using the Cochrane 'Risk of bias 2' tool (RoB 2) for randomized studies (Sterne 2019). Judgements about the risk of bias of included studies will be made according to the recommendations outlined in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2021). Disagreements will be resolved by discussion, or by involving a third review author. The interest of our review will be to assess the effect of assignment to the interventions at baseline. We will evaluate each primary outcome using the RoB2 tool. The five domains of the Cochrane RoB2 tool include the following. Bias arising from the randomization process. Bias due to deviations from intended interventions. Bias due to missing outcome data. Bias in measurement of the outcome. Bias in selection of the reported result. Each domain of the RoB2 tool comprises the following. A series of 'signalling' questions. A judgement about the risk of bias for the domain, facilitated by an algorithm that maps responses to the signalling questions to a proposed judgement. Free-text boxes to justify responses to the signalling questions and 'Risk of bias' judgements. An option to predict (and explain) the likely direction of bias. Responses to signalling questions elicit information relevant to an assessment of the risk of bias. These response options are as follows. Yes (may indicate either low or high risk of bias, depending on the most natural way to ask the question). Probably yes. Probably no. No. No information (may indicate no evidence of that problem or an absence of information leading to concerns about there being a problem). Based on the answer to the signalling question, a 'Risk of bias' judgement is assigned to each domain. These judgements include one of the following. High risk of bias Low risk of bias Some concerns To generate the risk of bias judgement for each domain in the randomized studies, we will use the Excel template, available at www.riskofbias.info/welcome/rob-2-0-tool/current-version-of-rob-2. This file will be stored on a scientific data website, available to readers. Risk of bias in cluster randomized controlled trials For the cluster randomized trials, we will be using the RoB2 tool to analyze the five standard domains listed above along with Domain 1b (bias arising from the timing of identification or recruitment of participants) and its related signalling questions. To generate the risk of bias judgement for each domain in the cluster RCTs, we will use the Excel template available at https://sites.google.com/site/riskofbiastool/welcome/rob-2-0-tool/rob-2-for-cluster-randomized-trials. This file will be stored on a scientific data website, available to readers. Risk of bias in cross-over randomized controlled trials For cross-over randomized trials, we will be using the RoB2 tool to analyze the five standard domains listed above along with Domain 2 (bias due to deviations from intended interventions), and Domain 3 (bias due to missing outcome data), and their respective signalling questions. To generate the risk of bias judgement for each domain in the cross-over RCTs, we will use the Excel template, available at https://sites.google.com/site/riskofbiastool/welcome/rob-2-0-tool/rob-2-for-crossover-trials, for each risk of bias judgement of cross-over randomized studies. This file will be stored on a scientific data website, available to readers. Overall risk of bias The overall 'Risk of bias' judgement for each specific trial being assessed will be based on each domain-level judgement. The overall judgements include the following. Low risk of bias (the trial is judged to be at low risk of bias for all domains). Some concerns (the trial is judged to raise some concerns in at least one domain but is not judged to be at high risk of bias for any domain). High risk of bias (the trial is judged to be at high risk of bias in at least one domain, or is judged to have some concerns for multiple domains in a way that substantially lowers confidence in the result). The 'risk of bias' assessments will inform our GRADE evaluations of the certainty of evidence for our primary outcomes presented in the 'Summary of findings' tables and will also be used to inform the sensitivity analyses; (see Sensitivity analysis). If there is insufficient information in study reports to enable an assessment of the risk of bias, studies will be classified as "awaiting assessment" until further information is published or made available to us. Measures of treatment effect Dichotomous data For dichotomous data, we will present proportions and, for two-group comparisons, results as average RR or odds ratio (OR) with 95% CIs. Ordered categorical data Continuous data We will report results for continuous outcomes as the mean difference (MD) with 95% CIs, if outcomes are measured in the same way between trials. Where some studies have reported endpoint data and others have reported change-from-baseline data (with errors), we will combine these in the meta-analysis, if the outcomes were reported using the same scale. We will use the standardized mean difference (SMD), with 95% CIs, to combine trials that measured the same outcome but used different methods. If we do not find three or more studies for a pooled analysis, we will summarize the results in a narrative form. Unit of analysis issues Cluster-randomized trials We plan to combine results from both cluster-randomized and individually randomized studies, providing there is little heterogeneity between the studies. If the authors of cluster-randomized trials conducted their analyses at a different level from that of allocation, and they have not appropriately accounted for the cluster design in their analyses, we will calculate the trials' effective sample sizes to account for the effect of clustering in data. When one or more cluster-RCT reports RRs adjusted for clustering, we will compute cluster-adjusted SEs for the other trials. When none of the cluster-RCTs provide cluster-adjusted RRs, we will adjust the sample size for clustering. We will divide, by the estimated design effects (DE), the number of events and number evaluated for dichotomous outcomes and the number evaluated for continuous outcomes, where DE = 1 + ((average cluster size 1) * ICC). The derivation of the estimated ICCs and DEs will be reported. We will utilize the intra-cluster correlation coefficient (ICC), derived from the trial (if available), or from another source (e.g., using the ICCs derived from other, similar trials) and then calculate the design effect with the formula provided in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2021). If this approach is used, we will report it and undertake sensitivity analysis to investigate the effect of variations in ICC. Studies with more than two treatment groups If we identify studies with more than two intervention groups (multi-arm studies), where possible we will combine groups to create a single pair-wise comparison or use the methods set out in the Cochrane Handbook to avoid double counting study participants (Higgins 2021). For the subgroup analyses, when the control group was shared by two or more study arms, we will divide the control group (events and total population) over the number of relevant subgroups to avoid double counting the participants. Trials with several study arms can be included more than once for different comparisons. Cross-over trials From cross-over trials, we will consider the first period of measurement only and will analyze the results together with parallel-group studies. Multiple outcome events In several outcomes, a participant might experience more than one outcome event during the trial period. For all outcomes, we will extract the number of participants with at least one event. Dealing with missing data We will contact the trial authors if the available data are unclear, missing, or reported in a format that is different from the format needed. We aim to perform a 'per protocol' or 'as observed' analysis; otherwise, we will perform a complete case analysis. This means that for treatment failure, we will base the analyses on the participants who received treatment and the number of participants for which there was an inability to clear malarial parasitaemia or prevent recrudescence after administration of an antimalarial medicine reported in the studies. Assessment of heterogeneity Heterogeneity in the results of the trials will be assessed by visually examining the forest plot to detect non-overlapping CIs, using the Chi2 test of heterogeneity (where a P value of less than 0.1 indicates statistical significance) and the I2 statistic of inconsistency (with a value of greater than 50% denoting moderate levels of heterogeneity). When statistical heterogeneity is present, we will investigate the reasons for it, using subgroup analysis. Assessment of reporting biases We will construct a funnel plot to assess the effect of small studies for the main outcome (when including more than 10 trials). Data synthesis The primary analysis will include all eligible studies that provide data regardless of the overall risk of bias as assessed by the RoB2 tool. Analyses will be conducted using Review Manager 5.4 (Review Manager 2020). Cluster-RCTs will be included in the main analysis after adjustment for clustering (see the previous section on cluster-RCTs). The meta-analysis will be performed using the Mantel-Haenszel random-effects model or the generic inverse variance method (when adjustment for clustering is performed by adjusting SEs), as appropriate. Subgroup analysis and investigation of heterogeneity The overall risk of bias will not be used as the basis in conducting our subgroup analyses. However, where data are available, we plan to conduct the following subgroup analyses, independent of heterogeneity. Dose of folic acid supplementation: higher doses (4 mg or more, daily) versus lower doses (less than 4 mg, daily). Moderate-severe anaemia at baseline (mean haemoglobin of participants in a trial at baseline below 100 g/L for pregnant women and children aged six to 59 months, and below 110 g/L for other populations) versus normal at baseline (mean haemoglobin above 100 g/L for pregnant women and children aged six to 59 months, and above 110 g/L for other populations). Antimalarial drug resistance to parasite: known resistance versus no resistance versus unknown/mixed/unreported parasite resistance. Folate status at baseline: Deficient (e.g. RBC folate concentration of less than 305 nmol/L, or serum folate concentration of less than 7nmol/L) and Insufficient (e.g. RBC folate concentration from 305 to less than 906 nmol/L, or serum folate concentration from 7 to less than 25 nmol/L) versus Sufficient (e.g. RBC folate concentration above 906 nmol/L, or serum folate concentration above 25 nmol/L). Presence of anaemia at baseline: yes versus no. Mandatory fortification status: yes, versus no (voluntary or none). We will only use the primary outcomes in any subgroup analyses, and we will limit subgroup analyses to those outcomes for which three or more trials contributed data. Comparisons between subgroups will be performed using Review Manager 5.4 (Review Manager 2020). Sensitivity analysis We will perform a sensitivity analysis, using the risk of bias as a variable to explore the robustness of the findings in our primary outcomes. We will verify the behaviour of our estimators by adding and removing studies with a high risk of bias overall from the analysis. That is, studies with a low risk of bias versus studies with a high risk of bias. Summary of findings and assessment of the certainty of the evidence For the assessment across studies, we will use the GRADE approach, as outlined in (Schünemann 2021). We will use the five GRADE considerations (study limitations based on RoB2 judgements, consistency of effect, imprecision, indirectness, and publication bias) to assess the certainty of the body of evidence as it relates to the studies which contribute data to the meta-analyses for the primary outcomes. The GRADEpro Guideline Development Tool (GRADEpro) will be used to import data from Review Manager 5.4 (Review Manager 2020) to create 'Summary of Findings' tables. The primary outcomes for the main comparison will be listed with estimates of relative effects, along with the number of participants and studies contributing data for those outcomes. These tables will provide outcome-specific information concerning the overall certainty of evidence from studies included in the comparison, the magnitude of the effect of the interventions examined, and the sum of available data on the outcomes we considered. We will include only primary outcomes in the summary of findings tables. For each individual outcome, two review authors (KSC, LFY) will independently assess the certainty of the evidence using the GRADE approach (Balshem 2011). For assessments of the overall certainty of evidence for each outcome that includes pooled data from included trials, we will downgrade the evidence from 'high certainty' by one level for serious (or by two for very serious) study limitations (risk of bias, indirectness of evidence, serious inconsistency, imprecision of effect estimates, or potential publication bias).
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Affiliation(s)
- Krista Crider
- National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Williams
- National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yan Ping Qi
- National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julie Gutman
- Division of Parasitic Diseases & Malaria, Malaria Branch, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Roybal Campus, Atlanta, GA, USA
| | - Lorraine Yeung
- National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cara Mai
- National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia Finkelstain
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Clara Pons-Duran
- ISGlobal, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
| | - Cinta Moraleda
- ISGlobal, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
| | - Lisa Rogers
- Food & Nutrition Action in Health Systems, Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | | | - Patricia Green
- National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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22
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Horvath A, Rogers L, Pollakis G, Baranov O, Pieroth N, Joseph S, Chachage M, Heitzer A, Maganga L, Msafiri F, Joachim A, Viegas E, Eller LA, Kibuuka H, Rerks-Ngarm S, Pitisuttithum P, Nitayapan S, Dhitavat J, Premsri N, Fidler S, Shattock RJ, Robb ML, Weber J, McCormack S, Munseri PJ, Lyamuya E, Nilsson C, Kroidl A, Hoelscher M, Wagner R, Geldmacher C, Held K. Systematic comparison of HIV-1 Envelope-specific IgG responses induced by different vaccination regimens: Can we steer IgG recognition towards regions of viral vulnerability? Front Immunol 2022; 13:1075606. [PMID: 36741409 PMCID: PMC9891136 DOI: 10.3389/fimmu.2022.1075606] [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: 10/20/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Immunogens and vaccination regimens can influence patterns of immune-epitope recognition, steering them towards or away from epitopes of potential viral vulnerability. HIV-1 envelope (Env)-specific antibodies targeting variable region 2 (V2) or 3 (V3) correlated with protection during the RV144 trial, however, it was suggested that the immunodominant V3 region might divert antibody responses away from other relevant sites. We mapped IgG responses against linear Env epitopes in five clinical HIV vaccine trials, revealing a specific pattern of Env targeting for each regimen. Notable V2 responses were only induced in trials administering CRF01_AE based immunogens, but targeting of V3 was seen in all trials, with the soluble, trimeric CN54gp140 protein eliciting robust V3 recognition. Strong V3 targeting was linked to greater overall response, increased number of total recognised antigenic regions, and where present, stronger V2 recognition. Hence, strong induction of V3-specific antibodies did not negatively impact the targeting of other linear epitopes in this study, suggesting that the induction of antibodies against V3 and other regions of potential viral vulnerability need not be necessarily mutually exclusive.
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Affiliation(s)
- Augusta Horvath
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Lisa Rogers
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Georgios Pollakis
- Institute of Infection Veterinary and Ecological Sciences (IVES/CIMI), University of Liverpool, Liverpool, United Kingdom
| | - Olga Baranov
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Nora Pieroth
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Sarah Joseph
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Mkunde Chachage
- National Institute for Medical Research-Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Asli Heitzer
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Lucas Maganga
- National Institute for Medical Research-Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Frank Msafiri
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Agricola Joachim
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Edna Viegas
- Instituto Nacional de Saúde, Maputo, Mozambique
| | - Leigh-Anne Eller
- United States Military HIV Research Program, Silver Spring, MD, United States.,Makerere University Walter Reed Project, Kampala, Uganda.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Supachai Rerks-Ngarm
- Department of Disease Control, Ministry of Public Health, Mueang Nonthaburi, Thailand
| | | | | | - Jittima Dhitavat
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nakorn Premsri
- Department of Disease Control, Ministry of Public Health, Mueang Nonthaburi, Thailand
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Robin J Shattock
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Merlin Lee Robb
- United States Military HIV Research Program, Silver Spring, MD, United States.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Jonathan Weber
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Sheena McCormack
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | | | - Eligius Lyamuya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Charlotta Nilsson
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden.,The Public Health Agency of Sweden, Solna, Sweden
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Ralf Wagner
- Institute of Medical Microbiology and Hygiene, University Regensburg, Regensburg, Germany.,Institute of Clinical Microbiology and Hygiene; University Hospital Regensburg, Regensburg, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Kathrin Held
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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23
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De Brún A, Rogers L, Drury A, Gilmore B. Evaluation of a formative peer assessment in research methods teaching using an online platform: A mixed methods pre-post study. Nurse Educ Today 2022; 108:105166. [PMID: 34656036 DOI: 10.1016/j.nedt.2021.105166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In higher education settings, there are increasing calls to shift away from traditional summative assessment practices, such end of term written tests, to explore methods of assessing learning in alternative ways. Peer assessment has been advocated as a means of formative assessment to enhance student engagement, empowering students to take responsibility for their own learning. While there is accumulating evidence for the value of peer assessment in higher education, one cannot assume peer feedback will translate appropriately to all settings and educational contexts. OBJECTIVES This study evaluated the implementation of formative online peer assessment in a nursing and midwifery research methods module. We explored students' expectations, experiences, and ultimately the acceptability of this approach. DESIGN A quantitative descriptive study. SETTING Ireland. METHODS An online survey to collate expectations and experiences of engagement in peer assessment. Scales were drawn from previous research and non-parametric tests explored changes in perceptions over time. Qualitative content analysis explored patterns evident in open-text responses. RESULTS The response rate was 28% (n = 74) at baseline and 31% at follow-up (n = 81). Peer assessment was a new experience for 95% of respondents. Students initially expressed apprehension, perceiving the task as daunting, and doubting their ability to provide feedback to peers. However, through providing instruction and tools to support students in the activity, high levels of satisfaction with the process and the experience were reported. Significant differences in perceptions of peer assessment were evident over time, including an enhanced belief that respondents had the requisite skills to appraise the work of their peers. CONCLUSIONS In sum, nursing and midwifery students agreed that peer assessment was a valuable learning experience as part of research methods training and critical skills development.
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Affiliation(s)
- A De Brún
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland; School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - L Rogers
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland; School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - A Drury
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - B Gilmore
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland; School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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24
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Duncan K, Arafah B, Rogers L. DDRE-41. TREATMENT OF REFRACTORY PITUITARY NEOPLASMS WITH TEMOZOLOMIDE IN THREE PATIENTS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
There is relatively little information regarding the efficacy of temozolomide (TMZ) for pituitary adenomas; less than 100 cases treated with TMZ are reported, with a variable response rate of 50-75%, depending on response criteria.
METHODS
Retrospective review of patients with pituitary tumors treated with TMZ at University Hospitals Cleveland Medical Center.
RESULTS
Three patients were identified. Patient age at the time of TMZ treatment was 20, 51, and 70 years. Two were female, one male. Histology was prolactinoma in two and Cushing’s disease in one. Each patient had undergone multiple surgeries and medical treatments with insufficient response or relapse. Two had received radiosurgery; it was withheld in a 20 year old male due to concerns of optic nerve radiation injury. A 5d q 28d regimen was used in each, beginning at 150mg/M2 daily for initial dose then increased to 200mg/M2 daily. Diplopia and headache improved in one patient, whose serum prolactin significantly declined (222.8 to 81.9 ng/ml). Headache resolved in another patient and prolactin remained stable. In the patient with Cushing’s disease, headaches improved and ACTH remained elevated but stable. The tumor remained stable on MRI in each patient. There were no adverse effects from TMZ used over 5 to 29 months.
CONCLUSIONS
Our clinical experience adds to the limited published information regarding the effectiveness of TMZ for pituitary adenomas. In our case series, clinical improvement was noted in each of 3 patients with pituitary adenomas that had failed or recurred after other therapies. Serum prolactin significantly declined in one patient. This data suggests a beneficial role for TMZ in treating pituitary adenomas.
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Affiliation(s)
- Kelsey Duncan
- Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Baha Arafah
- Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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25
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Elrayah EE, Rogers L, Doggui R, Al-Jawaldeh A. Vitamin D Insufficiency and Deficiency in the Eastern Mediterranean Region (EMR)-Misconceptions in Public Health Practice: A Scoping Review 2019-2020. J Nutr Sci Vitaminol (Tokyo) 2021; 66:389-395. [PMID: 33132340 DOI: 10.3177/jnsv.66.389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Vitamin D insufficiency and deficiency are a growing concern in the reasonably sunny Eastern Mediterranean Region (EMR). Variances in the metabolism of vitamin D across populations were observed and several biological and environmental factors are reported to affect its pathways and regulatory mechanisms. Methodologies for the assessment of vitamin D indicator metabolite and threshold levels for inadequacy remain evidently controversial. This review was conducted to appraise how vitamin D status is evaluated in populations of EMR. Online databases including PubMed and Google Scholar, and websites of UN agencies and ministries of health were searched thoroughly. Surveys and cross-sectional studies conducted between 2009 and 2019 which are reporting vitamin D levels in countries of EMR were retrieved and included in this review. Surveys from Afghanistan, Iran, Iraq, Jordan, Kuwait, Oman, Pakistan, and Saudi Arabia, were included in this review. The indicator mostly reported for vitamin D status assessment was 25-hydroxyvitamin D in serum samples. Differences between countries in the cut-off levels used for assessment of vitamin D status were observed. Mostly the surveys adopted either the Institute of Medicine (IOM) or the Endocrine Society (ES) guidance, but even those showed overlap in defining insufficiency and deficiency. This discordance in cut-offs jeopardizes the credibility of results and regional and global comparability. We concluded that there is a lack of consensus on the methodologies used to assess vitamin D levels across EMR. There is an urgent need for guidance on clinical and public health practices on the assessment of vitamin D status.
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Affiliation(s)
- Eglal E Elrayah
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO)
| | - Lisa Rogers
- Department of Nutrition for Health and Development, World Health Organization
| | - Radhouene Doggui
- Department of Family Medicine, Université de Sherbrooke.,Centre de Formation Médicale du Nouveau-Brunswick
| | - Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO)
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26
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Pawloski J, Fadel H, Haider S, Rogers L, Lee I, Robin A. SURG-14. Laser Ablation for Brain Metastases: Risk Factors for Neurologic Complication. Neurooncol Adv 2021. [PMCID: PMC8351207 DOI: 10.1093/noajnl/vdab071.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Laser interstitial thermal therapy (LITT) is a routinely used in treatment of recurrent brain metastases following SRS or open craniotomy. While considered safer than craniotomy, patients do experience neurologic decline following LITT. Identifying which patients are at risk for neurologic deterioration can help better advise patients on the most appropriate treatment options for their tumor. Objective The objective of the present study was to assess the frequency and identify risk factors for neurologic decline following LITT. Methods Data was gathered on patients who underwent LITT for ablation of metastatic brain tumors at our institution between 2014–2019. These cases were analyzed retrospectively and data was collected on patient demographics, tumor characteristics, procedural details, and post-operative complications and outcomes. Pre-operative neurologic function was compared to neurologic status at the 6–12 week post-op visit. Results 16 patients underwent LITT of a total of 18 metastatic lesions during the study time period and were included in the analysis. 7/16 patients demonstrated reduced KPS or worse neurologic function at 6–12 week follow up. 4 patients (25%) demonstrated neurologic deficits that were attributable to the laser ablation procedure, and each of these 4 patients had lesions in eloquent areas. Comparatively, none of the other 12 patients analyzed had eloquent lesions (p = 0.002). The presence of a pre-op neurologic deficit was not predictive of worsening neurologic function following LITT (p = 0.35). Average lesion size in patients who experienced neurologic deficit was 5.69cm3 compared to 3.15cm3 in those that did not (p = 0.1). Conclusion Our complications rate is similar to other published case series (15–44%). LITT, while better tolerated than standard craniotomy, can lead to neurologic decline in patients with brain metastases regardless of lesion size or pre-operative functional status. Eloquence is a significant predictor of neurologic complications following laser ablation.
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Affiliation(s)
| | | | | | - Lisa Rogers
- Henry Ford Hospital, Detroit, MI, USA
- Hermelin Brain Tumor Center, Detroit, MI, USA
| | - Ian Lee
- Henry Ford Hospital, Detroit, MI, USA
- Hermelin Brain Tumor Center, Detroit, MI, USA
| | - Adam Robin
- Henry Ford Hospital, Detroit, MI, USA
- Hermelin Brain Tumor Center, Detroit, MI, USA
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27
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Rogers L, Chen B, Liu K, McKenzie D, Suchowerska N, Kwan A. PD-0934 Spatial modulation enhances the effects of radiation on cancer cells. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07213-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Hauser A, Carnell G, Held K, Sulbaran G, Tischbierek N, Rogers L, Pollakis G, Tonks P, Hoelscher M, Ding S, Sanders RW, Geldmacher C, Sattentau Q, Weissenhorn W, Heeney JL, Peterhoff D, Wagner R. Stepwise Conformational Stabilization of a HIV-1 Clade C Consensus Envelope Trimer Immunogen Impacts the Profile of Vaccine-Induced Antibody Responses. Vaccines (Basel) 2021; 9:750. [PMID: 34358165 PMCID: PMC8310183 DOI: 10.3390/vaccines9070750] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 01/16/2023] Open
Abstract
Stabilization of the HIV-1 Envelope glycoprotein trimer (Env) in its native pre-fusion closed conformation is regarded as one of several requirements for the induction of neutralizing antibody (nAb) responses, which, in turn, will most likely be a prerequisite for the development of an efficacious preventive vaccine. Here, we systematically analyzed how the stepwise stabilization of a clade C consensus (ConC) Env immunogen impacts biochemical and biophysical protein traits such as antigenicity, thermal stability, structural integrity, and particle size distribution. The increasing degree of conformational rigidification positively correlates with favorable protein characteristics, leading to optimized homogeneity of the protein preparations, increased thermal stability, and an overall favorable binding profile of structure-dependent broadly neutralizing antibodies (bnAbs) and non-neutralizing antibodies (non-nAbs). We confirmed that increasing the structural integrity and stability of the Env trimers positively correlates with the quality of induced antibody responses by the immunogens. These and other data contribute to the selection of ConCv5 KIKO as novel Env immunogens for use within the European Union's H2020 Research Consortium EHVA (European HIV Alliance) for further preclinical analysis and phase 1 clinical development.
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Affiliation(s)
- Alexandra Hauser
- Institute of Medical Microbiology and Hygiene, Molecular Microbiology (Virology), University of Regensburg, 93053 Regensburg, Germany; (A.H.); (N.T.); (D.P.)
| | - George Carnell
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK; (G.C.); (P.T.); (J.L.H.)
| | - Kathrin Held
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (K.H.); (L.R.); (M.H.); (C.G.)
- German Center for Infection Research (DZIF), Partner site Munich, 80802 Munich, Germany
| | - Guidenn Sulbaran
- Institut de Biologie Structurale (IBS), University Grenoble Alpes, CEA, CNRS, 38000 Grenoble, France; (G.S.); (W.W.)
| | - Nadine Tischbierek
- Institute of Medical Microbiology and Hygiene, Molecular Microbiology (Virology), University of Regensburg, 93053 Regensburg, Germany; (A.H.); (N.T.); (D.P.)
| | - Lisa Rogers
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (K.H.); (L.R.); (M.H.); (C.G.)
- German Center for Infection Research (DZIF), Partner site Munich, 80802 Munich, Germany
| | - Georgios Pollakis
- Department of Clinical Infection, Microbiology, and Immunology (CIMI), University of Liverpool, Liverpool L69 7BE, UK;
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections (HPRU EZI), Liverpool L69 7BE, UK
| | - Paul Tonks
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK; (G.C.); (P.T.); (J.L.H.)
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (K.H.); (L.R.); (M.H.); (C.G.)
- German Center for Infection Research (DZIF), Partner site Munich, 80802 Munich, Germany
| | - Song Ding
- EuroVacc Foundation, 1105 BP Amsterdam, The Netherlands;
| | - Rogier W. Sanders
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10021, USA
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (K.H.); (L.R.); (M.H.); (C.G.)
- German Center for Infection Research (DZIF), Partner site Munich, 80802 Munich, Germany
| | - Quentin Sattentau
- The Sir Willian Dunn School of Pathology, The University of Oxford, Oxford OX1 3RE, UK;
| | - Winfried Weissenhorn
- Institut de Biologie Structurale (IBS), University Grenoble Alpes, CEA, CNRS, 38000 Grenoble, France; (G.S.); (W.W.)
| | - Jonathan L. Heeney
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK; (G.C.); (P.T.); (J.L.H.)
| | - David Peterhoff
- Institute of Medical Microbiology and Hygiene, Molecular Microbiology (Virology), University of Regensburg, 93053 Regensburg, Germany; (A.H.); (N.T.); (D.P.)
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Ralf Wagner
- Institute of Medical Microbiology and Hygiene, Molecular Microbiology (Virology), University of Regensburg, 93053 Regensburg, Germany; (A.H.); (N.T.); (D.P.)
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, 93053 Regensburg, Germany
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29
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O'Donovan R, Rogers L, Khurshid Z, De Brún A, Nicholson E, O'Shea M, Ward M, McAuliffe E. A systematic review exploring the impact of focal leader behaviours on health care team performance. J Nurs Manag 2021; 29:1420-1443. [PMID: 34196046 DOI: 10.1111/jonm.13403] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/28/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study is to understand how the behaviour of focal leaders impacts health care team performance and effectiveness. BACKGROUND Despite recent shifts towards more collectivistic leadership approaches, hierarchical structures that emphasize the role of an individual focal leader (i.e., the formal appointed leader) are still the norm in health care. Our understanding of the effect of focal leader behaviours on health care team performance remains unclear. EVALUATION A systematic review was conducted. Five electronic databases were searched using key terms. One thousand forty-seven records were retrieved. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. KEY ISSUES Fifty papers met the criteria for inclusion, were reviewed and synthesized under the following categories: task-focused leadership, directive leadership, empowering leadership and relational focused leadership. CONCLUSIONS Categories are discussed in relation to team performance outcomes, safety specific outcomes, individual-level outcomes and outcomes related to interpersonal dynamics. Emerging themes are explored to examine and reflect on how leadership is enacted in health care, to catalogue best practices and to cascade these leadership practices broadly. IMPLICATIONS FOR NURSING MANAGEMENT Empowering and relational leadership styles were associated with positive outcomes for nursing team performance. This underscores the importance of training and encouraging nursing leaders to engage in more collaborative leadership behaviours.
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Affiliation(s)
- Róisín O'Donovan
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Lisa Rogers
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Zuneera Khurshid
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Emma Nicholson
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Marie O'Shea
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Marie Ward
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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30
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Tesileanu CMS, van den Bent MJ, Sanson M, Wick W, Brandes AA, Clement PM, Erridge SC, Vogelbaum MA, Nowak AK, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Rogers L, Taal W, Rudà R, Weller M, McBain C, van Linde ME, Sabedot TS, Hoogstrate Y, von Deimling A, de Heer I, van IJcken WFJ, Brouwer RWW, Aldape K, Jenkins RB, Dubbink HJ, Kros JM, Wesseling P, Cheung KJ, Golfinopoulos V, Baumert BG, Gorlia T, Noushmehr H, French PJ. Prognostic significance of genome-wide DNA methylation profiles within the randomised, phase 3, EORTC CATNON trial on non-1p/19q deleted anaplastic glioma. Neuro Oncol 2021; 23:1547-1559. [PMID: 33914057 PMCID: PMC8408862 DOI: 10.1093/neuonc/noab088] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 12/27/2022] Open
Abstract
Background Survival in patients with IDH1/2-mutant (mt) anaplastic astrocytomas is highly variable. We have used the prospective phase 3 CATNON trial to identify molecular factors related to outcome in IDH1/2mt anaplastic astrocytoma patients. Methods The CATNON trial randomized 751 adult patients with newly diagnosed 1p/19q non-codeleted anaplastic glioma to 59.4 Gy radiotherapy +/− concurrent and/or adjuvant temozolomide. The presence of necrosis and/or microvascular proliferation was scored at central pathology review. Infinium MethylationEPIC BeadChip arrays were used for genome-wide DNA methylation analysis and the determination of copy number variations (CNV). Two DNA methylation-based tumor classifiers were used for risk stratification. Next-generation sequencing (NGS) was performed using 1 of the 2 glioma-tailored NGS panels. The primary endpoint was overall survival measured from the date of randomization. Results Full analysis (genome-wide DNA methylation and NGS) was successfully performed on 654 tumors. Of these, 432 tumors were IDH1/2mt anaplastic astrocytomas. Both epigenetic classifiers identified poor prognosis patients that partially overlapped. A predictive prognostic Cox proportional hazard model identified that independent prognostic factors for IDH1/2mt anaplastic astrocytoma patients included; age, mini-mental state examination score, treatment with concurrent and/or adjuvant temozolomide, the epigenetic classifiers, PDGFRA amplification, CDKN2A/B homozygous deletion, PI3K mutations, and total CNV load. Independent recursive partitioning analysis highlights the importance of these factors for patient prognostication. Conclusion Both clinical and molecular factors identify IDH1/2mt anaplastic astrocytoma patients with worse outcome. These results will further refine the current WHO criteria for glioma classification.
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Affiliation(s)
- C M S Tesileanu
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | | | - M Sanson
- Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - W Wick
- Neurology Department, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - A A Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - P M Clement
- Oncology Department, KU Leuven and Medical Oncology Department, UZ Leuven, Leuven, Belgium
| | - S C Erridge
- Neuro-Oncology Centre Edinburgh, Western General Hospital, Edinburgh, UK
| | - M A Vogelbaum
- Neuro-Oncology Department, Moffitt Cancer Center, Tampa, Florida, USA
| | - A K Nowak
- University of Western Australia, Perth, Australia; Co-Operative Group for Neuro-Oncology, University of Sydney, Sydney, Australia; Medical Oncology Department, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - J F Baurain
- Medical Oncology Department, King Albert II Cancer Institute, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - W P Mason
- Princess Margaret Cancer Centre, Toronto, Canada
| | - H Wheeler
- Northern Sydney Cancer Centre, Sydney, Australia
| | - O L Chinot
- Neuro-Oncology Department, Aix-Marseille University, Marseille, France
| | - S Gill
- Medical Oncology Department, Alfred Hospital, Melbourne, Australia
| | - M Griffin
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Rogers
- Radiation Oncology Department, Gammawest Cancer Services, Salt Lake City, UT, USA
| | - W Taal
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | - R Rudà
- Neuro-Oncology Department, University of Turin, Turin, Italy
| | - M Weller
- Neurology Department, University Hospital of Zurich, Zurich, Switzerland
| | - C McBain
- Clinical Oncology Department, The Christie NHS FT, Manchester, UK
| | - M E van Linde
- Medical Oncology Department, Amsterdam UMC, Amsterdam, the Netherlands
| | - T S Sabedot
- Neurosurgery Department, Henry Ford Health System, Detroit, MI, USA
| | - Y Hoogstrate
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | - A von Deimling
- Neuropathology Department, Ruprecht-Karls-University and, CCU Neuropathology, German Cancer Institute and Consortium, DKFZ, and DKTK, Heidelberg, Germany
| | - I de Heer
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
| | | | - R W W Brouwer
- Biomics Center, Erasmus MC, Rotterdam, the Netherlands
| | - K Aldape
- Princess Margaret Cancer Centre, Toronto, Canada
| | - R B Jenkins
- Pathology Department, Mayo Clinic, Rochester, MN, USA
| | - H J Dubbink
- Pathology Department, Erasmus MC, Rotterdam, the Netherlands
| | - J M Kros
- Pathology Department, Erasmus MC, Rotterdam, the Netherlands
| | - P Wesseling
- Pathology Department, Amsterdam UMC, Amsterdam, the Netherlands; Princess Máxima Center, Utrecht, the Netherlands
| | | | | | - B G Baumert
- Radiation-Oncology Department, Maastricht UMC, Maastricht, the Netherlands; Radiation-Oncology Institute, Cantonal Hospital Graubünden, Chur, Switzerland
| | | | - H Noushmehr
- Neurosurgery Department, Henry Ford Health System, Detroit, MI, USA
| | - P J French
- Neurology Department, Erasmus MC, Rotterdam, the Netherlands
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Rogers L, De Brún A, Birken SA, Davies C, McAuliffe E. Context counts: a qualitative study exploring the interplay between context and implementation success. J Health Organ Manag 2021; ahead-of-print. [PMID: 33682395 PMCID: PMC9073593 DOI: 10.1108/jhom-07-2020-0296] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE Implementing change in healthcare is difficult to accomplish due to the unpredictability associated with challenging the status quo. Adapting the intervention/practice/program being implemented to better fit the complex context is an important aspect of implementation success. Despite the acknowledged influence of context, the concept continues to receive insufficient attention at the team-level within implementation research. Using two heterogeneous multidisciplinary healthcare teams as implementation case studies, this study evaluates the interplay between context and implementation and highlights the ways in which context influences the introduction of a collective leadership intervention in routine practice. DESIGN/METHODOLOGY/APPROACH The multiple case study design adopted, employed a triangulation of qualitative research methods which involved observation (Case A = 16 h, Case B = 15 h) and interview data (Case A = 13 participants, Case B = 12 participants). Using an inductive approach, an in-depth thematic analysis of the data outlined the relationship between team-level contextual factors and implementation success. FINDINGS Themes are presented under the headings: (1) adapting to the everyday realities, a key determinant for implementation success and (2) implementation stimulating change in context. The findings demonstrate a dynamic relationship between context and implementation. The challenges of engaging busy healthcare professionals emphasised that mapping the contextual complexity of a site and adapting implementation accordingly is essential to enhance the likelihood of successful implementation. However, implementation also altered the surrounding context, stimulating changes within both teams. ORIGINALITY/VALUE By exposing the reciprocal relationship between team-level contextual factors and implementation, this research supports the improved design of implementation strategies through better understanding the interplay and mutual evolution of evidence-based healthcare interventions within different contexts.
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Affiliation(s)
- Lisa Rogers
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Sarah A Birken
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carmel Davies
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
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Abstract
Complementary feeding, when foods are introduced to complement a milk-based diet, generally occurs between 6 and 23 months of age. It is a critical period for both physical and cognitive development. During this period, the growth rate of the brain is one of the fastest during the life span and, consequently, the timing, dose, and duration of exposure to specific nutrients can result in both positive and negative effects. Complementary feeding is more than ensuring an adequate intake of nutrients; it also is about avoiding excess intakes of calories, salt, sugars, and unhealthy fats. Meals are cultural and social events where young children observe, imitate, learn about foods to like or dislike, and form lifelong eating habits and practices. Meals are also when a child learns to touch foods and connect food tastes to how foods look and feel. Ideally, complementary feeding is responsive and promotes child autonomy, but it can also be used to manage behavior problems or overly indulge a child, resulting in long-term consequences for nutrition and health. Therefore, in addition to what a child is fed, attention to how a child is fed is also important. In this review, 12 topics relevant for updating global guidance on complementary feeding were identified: age of introduction of complementary foods; continued breastfeeding; responsive feeding; safe preparation and storage of complementary foods; food textures, flavors, and acceptance; energy and meal and snack frequency; fats, protein, and carbohydrates; dietary diversity; milks other than breast milk; fluid needs; unhealthy foods and beverages; and use of vitamin and mineral supplements or supplementary foods.
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Affiliation(s)
- Chessa K Lutter
- Division of Food Security and Agriculture, RTI International, Washington, DC, USA
| | | | - Lisa Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
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Medina‐Rivera M, Centeno‐Tablante E, Finkelstein JL, Rayco‐Solon P, Peña‐Rosas JP, Garcia‐Casal MN, Rogers L, Ridwan P, Martinez SS, Andrade J, Layden AJ, Chang J, Zambrano MP, Ghezzi‐Kopel K, Mehta S. Presence of Ebola virus in breast milk and risk of mother-to-child transmission: synthesis of evidence. Ann N Y Acad Sci 2021; 1488:33-43. [PMID: 33113592 PMCID: PMC8048832 DOI: 10.1111/nyas.14519] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/16/2020] [Accepted: 10/08/2020] [Indexed: 12/28/2022]
Abstract
To help inform global guidelines on infant feeding, this systematic review synthesizes evidence related to the presence of the Ebola virus (EBOV) in breast milk and its potential risk of viral transmission to the infant when breastfeeding. We relied on a comprehensive search strategy to identify studies including women with suspected, probable, or confirmed EBOV infection, intending to breastfeed or give breast milk to an infant. Our search identified 10,454 records, and after deduplication and screening, we assessed 148 full texts. We included eight studies reporting on 10 breastfeeding mothers and their children (one mother with twins), who provided breast milk samples for assessment. EBOV was detected via RT-PCR or viral culture in seven out of ten breast milk samples. Four out of the five-breastfed infants with EBOV-positive breast milk were found positive for EBOV infection, and all of these EBOV-positive infants died. Since previous reports have detected EBOV in tears, saliva, sweat, and contaminated surfaces, with the current evidence, it is not possible to conclude with certainty that breast milk was the main route of EBOV transmission.
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Affiliation(s)
| | | | | | - Pura Rayco‐Solon
- Department of Maternal, Newborn, Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
| | | | | | - Lisa Rogers
- Department of Nutrition and Food SafetyWorld Health OrganizationGenevaSwitzerland
| | - Pratiwi Ridwan
- Division of Nutritional SciencesCornell UniversityIthacaNew York
| | - Sabrina Sales Martinez
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social WorkFlorida International UniversityMiamiFlorida
| | - Joyce Andrade
- Hospital de Niños Roberto Gilbert ElizaldeGuayaquilEcuador
| | | | - Juan Chang
- Hospital de Niños Roberto Gilbert ElizaldeGuayaquilEcuador
| | | | | | - Saurabh Mehta
- Division of Nutritional SciencesCornell UniversityIthacaNew York
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Centeno-Tablante E, Medina-Rivera M, Finkelstein JL, Herman HS, Rayco-Solon P, Garcia-Casal MN, Rogers L, Ghezzi-Kopel K, Zambrano Leal MP, Andrade Velasquez JK, Chang Asinc JG, Peña-Rosas JP, Mehta S. Update on the Transmission of Zika Virus Through Breast Milk and Breastfeeding: A Systematic Review of the Evidence. Viruses 2021; 13:v13010123. [PMID: 33477428 PMCID: PMC7830280 DOI: 10.3390/v13010123] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 12/25/2022] Open
Abstract
We systematically searched regional and international databases and screened 1658 non-duplicate records describing women with suspected or confirmed ZIKV infection, intending to breastfeed or give breast milk to an infant to examine the potential of mother-to-child transmission of Zika virus (ZIKV) through breast milk or breastfeeding-related practices. Fourteen studies met our inclusion criteria and inform this analysis. These studies reported on 97 mother-children pairs who provided breast milk for ZIKV assessment. Seventeen breast milk samples from different women were found positive for ZIKV via RT-PCR, and ZIKV replication was found in cell cultures from five out of seven breast milk samples from different women. Only three out of six infants who had ZIKV infection were breastfed, no evidence of clinical complications was found to be associated with ZIKV RNA in breast milk. This review updates our previous report by including 12 new articles, in which we found no evidence of ZIKV mother-to-child transmission through breast milk intake or breastfeeding. As the certainty of the present evidence is low, additional studies are still warranted to determine if ZIKV can be transmitted through breastfeeding.
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Affiliation(s)
- Elizabeth Centeno-Tablante
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA; (E.C.-T.); (M.M.-R.); (J.L.F.); (H.S.H.)
| | - Melisa Medina-Rivera
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA; (E.C.-T.); (M.M.-R.); (J.L.F.); (H.S.H.)
| | - Julia L. Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA; (E.C.-T.); (M.M.-R.); (J.L.F.); (H.S.H.)
| | - Heather S. Herman
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA; (E.C.-T.); (M.M.-R.); (J.L.F.); (H.S.H.)
| | - Pura Rayco-Solon
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva CH-1211, Switzerland;
| | - Maria Nieves Garcia-Casal
- Department of Nutrition and Food Safety, World Health Organization, Geneva, CH-1211, Switzerland; (M.N.G.-C.); (L.R.); (J.P.P.-R.)
| | - Lisa Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, CH-1211, Switzerland; (M.N.G.-C.); (L.R.); (J.P.P.-R.)
| | | | - Mildred P. Zambrano Leal
- Hospital de Niños Roberto Gilbert Elizalde, Guayaquil 090514, Ecuador; (M.P.Z.L.); (J.K.A.V.); (J.G.C.A.)
| | - Joyce K. Andrade Velasquez
- Hospital de Niños Roberto Gilbert Elizalde, Guayaquil 090514, Ecuador; (M.P.Z.L.); (J.K.A.V.); (J.G.C.A.)
| | - Juan G. Chang Asinc
- Hospital de Niños Roberto Gilbert Elizalde, Guayaquil 090514, Ecuador; (M.P.Z.L.); (J.K.A.V.); (J.G.C.A.)
| | - Juan Pablo Peña-Rosas
- Department of Nutrition and Food Safety, World Health Organization, Geneva, CH-1211, Switzerland; (M.N.G.-C.); (L.R.); (J.P.P.-R.)
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA; (E.C.-T.); (M.M.-R.); (J.L.F.); (H.S.H.)
- Correspondence:
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Centeno‐Tablante E, Medina‐Rivera M, Finkelstein JL, Rayco‐Solon P, Garcia‐Casal MN, Rogers L, Ghezzi‐Kopel K, Ridwan P, Peña‐Rosas JP, Mehta S. Transmission of SARS-CoV-2 through breast milk and breastfeeding: a living systematic review. Ann N Y Acad Sci 2021; 1484:32-54. [PMID: 32860259 PMCID: PMC7970667 DOI: 10.1111/nyas.14477] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) is caused by infection with a novel coronavirus strain, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At present, there is limited information on potential transmission of the infection from mother to child, particularly through breast milk and breastfeeding. Here, we provide a living systematic review to capture information that might necessitate changes in the guidance on breast milk and breastfeeding given the uncertainty in this area. Our search retrieved 19,414 total records; 605 were considered for full-text eligibility and no ongoing trials were identified. Our review includes 340 records, 37 with breast milk samples and 303 without. The 37 articles with analyzed breast milk samples reported on 77 mothers who were breastfeeding their children; among them, 19 of 77 children were confirmed COVID-19 cases based on RT-PCR assays, including 14 neonates and five older infants. Nine of the 68 analyzed breast milk samples from mothers with COVID-19 were positive for SARS-CoV-2 RNA; of the exposed infants, four were positive and two were negative for COVID-19. Currently, there is no evidence of SARS-CoV-2 transmission through breast milk. Studies are needed with longer follow-up periods that collect data on infant feeding practices and on viral presence in breast milk.
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Affiliation(s)
| | | | | | - Pura Rayco‐Solon
- Department of Maternal, Newborn,
Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
| | | | - Lisa Rogers
- Department of Nutrition and Food
SafetyWorld Health OrganizationGenevaSwitzerland
| | | | - Pratiwi Ridwan
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
| | | | - Saurabh Mehta
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
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Saad F, Rogers L, Doggui R, Al-Jawaldeh A. Assessment of Vitamin A Supplementation Practices in Countries of the Eastern Mediterranean Region: Evidence to Implementation. J Nutr Sci Vitaminol (Tokyo) 2021; 67:1-12. [PMID: 33642459 DOI: 10.3177/jnsv.67.1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Vitamin A is an essential nutrient necessary for human growth and development, with critical roles in vision, immune function reproduction and maintenance of epithelial cellular integrity. Inadequate intake of vitamin A places populations at risk of developing diseases associated with vitamin A deficiency (VAD). VAD is highly prevalent across the Eastern Mediterranean Region (EMR) in children under 5 y and women of childbearing age. Therefore, infants and young children, pregnant women and postpartum women are commonly targeted by supplementation programs. Although, vitamin A supplementation has been shown to decrease preventable childhood diseases and deaths related to VAD, supplementation of vitamin A has been greatly misused in several countries within the EMR raising concern around the process of supplementing the target population. Countries across the EMR have reported different supplementation practices depending on the income level of the country, the availability of vitamin A and the prevalence rates of VAD. Although some countries had higher supplementation rates than others, the concern lies in the middle-income countries and their supplementation practices. Some of the countries across the region do not follow the World Health Organization's (WHO) guidelines for vitamin A supplementation for the recommended age groups. The objective of this study is to assess the vitamin A supplementation practices across the countries in the EMR, determine the gaps in the supplementation practices and the issue with supplementing to healthy populations where VAD is not a public health concern, and provide recommendations for proper vitamin A supplementation within the region.
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Affiliation(s)
- Farah Saad
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO)
| | - Lisa Rogers
- Department of Nutrition for Health and Development, World Health Organization
| | - Radhouene Doggui
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke.,Centre de Formation Médicale du Nouveau-Brunswick
| | - Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO)
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Rogers L, De Brún A, Birken SA, Davies C, McAuliffe E. The micropolitics of implementation; a qualitative study exploring the impact of power, authority, and influence when implementing change in healthcare teams. BMC Health Serv Res 2020; 20:1059. [PMID: 33228702 PMCID: PMC7684932 DOI: 10.1186/s12913-020-05905-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 07/21/2020] [Accepted: 11/06/2020] [Indexed: 11/27/2022] Open
Abstract
Background Healthcare organisations are complex social entities, comprising of multiple stakeholders with differing priorities, roles, and expectations about how care should be delivered. To reach agreement among these diverse interest groups and achieve safe, cost-effective patient care, healthcare staff must navigate the micropolitical context of the health service. Micropolitics in this study refers to the use of power, authority, and influence to affect team goals, vision, and decision-making processes. Although these concepts are influential when cultivating change, there is a dearth of literature examining the mechanisms through which micropolitics influences implementation processes among teams. This paper addresses this gap by exploring the role of power, authority, and influence when implementing a collective leadership intervention in two multidisciplinary healthcare teams. Methods The multiple case study design adopted employed a triangulation of qualitative research methods. Over thirty hours of observations (Case A = 16, Case B = 15) and twenty-five interviews (Case A = 13, Case B = 12) were completed. An in-depth thematic analysis of the data using an inductive coding approach was completed to understand the mechanisms through which contextual factors influenced implementation success. A context coding framework was also employed throughout implementation to succinctly collate the data into a visual display and to provide a high-level overview of implementation effect (i.e. the positive, neutral, or negative impact of contextual determinants on implementation). Results The findings emphasised that implementing change in healthcare teams is an inherently political process influenced by prevailing power structures. Two key themes were generated which revealed the dynamic role of these concepts throughout implementation: 1) Exerting hierarchical influence for implementation; and 2) Traditional power structures constraining implementation. Gaining support across multiple levels of leadership was influential to implementation success as the influence exercised by these individuals persuaded follower engagement. However, the historical dynamics of each team determined how this influence was exerted and perceived, which negatively impacted some participants’ experiences of the implementation process. Conclusion To date, micropolitics has received scant attention in implementation science literature. This study introduces the micropolitical concepts of power, authority and influence as essential contextual determinants and outlines the mechanisms through which these concepts influence implementation processes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05905-z.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland.
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, Noth Carolina, USA
| | - Carmel Davies
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland
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De Brún A, Anjara S, Cunningham U, Khurshid Z, Macdonald S, O’Donovan R, Rogers L, McAuliffe E. The Collective Leadership for Safety Culture (Co-Lead) Team Intervention to Promote Teamwork and Patient Safety. Int J Environ Res Public Health 2020; 17:ijerph17228673. [PMID: 33266448 PMCID: PMC7700115 DOI: 10.3390/ijerph17228673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 11/18/2022]
Abstract
Traditional hierarchical leadership has been implicated in patient safety failings internationally. Given that healthcare is almost wholly delivered by multidisciplinary teams, there have been calls for a more collective and team-based approach to the sharing of leadership and responsibility for patient safety. Although encouraging a collective approach to accountability can improve the provision of high quality and safe care, there is a lack of knowledge of how to train teams to adopt collective leadership. The Collective Leadership for Safety Cultures (Co-Lead) programme is a co-designed intervention for multidisciplinary healthcare teams. It is an open-source resource that offers teams a systematic approach to the development of collective leadership behaviours to promote effective teamworking and enhance patient safety cultures. This paper provides an overview of the co-design, pilot testing, and refining of this novel intervention prior to its implementation and discusses key early findings from the evaluation. The Co-Lead intervention is grounded in the real-world experiences and identified needs and priorities of frontline healthcare staff and management and was co-designed based on the evidence for collective leadership and teamwork in healthcare. It has proven feasible to implement and effective in supporting teams to lead collectively to enhance safety culture. This intervention overview will be of value to healthcare teams and practitioners seeking to promote safety culture and effective teamworking by supporting teams to lead collectively.
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Affiliation(s)
- Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland; (S.A.); (U.C.); (Z.K.); (S.M.); (R.O.); (L.R.); (E.M.)
- Correspondence:
| | - Sabrina Anjara
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland; (S.A.); (U.C.); (Z.K.); (S.M.); (R.O.); (L.R.); (E.M.)
| | - Una Cunningham
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland; (S.A.); (U.C.); (Z.K.); (S.M.); (R.O.); (L.R.); (E.M.)
- Transformation Office, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Zuneera Khurshid
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland; (S.A.); (U.C.); (Z.K.); (S.M.); (R.O.); (L.R.); (E.M.)
| | - Steve Macdonald
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland; (S.A.); (U.C.); (Z.K.); (S.M.); (R.O.); (L.R.); (E.M.)
- School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
| | - Róisín O’Donovan
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland; (S.A.); (U.C.); (Z.K.); (S.M.); (R.O.); (L.R.); (E.M.)
| | - Lisa Rogers
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland; (S.A.); (U.C.); (Z.K.); (S.M.); (R.O.); (L.R.); (E.M.)
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland; (S.A.); (U.C.); (Z.K.); (S.M.); (R.O.); (L.R.); (E.M.)
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Wang A, Chiou J, Poirion OB, Buchanan J, Valdez MJ, Verheyden JM, Hou X, Kudtarkar P, Narendra S, Newsome JM, Guo M, Faddah DA, Zhang K, Young RE, Barr J, Sajti E, Misra R, Huyck H, Rogers L, Poole C, Whitsett JA, Pryhuber G, Xu Y, Gaulton KJ, Preissl S, Sun X. Single-cell multiomic profiling of human lungs reveals cell-type-specific and age-dynamic control of SARS-CoV2 host genes. eLife 2020; 9:e62522. [PMID: 33164753 PMCID: PMC7688309 DOI: 10.7554/elife.62522] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/08/2020] [Indexed: 12/12/2022] Open
Abstract
Respiratory failure associated with COVID-19 has placed focus on the lungs. Here, we present single-nucleus accessible chromatin profiles of 90,980 nuclei and matched single-nucleus transcriptomes of 46,500 nuclei in non-diseased lungs from donors of ~30 weeks gestation,~3 years and ~30 years. We mapped candidate cis-regulatory elements (cCREs) and linked them to putative target genes. We identified distal cCREs with age-increased activity linked to SARS-CoV-2 host entry gene TMPRSS2 in alveolar type 2 cells, which had immune regulatory signatures and harbored variants associated with respiratory traits. At the 3p21.31 COVID-19 risk locus, a candidate variant overlapped a distal cCRE linked to SLC6A20, a gene expressed in alveolar cells and with known functional association with the SARS-CoV-2 receptor ACE2. Our findings provide insight into regulatory logic underlying genes implicated in COVID-19 in individual lung cell types across age. More broadly, these datasets will facilitate interpretation of risk loci for lung diseases.
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Affiliation(s)
- Allen Wang
- Center for Epigenomics & Department of Cellular & Molecular Medicine, University of California, San DiegoSan DiegoUnited States
| | - Joshua Chiou
- Biomedical Sciences Graduate Program, University of California San DiegoLa JollaUnited States
- Department of Pediatrics, University of California-San DiegoLa JollaUnited States
| | - Olivier B Poirion
- Center for Epigenomics & Department of Cellular & Molecular Medicine, University of California, San DiegoSan DiegoUnited States
| | - Justin Buchanan
- Center for Epigenomics & Department of Cellular & Molecular Medicine, University of California, San DiegoSan DiegoUnited States
| | - Michael J Valdez
- Biomedical Sciences Graduate Program, University of California San DiegoLa JollaUnited States
- Department of Pediatrics, University of California-San DiegoLa JollaUnited States
| | - Jamie M Verheyden
- Department of Pediatrics, University of California-San DiegoLa JollaUnited States
| | - Xiaomeng Hou
- Center for Epigenomics & Department of Cellular & Molecular Medicine, University of California, San DiegoSan DiegoUnited States
| | - Parul Kudtarkar
- Department of Pediatrics, University of California-San DiegoLa JollaUnited States
| | - Sharvari Narendra
- Department of Pediatrics, University of California-San DiegoLa JollaUnited States
| | - Jacklyn M Newsome
- Department of Pediatrics, University of California-San DiegoLa JollaUnited States
| | - Minzhe Guo
- Division of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical CenterCincinnatiUnited States
- Divisions of Pulmonary Biology and Biomedical Informatics, University of Cincinnati College of MedicineCincinnatiUnited States
| | | | - Kai Zhang
- Ludwig Institute for Cancer ResearchLa JollaUnited States
| | - Randee E Young
- Department of Pediatrics, University of California-San DiegoLa JollaUnited States
- Laboratory of Genetics, Department of Medical Genetics, University of Wisconsin-MadisonMadisonUnited States
| | - Justinn Barr
- Department of Pediatrics, University of California-San DiegoLa JollaUnited States
| | - Eniko Sajti
- Department of Pediatrics, University of California-San DiegoLa JollaUnited States
| | - Ravi Misra
- Department of Pediatrics and Clinical & Translational Science Institute, University of Rochester Medical CenterRochesterUnited States
| | - Heidie Huyck
- Department of Pediatrics and Clinical & Translational Science Institute, University of Rochester Medical CenterRochesterUnited States
| | - Lisa Rogers
- Department of Pediatrics and Clinical & Translational Science Institute, University of Rochester Medical CenterRochesterUnited States
| | - Cory Poole
- Department of Pediatrics and Clinical & Translational Science Institute, University of Rochester Medical CenterRochesterUnited States
| | - Jeffery A Whitsett
- Division of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical CenterCincinnatiUnited States
- Divisions of Pulmonary Biology and Biomedical Informatics, University of Cincinnati College of MedicineCincinnatiUnited States
| | - Gloria Pryhuber
- Department of Pediatrics and Clinical & Translational Science Institute, University of Rochester Medical CenterRochesterUnited States
| | - Yan Xu
- Division of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical CenterCincinnatiUnited States
- Divisions of Pulmonary Biology and Biomedical Informatics, University of Cincinnati College of MedicineCincinnatiUnited States
| | - Kyle J Gaulton
- Department of Pediatrics, University of California-San DiegoLa JollaUnited States
| | - Sebastian Preissl
- Center for Epigenomics & Department of Cellular & Molecular Medicine, University of California, San DiegoSan DiegoUnited States
| | - Xin Sun
- Department of Pediatrics, University of California-San DiegoLa JollaUnited States
- Department of Biological Sciences, University of California-San DiegoLa JollaUnited States
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40
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Suchowerska N, Kench P, Rogers L, Estaves A, Gorjiara T, McKenzie D. OC-0682: CBCT dose prior to radiotherapy causes up to 15 times more cell death than predicted. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00704-0] [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: 10/22/2022]
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Rogers L, De Brún A, McAuliffe E. Defining and assessing context in healthcare implementation studies: a systematic review. BMC Health Serv Res 2020; 20:591. [PMID: 32600396 PMCID: PMC7322847 DOI: 10.1186/s12913-020-05212-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [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] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The implementation of evidence-based healthcare interventions is challenging, with a 17-year gap identified between the generation of evidence and its implementation in routine practice. Although contextual factors such as culture and leadership are strong influences for successful implementation, context remains poorly understood, with a lack of consensus regarding how it should be defined and captured within research. This study addresses this issue by providing insight into how context is defined and assessed within healthcare implementation science literature and develops a definition to enable effective measurement of context. METHODS Medline, PsychInfo, CINAHL and EMBASE were searched. Articles were included if studies were empirical and evaluated context during the implementation of a healthcare initiative. These English language articles were published in the previous 10 years and included a definition and assessment of context. Results were synthesised using a narrative approach. RESULTS Three thousand and twenty-one search records were obtained of which 64 met the eligibility criteria and were included in the review. Studies used a variety of definitions in terms of the level of detail and explanation provided. Some listed contextual factors (n = 19) while others documented sub-elements of a framework that included context (n = 19). The remaining studies provide a rich definition of general context (n = 11) or aspects of context (n = 15). The Alberta Context Tool was the most frequently used quantitative measure (n = 4), while qualitative papers used a range of frameworks to evaluate context. Mixed methods studies used diverse approaches; some used frameworks to inform the methods chosen while others used quantitative measures to inform qualitative data collection. Most studies (n = 50) applied the chosen measure to all aspects of study design with a majority analysing context at an individual level (n = 29). CONCLUSIONS This review highlighted inconsistencies in defining and measuring context which emphasised the need to develop an operational definition. By providing this consensus, improvements in implementation processes may result, as a common understanding will help researchers to appropriately account for context in research.
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Affiliation(s)
- L. Rogers
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
| | - A. De Brún
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
| | - E. McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
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42
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Eads JR, Krishnamurthi SS, Saltzman J, Bokar JA, Savvides P, Meropol NJ, Gibbons J, Koon H, Sharma N, Rogers L, Pink JJ, Xu Y, Beumer JH, Riendeau J, Fu P, Gerson SL, Dowlati A. Phase I clinical trial of temozolomide and methoxyamine (TRC-102), an inhibitor of base excision repair, in patients with advanced solid tumors. Invest New Drugs 2020; 39:142-151. [PMID: 32556884 DOI: 10.1007/s10637-020-00962-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/11/2020] [Indexed: 11/26/2022]
Abstract
Temozolomide (TMZ) generates DNA adducts that are repaired by direct DNA and base excision repair mechanisms. Methoxyamine (MX, TRC-102) potentiates TMZ activity by binding to apurinic and apyrimidinic (AP) sites after removal of N3-methyladenine and N7-methylguanine, inhibiting site recognition of AP endonuclease. We conducted a phase I trial to determine the maximum tolerated dose and dose-limiting toxicities (DLTs) of intravenous MX when given with oral TMZ. Patients with advanced solid tumors and progression on standard treatment were enrolled to a standard 3 + 3 dose escalation trial assessing escalating doses of TMZ and MX. Tumor response was assessed per RECIST and adverse events (AEs) by CTCAEv3. Pharmacokinetics (PK) of MX and COMET assays on peripheral blood mononuclear cells were performed. 38 patients were enrolled-median age 59.5 years (38-76), mean number of cycles 2.9 [1-13]. No DLTs were observed. Cycle 1 grade 3 AEs included fatigue, lymphopenia, anemia, INR, leukopenia, neutropenia, allergic reaction, constipation, psychosis and paranoia. Cycle 2-13 grade 4 AEs included thrombocytopenia and confusion. A partial response was seen in 1 patient with a pancreatic neuroendocrine tumor (PNET) and six additional patients, each with different tumor types, demonstrated prolonged stable disease. MX PK was linear with dose and was not affected by concomitant TMZ. TMZ 200 mg/m2 daily × 5 may be safely administered with MX 150 mg/m2 intravenously once on day 1 with minimal toxicity. Further studies assessing this drug combination in select tumor types where temozolomide has activity may be warranted.
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Affiliation(s)
- Jennifer R Eads
- Case Comprehensive Cancer Center, Case Western Reserve University, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside 1200, Cleveland, OH, 44106, USA
| | - Smitha S Krishnamurthi
- Case Comprehensive Cancer Center, Case Western Reserve University, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside 1200, Cleveland, OH, 44106, USA
| | - Joel Saltzman
- Case Comprehensive Cancer Center, Case Western Reserve University, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside 1200, Cleveland, OH, 44106, USA
| | - Joseph A Bokar
- Case Comprehensive Cancer Center, Case Western Reserve University, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside 1200, Cleveland, OH, 44106, USA
| | - Panos Savvides
- St. Joseph's Hospital and Medical Center, University of Arizona Comprehensive Cancer Center, University of Arizona, Phoenix, AZ, USA
| | - Neal J Meropol
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
- Flatiron Health, New York, NY, USA
| | - Joseph Gibbons
- Case Comprehensive Cancer Center, Case Western Reserve University, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside 1200, Cleveland, OH, 44106, USA
| | - Henry Koon
- Case Comprehensive Cancer Center, Case Western Reserve University, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside 1200, Cleveland, OH, 44106, USA
| | - Neelesh Sharma
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Lisa Rogers
- Case Comprehensive Cancer Center, Case Western Reserve University, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside 1200, Cleveland, OH, 44106, USA
| | - John J Pink
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Yan Xu
- Case Comprehensive Cancer Center, Cleveland State University, Cleveland, OH, USA
| | - Jan H Beumer
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Riendeau
- Case Comprehensive Cancer Center, Case Western Reserve University, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside 1200, Cleveland, OH, 44106, USA
| | - Pingfu Fu
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Stanton L Gerson
- Case Comprehensive Cancer Center, Case Western Reserve University, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside 1200, Cleveland, OH, 44106, USA
| | - Afshin Dowlati
- Case Comprehensive Cancer Center, Case Western Reserve University, University Hospitals Seidman Cancer Center, 11100 Euclid Avenue, Lakeside 1200, Cleveland, OH, 44106, USA.
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Rogers L, De Brún A, McAuliffe E. Development of an integrative coding framework for evaluating context within implementation science. BMC Med Res Methodol 2020; 20:158. [PMID: 32539710 PMCID: PMC7296653 DOI: 10.1186/s12874-020-01044-5] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This research aims to explore an identified gap in implementation science methodology, that is, how to assess context in implementation research. Context is among the strongest influences on implementation success but is a construct that is poorly understood and reported within the literature. Consequently, there is little guidance on how to research context. This study addresses this issue by developing a method to account for the active role of context during implementation research. Through use of a case study, this paper demonstrates the value of using our context coding framework. METHODS The developed context coding framework was guided by the sub-elements of the Consolidated Framework for Implementation Research (CFIR). Employing a constructivist approach, this framework builds on the CFIR and enables a deeper exploration of context at multiple levels of the health system. The coding framework enables the collation of various data sources such as organisational reports, culture audits, interview, survey, and observational data. It may be continuously updated as new data emerge and can be adapted by researchers as required. A pre-existing rating criterion has been integrated to the context coding framework to highlight the influence and relative strength of each contextual factor prior to and during implementation. RESULTS It is anticipated that the context coding framework will facilitate a standardised approach to assessing context. This will provide a deeper understanding of how to account for the influence of context, ultimately providing guidance that should increase the likelihood of implementation success. The coding framework enables implementation progress to be monitored, facilitating the identification of contextual changes and variations across settings at different levels of the healthcare system. It is expected this framework will inform the selection of appropriate implementation strategies and enable the monitoring of such strategies regarding their impact on local context. CONCLUSIONS This research contributes to the extant literature by advancing methodologies for the consideration and assessment of context in implementation research. This context coding framework may be used in any setting to provide insight into the characteristics of particular contexts throughout implementation processes.
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Affiliation(s)
- L. Rogers
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - A. De Brún
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - E. McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
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Medina-Rivera M, Centeno-Tablante E, Finkelstein J, Peña-Rosas JP, Garcia-Casal MN, Rogers L, Ridwan P, Martinez SS, Andrade J, Layden AJ, Chang J, Zambrano MP, Ghezzi-Kopel K, Mehta S. Presence of Ebola Virus in Breast Milk and Its Risk of Transmission to Breastfeeding Infants: Synthesis of Evidence. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa054_108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
This study aimed to synthesize evidence related to the presence in and transmission of the Ebola virus (EBOV) through breast milk to help inform global guidelines on infant feeding.
Methods
We conducted a comprehensive systematic search in international and regional databases to identify original studies describing women with suspected or confirmed EBOV infection intending to breastfeed or give breast milk to an infant. Studies documenting any breastfeeding woman who has been vaccinated or is suspected or confirmed of viral infection at any time during or after pregnancy were identified. Records were independently screened by two authors and after duplicate records were removed, studies that met the inclusion criteria were selected for data extraction.
Results
From a total of 24,473 non-duplicate studies, we found six case reports that included seven breastfeeding mothers with suspected or confirmed EBOV infection and their eight children (one mother with twins). EBOV was detected via RT-PCR and/or by culture in five out of six breast milk samples that were collected from the mothers. Five out of the seven breastfed infants were found positive for EBOV infection and all of the identified cases led to death.
Conclusions
Ebola virus was detected in 5 out of 6 breast milk samples analyzed. Since the virus has also been detected in tears, saliva, and sweat, it is not possible to conclude with certainty that the transmission was through breast milk. Prospective studies are needed in order to define the safety of feeding infants with breast milk from mothers infected with EBOV.
Funding Sources
Department of Nutrition and Food Safety, WHO.
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Affiliation(s)
| | | | | | | | | | - Lisa Rogers
- Department of Nutrition and Food Safety, World Health Organization
| | | | | | | | | | - Juan Chang
- Hospital de Niños Roberto Gilbert Elizalde
| | | | | | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University
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45
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Gannon B, Herrmann R, Sinha A, Ghezzi-Kopel K, Rogers L, Nieves Garcia-Casal M, Peña-Rosas JP, Mehta S. The Accuracy of Dried Blood Spots Compared to Plasma or Serum Retinol for the Diagnosis of Vitamin A Deficiency: A DTA Systematic Review and Meta-Analysis. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa041_010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Dried blood spots (DBS) do not require a cold chain, making them easier to store and transport compared to serum or plasma samples in resource-limited settings. Our objective was to determine the accuracy of DBS compared to serum or plasma retinol for assessing vitamin A status in individuals and populations.
Methods
A systematic review of diagnostic test accuracy (DTA) was performed using standard Cochrane Methods for Screening and Diagnostic Tests. All human studies were included if they determined retinol in DBS (index test) and compared results to retinol determined in either plasma or serum samples (reference standard). Index and reference methods could use either capillary or venous blood with retinol quantified by HPLC. We used the WHO threshold of 0.70 μmol/L to define low retinol concentrations. Meta-analysis determined summary estimates of sensitivity and specificity using the bivariate model, which models logit transformed sensitivities and specificities as a bivariate normal distribution including a parameter for the negative correlation between sensitivity and specificity. Rstudio (Version 1.1.456, RStudio, Inc. Boston, MA) was used for analysis.
Results
Our search (conducted April 10, 2019) identified 9021 records, and 285 studies were assessed in full-text for inclusion; 6 publications reported 8 studies comprising 397 participants, 50 of which had low serum retinol by the reference method. The use of DBS to determine a low retinol level had summary estimates (95% CIs) for sensitivity of 86.7% (71.4 to 94.5) and specificity of 99.5% (89.7 to 100.0).
Conclusions
Use of DBS to determine low retinol has been shown to have good sensitivity and high specificity compared to serum or plasma. Use of DBS can reduce the need for centrifugation and cold chain for storage and transport. The mixed use of capillary and venous blood in both index and reference methods merits further investigation for the determination of retinol in DBS.
Funding Sources
None declared.
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Affiliation(s)
- Bryan Gannon
- Division of Nutritional Sciences, Cornell University
| | | | - Anju Sinha
- Division of Reproductive, Maternal and Child Health, Indian Council of Medical Research
| | | | - Lisa Rogers
- Department of Nutrition and Food Safety, World Health Organization
| | | | | | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University
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46
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Joachim A, Ahmed MIM, Pollakis G, Rogers L, Hoffmann VS, Munseri P, Aboud S, Lyamuya EF, Bakari M, Robb ML, Wahren B, Sandstrom E, Nilsson C, Biberfeld G, Geldmacher C, Held K. Induction of Identical IgG HIV-1 Envelope Epitope Recognition Patterns After Initial HIVIS-DNA/MVA-CMDR Immunization and a Late MVA-CMDR Boost. Front Immunol 2020; 11:719. [PMID: 32411138 PMCID: PMC7198863 DOI: 10.3389/fimmu.2020.00719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/30/2020] [Indexed: 01/16/2023] Open
Abstract
In the RV144 trial, to date the only HIV-1 vaccine efficacy trial demonstrating a modestly reduced risk of HIV-1 acquisition, antibody responses toward the HIV Envelope protein (Env) variable (V) 2 and V3 regions were shown to be correlated with a reduced risk of infection. These potentially protective antibody responses, in parallel with the vaccine efficacy, however, waned quickly. Dissecting vaccine-induced IgG recognition of antigenic regions and their variants within the HIV-1 Env from different vaccine trials will aid in designing future HIV-1 immunogens and vaccination schedules. We, therefore, analyzed the IgG response toward linear HIV-1 Env epitopes elicited by a multi-clade, multigene HIVIS-DNA priming, and heterologous recombinant modified vaccinia virus Ankara (MVA-CMDR) boosting regimen (HIVIS03) and assessed whether a late MVA-CMDR boost 3 years after completion of the initial vaccination schedule (HIVIS06) restored antibody responses toward these epitopes. Here we report that vaccination schedule in the HIVIS03 trial elicited IgG responses against linear epitopes within the V2 and V3 tip as well as against the gp41 immunodominant region in a high proportion of vaccinees. Antibodies against the V2 and gp41 Env regions were restricted to variants with close homology to the MVA-CMDR immunogen sequence, while V3 responses were more cross-reactive. Boosting with a late third MVA-CMDR after 3 years effectively restored waned IgG responses to linear Env epitopes and induced targeting of identical antigenic regions and variants comparable to the previous combined HIVIS-DNA/MVA-CMDR regimen. Our findings support the notion that anti-HIV-1 Env responses, associated with a reduced risk of infection in RV144, could be maintained by regular boosting with a single dose of MVA-CMDR.
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Affiliation(s)
- Agricola Joachim
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Mohamed I M Ahmed
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Georgios Pollakis
- Faculty of Health and Life Science, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections (HPRU EZI), Liverpool, United Kingdom
| | - Lisa Rogers
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Verena S Hoffmann
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Munich, Germany
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Eligius F Lyamuya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Muhammad Bakari
- Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Merlin L Robb
- Walter Reed Army Institute of Research (WRAIR), Rockville, MD, United States.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Britta Wahren
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Eric Sandstrom
- Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden
| | - Charlotta Nilsson
- Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden.,The Public Health Agency of Sweden, Solna, Sweden
| | - Gunnel Biberfeld
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Kathrin Held
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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De Brun A, Rogers L, O'Shea M, McAuliffe E. Understanding the impact of a collective leadership intervention on team working and safety culture in healthcare teams: a realist evaluation protocol. HRB Open Res 2020; 2:5. [PMID: 32296745 PMCID: PMC7140778 DOI: 10.12688/hrbopenres.12860.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 12/29/2022] Open
Abstract
There is accumulating evidence for the value of collective and shared approaches to leadership across sectors and settings. However, relatively little research has explored collective leadership in healthcare and thus, there is little understanding of what works for healthcare teams, why, how and to what extent. This study describes the approach that will be adopted to the realist evaluation of a collective leadership intervention with four heterogenous healthcare teams in four different settings. A realist evaluation will be conducted. Realist evaluation is a theory-based approach to evaluation. It enables the use of mixed-methods to explore the research question of interest. Development of an initial programme theory (IPT) constitutes the first phase of the approach. This IPT will be informed by interviews with members of teams identified as working collectively, an examination of extant literature using realist synthesis, and will be refined through consultation with an expert panel. A multiple case study design will be adopted to explore the impact of the intervention, including quantitative scales on teamworking, leadership and safety culture, realist interviews with key informants and observations of teams during intervention sessions. Analysis of data will be guided by the IPT to refine the theory and context-mechanism-outcome configurations. Findings from the cases will be compared to identify patterns or demi-regularities and to explore if the intervention operates differently in different contexts. This analysis and synthesis of findings across the teams will inform the development of a middle range theory that will not only add to our understanding of how collective leadership influences teamwork and patient safety, but also provide guidance for future collective leadership interventions. Favourable ethical opinion has been received from the University College Dublin Ethics Committee. Results will be disseminated via publication in peer-review journals, national and international conferences and to stakeholders/interest groups.
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Affiliation(s)
- Aoife De Brun
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Lisa Rogers
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Marie O'Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Pallesen KS, Rogers L, Anjara S, De Brún A, McAuliffe E. A qualitative evaluation of participants' experiences of using co-design to develop a collective leadership educational intervention for health-care teams. Health Expect 2020; 23:358-367. [PMID: 31999883 PMCID: PMC7104638 DOI: 10.1111/hex.13002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 07/08/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Co‐design involves stakeholders as design partners to ensure a better fit to user needs. Many benefits of involving stakeholders in design processes have been proposed; however, few studies have evaluated participants’ experience of co‐design in the development of educational interventions. As part of a larger study, health‐care professionals, researchers and patients co‐designed a collective leadership intervention for health‐care teams. This study evaluated their experiences of the co‐design process. Methods Semi‐structured interviews were conducted with individuals (n = 10) who took part in the co‐design workshops. Interviews were audio‐recorded, transcribed verbatim and analysed thematically. Results Four key themes were identified from the data: (a) Managing expectations in an open‐ended process; (b) Establishing a positive team climate; (c) Focusing on frustrations—challenging but informative; and (d) Achieving a genuine co‐design partnership. Conclusions The development of a positive team climate is essential to the co‐design process. Organizers should focus on building strong working relationships from the beginning to enable open discussion. Organizers of co‐design should be conscious of establishing and maintaining a genuine partnership where participants are involved as equal partners and co‐creators. This can be done through the continuous use of feedback to allow participants to influence the workshop directions, and through limiting researcher domination. Lastly, co‐design can be daunting, but organizers can positively impact participants’ experience by acknowledging the emergent nature of the process in order to reduce participant apprehension, thereby limiting the barriers to participation.
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Affiliation(s)
- Kirsten Siig Pallesen
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - Lisa Rogers
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - Sabrina Anjara
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
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Petrova NL, Donaldson NK, Tang W, MacDonald A, Allen J, Lomas C, Leech N, Ainarkar S, Bevans J, Plassmann P, Kluwe B, Ring F, Whittam A, Rogers L, McMillan J, Simpson R, Donaldson ANA, Machin G, Edmonds ME. Infrared thermography and ulcer prevention in the high-risk diabetic foot: data from a single-blind multicentre controlled clinical trial. Diabet Med 2020; 37:95-104. [PMID: 31629373 DOI: 10.1111/dme.14152] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 11/28/2022]
Abstract
AIM To assess the usefulness of monthly thermography and standard foot care to reduce diabetic foot ulcer recurrence. METHODS People with diabetes (n = 110), neuropathy and history of ≥ 1 foot ulcer participated in a single-blind multicentre clinical trial. Feet were imaged with a novel thermal imaging device (Diabetic Foot Ulcer Prevention System). Participants were randomized to intervention (active thermography + standard foot care) or control (blinded thermography + standard foot care) and were followed up monthly until ulcer recurrence or for 12 months. Foot thermograms of participants from the intervention group were assessed for hot spots (areas with temperature ≥ 2.2°C higher than the corresponding contralateral site) and acted upon as per local standards. RESULTS After 12 months, 62% of participants were ulcer-free in the intervention group and 56% in the control group. The odds ratios of ulcer recurrence (intervention vs control) were 0.82 (95% CI 0.38, 1.8; P = 0.62) and 0.55 (95% CI 0.21, 1.4; P = 0.22) in univariate and multivariate logistic regression analyses, respectively. The hazard ratios for the time to ulcer recurrence (intervention vs control) were 0.84 (95% CI 0.45, 1.6; P = 0.58) and 0.67 (95% CI 0.34, 1.3; P = 0.24) in univariate and multivariate Cox regression analyses, respectively. CONCLUSIONS Monthly intervention with thermal imaging did not result in a significant reduction in ulcer recurrence rate or increased ulcer-free survival in this cohort at high risk of foot ulcers. This trial has, however, informed the design of a refined study with longer follow-up and group stratification, further aiming to assess the efficacy of thermography to reduce ulcer recurrence.
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Affiliation(s)
- N L Petrova
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - N K Donaldson
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
| | - W Tang
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
| | - A MacDonald
- Microvascular Diagnostics, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - J Allen
- Microvascular Diagnostics, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - C Lomas
- Podiatry Department, Diabetes Centre, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - N Leech
- Podiatry Department, Diabetes Centre, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - S Ainarkar
- Community Podiatry Department, Pennine Acute Hospitals Trust, Manchester, UK
| | - J Bevans
- Community Podiatry Department, Pennine Acute Hospitals Trust, Manchester, UK
| | | | - B Kluwe
- Department of Computing, University of South Wales, Pontypridd, UK
| | - F Ring
- Department of Computing, University of South Wales, Pontypridd, UK
| | - A Whittam
- Temperature and Humidity, National Physical Laboratory, London, UK
| | - L Rogers
- Temperature and Humidity, National Physical Laboratory, London, UK
| | - J McMillan
- Temperature and Humidity, National Physical Laboratory, London, UK
| | - R Simpson
- Temperature and Humidity, National Physical Laboratory, London, UK
| | - A N A Donaldson
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
| | - G Machin
- Temperature and Humidity, National Physical Laboratory, London, UK
| | - M E Edmonds
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
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Ahluwalia M, Dhruv H, Fallah J, Berens M, Drappatz J, Ye X, Lesser G, Cloughesy T, Walbert T, Holdhoff M, Peereboom D, Nabors L, Wen P, Grossman S, Rogers L. ACTR-43. GENOMIC ANALYSIS OF RESPONDERS OF PHASE II TRIAL OF TEMOZOLOMIDE AND TRC-102 (BASE EXCISION REPAIR INHIBITOR) IN BEVACIZUMAB-NAÏVE GLIOBLASTOMA AT FIRST RECURRENCE. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Temozolomide forms O6-methylguanine (O6mG), 7-methylguanine (N7mG), and 3- methyladenine (N3mA) DNA adducts. The O6mG DNA adduct is repaired by MGMT. N7mG and N3mA DNA adducts are removed by the base excision repair (BER) pathway, initiated by N- methylpurine DNA glycosolase (MPG). TRC-102 is a BER inhibitor that binds to the apurinic site created through the action of MPG.
METHODS
A phase II study of adult glioblastoma in first recurrence was performed in the Adult Brain Tumor Consortium with temozolomide, 150 mg/ m2 and TRC-102, 150 mg (1–5/ 28 days). Primary objective included radiographic response rate. Secondary objectives included safety and PFS-6. Exploratory objectives included tumor expression of N-methylpurine DNA glycosylase (MPG). The study tested hypothesis that combination therapy will achieve 30% RR. To understand the context of vulnerability to TRC102 we performed RNA sequencing on treatment naïve tissue from 7 patients.
RESULTS
Nineteen patients were enrolled in first stage. Median age was 60 years (range: 48–76), 53% females, median KPS was 80 (range: 70–90). Median cycles of treatment was 2 (range: 1–12). No responses were observed. Median OS was 11.0 months (95% CI: 8–18 months), median PFS was 2.0 months (95% CI: 1.8–3.6 months). PFS-6 rate was 10.5 % (2/19). The combination was safe. MPG staining was negative in six, 1+ in five and 2+ in three patients. PFS of 11 + months in two patients (exceptional responders) was associated with MPG expression. Preliminary analysis on RNA sequencing revealed significant enrichment for DNA Damage Response pathways (MsigDB), chromosomal instability gene signature (CIN70 and CIN25), and proliferative gene signature (PCNA25) in these 2 patients.
CONCLUSIONS
TRC 102 with temozolomide has acceptable safety but did not meet the primary endpoint of response. Gene signature of MsigDB, CIN70, CIN25 and PCNA25 was seen in exceptional responders and biomarker driven study is planned.
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Affiliation(s)
- Manmeet Ahluwalia
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | - Jan Drappatz
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Xiaobu Ye
- Johns Hopkins University, Baltimore, MD, USA
| | - Glenn Lesser
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | | | | | | | - Louis Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patrick Wen
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stuart Grossman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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