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Xie L, Atem F, Mathew MS, Almandoz JP, Schellinger JN, Kapera O, Ngenge S, Francis J, Marroquin EM, McAdams C, Kukreja S, Schneider BE, Messiah SE. Factors Associated with the Decision to Complete Bariatric Metabolic Surgery among a Racially and Ethnically Diverse Sample of Adults: A Classification and Regression Tree Analysis. Obes Surg 2024; 34:1513-1522. [PMID: 38105283 DOI: 10.1007/s11695-023-06999-0] [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: 10/18/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Less than 50% of eligible candidates who are referred complete Bariatric Metabolic Surgery (BMS). The factors influencing the decision to complete BMS, particularly how these factors vary across different racial and ethnic groups, remain largely unexplored. METHODS This prospective cohort study included adult patients referred to a bariatric surgeon or obesity medicine program between July 2019-September 2022. Sociodemographic characteristics, body mass index (BMI), anxiety, depression, body appreciation, and patient-physician relationship information were collected via survey and electronic health records. The association between BMS completion and potential decision-driving factors was examined using Classification and Regression Tree (CART) analysis. RESULTS A total of 406 BMS -eligible patients participated in the study (mean [SD] age: 47.5 [11.6] years; 87.2% women; 18.0% Hispanic, 39% non-Hispanic Black [NHB], and 39% non-Hispanic White [NHW]; mean [SD] BMI: 45.9 [10.1] kg/m2). A total of 147 participants (36.2%) completed BMS. Overall, the most influential factor driving the decision to complete BMS was younger age (< 68.4 years), higher patient satisfaction, and BMI (≥ 38.0 kg/m2). Hispanic participants prioritized age (< 55.4 years), female sex, and body appreciation. For NHB participants, the highest ranked factors were age < 56.3 years, BMI ≥ 35.8 kg/m2, and higher patient satisfaction. For NHW patients, the most influential factors were age (39.1 to 68.6 years) and higher body appreciation. CONCLUSION These findings highlight racial and ethnic group differences in the factors motivating individuals to complete BMS. By acknowledging these differences, healthcare providers can support patients from different backgrounds more effectively in their decision-making process regarding BMS.
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Affiliation(s)
- Luyu Xie
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA.
- Center for Pediatric Population Health, Dallas, TX, USA.
| | - Folefac Atem
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | - M Sunil Mathew
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Olivia Kapera
- Center for Pediatric Population Health, Dallas, TX, USA
- University of Texas Health Science Center at Houston, School of Public Health, Austin, TX, USA
| | - Sophia Ngenge
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | - Jackson Francis
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | | | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Benjamin E Schneider
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
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Kim Y, Bae KS, Choi UY, Han SB, Kim JH. Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in Korea: Prescription and Treatment Completion. J Korean Med Sci 2024; 39:e64. [PMID: 38412611 PMCID: PMC10896699 DOI: 10.3346/jkms.2024.39.e64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/19/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The treatment of pediatric patients with latent tuberculosis infection (LTBI) is a crucial TB control strategy. LTBI is not a reportable communicable disease, and data regarding LTBI treatment in pediatric patients in Korea are scarce. This study aimed to investigate the prescription patterns and treatment completion rates among pediatric patients with LTBI in Korea by analyzing National Health reimbursement claims data. METHODS We retrospectively analyzed outpatient prescription records for pediatric patients aged 18 or younger with LTBI-related diagnostic codes from 2016 to 2020. We compared the frequency of prescriptions for the standard treatment regimen (9 months of isoniazid [9H]) and an alternative treatment regimen (3 months of isoniazid plus rifampicin [3HR]). We also assessed the treatment incompletion rates by age group, treatment regimen, treatment duration, the level of medical facility, physician's specialty, and hospital location. We performed multivariable analysis to identify factors influencing treatment incompletion. RESULTS Among the 11,362 patients who received LTBI treatment, 6,463 (56.9%) were prescribed the 9H regimen, while 4,899 (43.1%) received the 3HR regimen. Patients in the 3HR group were generally older than those in the 9H group. The proportion of 3HR regimen prescriptions significantly greater in the later period (2018-2020), in primary hospitals, under the management of non-pediatric specialists, and in metropolitan regions. The overall treatment incompletion rate was 39.7% (9H group: 46.9%, 3HR group: 30.3%). In the multivariable analysis, 9H regimen prescription was the strongest factor associated with treatment incompletion (adjusted odds ratio, 2.42; 95% confidence interval, 2.20-2.66; P < 0.001). Additionally, management in a primary hospital, a hospital's location in a non-metropolitan region, and management by a non-pediatric specialist were also significant risk factors for treatment incompletion. CONCLUSION Our study results suggest that promoting the use of 3HR regimen prescriptions could be an effective strategy to enhance treatment completion. Physicians in primary hospitals, hospitals located in non-metropolitan regions, and physicians without a pediatric specialty require increased attention when administering LTBI treatment to pediatric patients to ensure treatment completion.
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Affiliation(s)
- Yejin Kim
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kil Seong Bae
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Pediatrics, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ui Yoon Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Pediatrics, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Seung Beom Han
- Department of Pediatrics, Hallym University Hangang Sacred Hospital, Seoul, Korea
| | - Jong-Hyun Kim
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kitila SB, Feyissa GT, Wordofa MA. Completion of the Maternal Health Care Continuum-Barriers and Facilitators Among Pregnant Women in Jimma Zone, Southwest Ethiopia: A Prospective Study. Health Serv Insights 2023; 16:11786329231214607. [PMID: 38046557 PMCID: PMC10691321 DOI: 10.1177/11786329231214607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background Continuum of care (CoC) for Maternal Health Care (MHC) is a key strategy aimed at saving lives and promoting the well-being of women and newborns. To achieve the global targets for reducing maternal and newborn mortality, it is preferable to ensure the completion of key care stages (Antenatal, Institutional Delivery, and Postnatal) rather than fragmented care. Therefore, investigating the determinants of CoC completion for MHC is imperative for recommending schemes and designing strategies. Objective To assess the determinants influencing completion of the maternal healthcare continuum among pregnant women in Jimma Zone, Southwest Ethiopia. Methods and Materials A community-based prospective study was conducted from July 2020 to June 2021 among 1065 pregnant women from randomly selected woredas in Jimma Zone. The data were collected, entered using Epi-data and analyzed with SPSS software. Binary logistic regression was used to select candidate variables for multivariate analysis. Multivariate analysis was performed to identify associations between the dependent and independent factors. Principal Component Analysis (PCA) was used to determine the socioeconomic index. Results The overall completion rate was 16.1% (CI, 13.8%-18.5%), with significant dropouts observed between the first and the fourth ANC.Factors associated with the completion of MHC included the women's residence (AOR: 1.73 95% CI: 1.07, 2.81), educational status of their partners (AOR: 5.60 95% CI: 2.40, 13.08), women's occupation (AOR: 2.57 95% CI: 1.28, 5.16), knowledge of ANC (AOR: 7.64 95% CI: 4.03, 14.48), knowledge of PNC (AOR: 4.88 95% CI: 3.21, 7.42), service provided during ANC contacts (AOR: 3.39 95% CI: 1.94, 5.93), parity (AOR: 1.86 95% CI: 1.11, 3.12), time of booking for ANC (AOR: 2.10 95% CI: 1.45, 3.03), and nature of care (AOR: 2.03 95% CI: 1.07, 3.82). Additionally, factors such as topography, distance, lack of transportation, facility closeness, and indirect costs were associated with the completion for MHC. Conclusion and Recommendations The completion rate of CoC for MHC remains low. Factors influencing completion include women's residence, partners' educational status, women's occupation, services provided during ANC, history of PNC use, parity, time of booking for ANC, knowledge of ANC and PNC, and nature of care. To address this, strategies should focus on empowering women economically, improving knowledge of ANC and PNC, enhancing the capacity of health facilities to provide comprehensive ANC services, and making the service delivery more supportive. Further research is recommended to explore the impact of CoC for MHC on birth outcomes.
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Affiliation(s)
- Sena Belina Kitila
- School of Nursing, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Muluemebet Abera Wordofa
- Population and Family Health Department, Faculty of Public Health, Institute of Health, Jimma University, Ethiopia
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Soletti GJ, Audisio K, Cancelli G, Rahouma M, Dimagli A, Harik L, Olaria RP, Alzghari T, An KR, Polk H, Lia H, Tam DY, Fremes SE, Gaudino M. Predictors of premature termination and completion of randomized controlled trials. Contemp Clin Trials 2023; 130:107219. [PMID: 37156372 DOI: 10.1016/j.cct.2023.107219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
Randomized clinical trials (RCTs) have a key role in progressing biomedical research and guiding clinical decision making, but premature termination remains high (up to 30%), raising concerns regarding funding expenditure and resource allocation. This brief report sought to identify variables associated with RCTs' premature termination and completion.
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Affiliation(s)
- Giovanni J Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Katia Audisio
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mohammed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | - Talal Alzghari
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Kevin R An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Hillary Polk
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Hillary Lia
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Derrick Y Tam
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
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Fackelmayer OJ, Inabnet WB. Lobectomy or Total Thyroidectomy-Where Is the Pendulum now for Differentiated Thyroid Cancer? Surg Oncol Clin N Am 2023; 32:373-381. [PMID: 36925191 DOI: 10.1016/j.soc.2022.10.011] [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: 03/17/2023]
Abstract
Thyroid surgery remains an essential treatment of thyroid cancer. The historical one-size-fits-all approach to differentiated (papillary and follicular) thyroid carcinoma of total thyroidectomy with central lymph node dissection has been shown to be overtreatment with associated risk of perioperative complications including nerve palsy and hypoparathyroidism. Furthermore, thyroid lobectomy may obviate life-long thyroid hormone replacement. Low-risk thyroid cancers have a low risk of recurrence and those that do recur can be salvaged with reoperation without compromising prognosis. Perioperative risk stratification for recurrence and death greatly influence the need for total thyroidectomy.
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Affiliation(s)
- Oliver J Fackelmayer
- Divsion of General, Endocrine and Metabolic Surgery, University of Kentucky, Lexington, KY 40508, USA; General, Endocrine & Metabolic Surgery, University of Kentucky, 125 East Maxwell Street, Suite 302, Lexington, KY 40508, USA.
| | - William B Inabnet
- Divsion of General, Endocrine and Metabolic Surgery, University of Kentucky, Lexington, KY 40508, USA; Department of Surgery, University of Kentucky College of Medicine, UK HealthCare, 800 Rose Street, MN268, Lexington, KY 40508, USA
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Adepoju VA, Adelekan A, Adepoju OE, Onyezue OI, Imoyera W, Nkeiruka A, Olofinbiyi AB. Barriers and Facilitators of Isoniazid Preventive Therapy Implementation among People Living with HIV in Nigeria: A Scoping Review of the Literature. West Afr J Med 2023; 40:336-344. [PMID: 37018383] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Implementation of Isoniazid Preventive Therapy (IPT) among People Living with HIV (PLHIV) continues to be a significant challenge, and there is a shortage of effective interventions. This scoping review aimed to determine barriers and facilitators of IPT implementation including its uptake and completion among PLHIV in Nigeria. METHODS PubMed, Medline Ovid, Scopus, Google scholar, web of science and Cochrane Library were searched for articles published between January 2019 to June 2022 that addressed barriers and facilitators of IPT uptake and completion in Nigeria. The study used the PRISMA checklist to ensure the quality of the study. RESULTS The initial search revealed 780 studies, of which 15 studies were finally included in the scoping review. The authors inductively organized IPT barriers among PLHIV into patients-, health system-,programmatic- and provider-related barriers. Facilitators of IPT were sub-categorized into programmatic (Monitoring and Evaluation or logistic), patient-related and provider-related (capacity building) and health systems sub-categories. Most studies highlighted more barriers than facilitators, and across all studies, IPT uptake was 3% - 61.2% while IPT completion was 40 - 87.9% but these figures are higher in quality improvement studies. CONCLUSION Identified barriers include health system, and programmatic-across, and in all the studies, IPT uptake was 3%-61.2%. Cost-effective and locally developed interventions addressing context-specific barriers should be developed to address patient, provider, programmatic, and health systems-specific findings in our study with a clear understanding that there may be other barriers limiting uptake and completion of IPT at the level of community and caregivers.
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Affiliation(s)
- V A Adepoju
- Department of HIV and Infectious Diseases, Jhpiego (an affiliate of John Hopkins University), Abuja, Nigeria. ;
- Department of Adolescent Research, Adolescent Friendly Research Initiative and Care (ADOLFRIC), Ado-Ekiti, Ekiti State, Nigeria
| | - A Adelekan
- Blue Gate Research Institute, Ibadan, Oyo State, Nigeria
| | - O E Adepoju
- Department of Adolescent Research, Adolescent Friendly Research Initiative and Care (ADOLFRIC), Ado-Ekiti, Ekiti State, Nigeria
| | - O I Onyezue
- Prevention and Community Directorate , APIN Public Health Initiatives, Nigeria
| | - W Imoyera
- Department of HIV and Infectious Diseases, Jhpiego (an affiliate of John Hopkins University), Abuja, Nigeria. ;
| | - A Nkeiruka
- Department of HIV/AIDS, Achieving Health Nigeria Initiative, Nigeria
| | - A B Olofinbiyi
- Department of Adolescent Research, Adolescent Friendly Research Initiative and Care (ADOLFRIC), Ado-Ekiti, Ekiti State, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
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Adepoju VA, Adelekan A, Agbaje A, Quaitey F, Ademola-Kay T, Udoekpo AU, Sokoya OD. Completion of 6-mo isoniazid preventive treatment among eligible under six children: A cross-sectional study, Lagos, Nigeria. World J Clin Cases 2023; 11:104-115. [PMID: 36687175 PMCID: PMC9846979 DOI: 10.12998/wjcc.v11.i1.104] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/15/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nigeria is one of the thirty high burden countries with significant contribution to the global childhood tuberculosis epidemic. Tuberculosis annual risk for children could be as high as 4% particularly in high tuberculosis (TB) prevalent communities. Isoniazid (INH) Preventive Therapy has been shown to prevent TB incidence but data on its implementation among children are scarce.
AIM To determine the completion of INH among under six children that were exposed to adults with smear positive pulmonary TB in Lagos, Nigeria.
METHODS This was a hospital-based retrospective cross-sectional review of 265 medical records of eligible children < 6 years old enrolled for INH across 32 private hospitals in Lagos, Nigeria. The study took place between July and September 2020. Data was collected on independent variables (age, gender, type of facility, TB screening, dose and weight) and outcome variables (INH outcome and proportion lost to follow up across months 1-6 of INH treatment).
RESULTS About 53.8% of the participants were female, 95.4% were screened for TB and none was diagnosed of having TB. The participants’ age ranged from 1 to 72 mo with a mean of 36.01 ± 19.67 mo, and 40.2% were between the ages of 1-24 mo. Only 155 (59.2%) of the 262 participants initiated on INH completed the six-month treatment. Cumulatively, 107 (41.0%) children were lost to follow-up at the end of the sixth month. Of the cumulative 107 loss to follow-up while on INH, largest drop-offs were reported at the end of month 2, 52 (49%) followed by 20 (19%), 17 (16%), 11 (10.2%) and 7 (6.5%) at months 3, 4, 5 and 6 respectively. The analysis showed that there was no significant association between age, gender, type of facility and completion of INH treatment (P > 0.005).
CONCLUSION This study demonstrated suboptimal INH completion rate among children with only 6 out of 10 children initiated on INH who completed a 6-mo treatment in Lagos, Nigeria. The huge drop-offs in the first 2 mo of INH calls for innovative strategies such as the use of 60-d INH calendar that would facilitate reminder and early engagement of children on INH and their caregivers in care and across the entire period of treatment.
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Affiliation(s)
- Victor Abiola Adepoju
- Department of HIV and Infectious Diseases, Jhpiego Nigeria, Federal Capital Territory, Abuja 900918, Nigeria
| | - Ademola Adelekan
- Department of Research, Bluegate Research Institute, Ibadan 211271, Oyo State, Nigeria
| | - Aderonke Agbaje
- Clinical Services, Institute of Human Virology of Nigeria, Abuja 900918, Nigeria
| | - Femi Quaitey
- Department of HIV and Infectious Diseases, Jhpiego Nigeria, Uyo 520108, AkwaIbom, Nigeria
| | - Tobi Ademola-Kay
- Adolescent and Youth Care, Youth Development and Empowerment Initiative, Lagos 23401, Nigeria
| | - Ann Uduak Udoekpo
- Monitoring and Evaluation, Jhpiego Nigeria, Uyo 520108, AkwaIbom, Nigeria
| | - Olusola Daniel Sokoya
- Lagos State Tuberculosis, Buruli Ulcer and Leprosy Control Program, Ikeja 100001, Lagos, Nigeria
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Huang L, Nguyen JL, Alfred T, Perdrizet J, Cane A, Arguedas A. PCV13 Pediatric Routine Schedule Completion and Adherence Before and During the COVID-19 Pandemic in the United States. Infect Dis Ther 2022; 11:2141-2158. [PMID: 36219342 PMCID: PMC9552144 DOI: 10.1007/s40121-022-00699-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction A 13-valent pneumococcal conjugate vaccine (PCV13) was licensed to protect against emerging Streptococcus pneumoniae serotypes. Healthcare services, including routine childhood immunizations, were disrupted as a result of coronavirus disease 2019 (COVID-19). This study compared PCV13 routine vaccination completion and adherence among US infants before and during the COVID-19 pandemic and the relationship between primary and booster dose completion and adherence. Methods Retrospective data from Optum’s de-identified Clinformatics® Data Mart were used to create three cohorts using data collected between January 2017 and December 2020: cohort 1 (C1), pre-COVID; cohort 2 (C2), cross-COVID; and cohort 3 (C3), during COVID. Study endpoints were completion and adherence to the primary PCV13 series (analyzed using univariate logistic regression) and completion of and adherence to the booster dose (analyzed descriptively). Results The analysis included 142,853 infants in C1, 27,211 infants in C2, and 53,306 infants in C3. Among infants with at least 8 months of follow-up from birth, three-primary-dose completion (receipt of all three doses within 8 months after birth) and adherence (receipt of doses at recommended times) were significantly higher before (C1 and C2) versus during (C3) COVID-19 (odds ratio [OR] 1.12 [95% confidence interval [CI] 1.07, 1.16] and OR 1.10 [95% CI 1.05, 1.15], respectively). A significantly higher percentage of infants received a booster dose before versus during COVID-19 (83.2% vs. 80.2%; OR 1.23; 95% CI 1.17, 1.29); similarly, booster dose adherence was higher before than during COVID-19 (51.2% vs. 47.4%; OR 1.17; 95% CI 1.13, 1.21). The odds of booster dose completion were 8.26 (95% CI 7.92, 8.60) and 7.90 (95% CI 7.14, 8.74) times as likely in infants who completed all three primary doses than in infants who did not complete primary doses before COVID-19 and during COVID-19, respectively. Conclusions PCV13 full completion was lower during the COVID-19 pandemic compared with pre-pandemic (79.0% vs. 77.1%). Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00699-5.
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Affiliation(s)
- Liping Huang
- Patient and Health Impact, Pfizer Inc, 235 East 42nd Street, New York City, NY, 10017, USA.
| | - Jennifer L Nguyen
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Tamuno Alfred
- Statistical Research and Data Science Center, Pfizer Inc, New York City, NY, USA
| | - Johnna Perdrizet
- Patient and Health Impact, Pfizer Inc, 235 East 42nd Street, New York City, NY, 10017, USA
| | - Alejandro Cane
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Adriano Arguedas
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
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Lattimore CM, Meneveau MO, Marsh KM, Shada AL, Slingluff CL, Dengel LT. A Novel Fascial Flap Technique After Inguinal Complete Lymph Node Dissection for Melanoma. J Surg Res 2022; 278:356-363. [PMID: 35671681 DOI: 10.1016/j.jss.2022.04.039] [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: 12/06/2021] [Revised: 03/07/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Inguinal complete lymph node dissection (CLND) for metastatic melanoma exposes the femoral vein and artery. To protect femoral vessels while preserving the sartorius muscle, we developed a novel sartorius and adductor fascial flap (SAFF) technique for coverage. METHODS The SAFF technique includes dissection of fascia off sartorius and/or adductor muscles, rotation over femoral vasculature, and suturing into place. Patients who underwent inguinal CLND with SAFF for melanoma at our institution were identified retrospectively from a prospectively-collected database. Patient characteristics and post-operative outcomes were obtained. Multivariate logistic regression assessed associations of palpable and non-palpable disease with wound complications. RESULTS From 2008 to 2019, 51 patients underwent CLND with SAFF. Median age was 62 years, and 59% were female. Thirty-one (61%) patients were presented with palpable disease and 20 (39%) had non-palpable disease. Fifty-five percent (95% confidence interval CI: 40%-69%) experienced at least one wound complication: wound infection was most common (45%; 95% CI: 31%-60%), while bleeding was the least (2%; 95% CI: 0.05%-11%). Complications were similar, with and without palpable disease. CONCLUSIONS The SAFF procedure covers femoral vessels, minimizes bleeding, preserves the sartorius muscle, and uses standard surgical techniques easily adoptable by surgeons who perform inguinal CLND.
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Affiliation(s)
- Courtney M Lattimore
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Max O Meneveau
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Katherine M Marsh
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Amber L Shada
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Craig L Slingluff
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Lynn T Dengel
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Wang S, Ji B, Li C, Han W, Wang X, Zhou Z, Chen D, Feng Q, Liang J, Lv J, Bi N, Deng L, Wang W, Zhang T, Xiao Z. Factors affecting the completion of concurrent chemotherapy and impact of non-completion on survival in locally advanced esophageal squamous cell carcinoma. Esophagus 2022; 19:717-725. [PMID: 35760946 DOI: 10.1007/s10388-022-00930-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/30/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND To investigate whether completion of concurrent chemotherapy (CCT) improves overall survival (OS) of patients with locally advanced esophageal squamous cell carcinoma (ESCC), and to identify predictors of non-completion of CCT. METHODS Data of ESCC patients treated with definitive concurrent chemoradiotherapy from January 2012 to December 2017 were retrospectively analyzed. CCT completion was defined as receiving recommended cycles with at most 25% dose reduction. Propensity score matching (PSM) analysis was applied to adjust unbalanced covariates between groups. Multivariate logistic regression model was used to identify factors affecting CCT completion. RESULTS Of the 487 patients in the study, 194 patients (39.8%) had completed CCT. The majority (90.7%) had stage III-IV disease. Three-year OS rate was significantly higher in the completion group than non-completion group (35.4% vs. 30.3%; p = 0.025). Multivariate Cox analysis showed CCT completion was independently associated with longer OS (p = 0.005). The independent risk factors for CCT non-completion were weekly CCT regimen [odds ratio (OR) = 4.35, 95% CI 2.26-8.37; p < 0.001], clinical target volume (CTV)-elective nodal irradiation (ENI) (OR = 3.86, 95% CI 2.41-6.18; p < 0.001), planning target volume (PTV)/50 cm3 (OR = 1.09, 95% CI 1.02-1.16; p = 0.017), age (OR = 1.04, 95% CI 1.01-1.07, p = 0.011), and tumor in middle/lower esophagus (OR = 1.59, 95% CI 1.05-2.43, p = 0.030). CONCLUSION CCT completion can provide superior OS for ESCC patients treated with definitive CCRT. Weekly CCT regimen, CTV-ENI, PTV, older age, and tumor location are independent predictors of non-completion of CCT.
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Affiliation(s)
- Shijia Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Baoyan Ji
- Department of Oncology, Qinghai Provincial People's Hospital, Xining, 810000, Qinghai, People's Republic of China
| | - Chen Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Weiming Han
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Jun Liang
- Department of Radiation Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen, 518000, Guangdong, People's Republic of China
| | - Jima Lv
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Wenqing Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Tao Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, People's Republic of China.
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Pedersen CG, Nielsen CV, Lynggaard V, Zwisler AD, Maribo T. The patient education strategy "learning and coping" improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial. BMC Cardiovasc Disord 2022; 22:364. [PMID: 35941553 PMCID: PMC9361528 DOI: 10.1186/s12872-022-02774-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Adherence and completion of programmes in educational and physical exercise sessions is essential in cardiac rehabilitation (CR) to obtain the known benefits on morbidity, mortality, risk factors, lifestyle, and quality of life. The patient education strategy “Learning and Coping” (LC) has been reported to positively impact adherence and completion in a hospital setting. It is unknown if LC has impact on adherence in primary healthcare settings, and whether LC improves self-management. The aim of this pragmatic primary healthcare-based study was to examine whether patients attending CR based on LC had a better adherence to patient education and physical exercise, higher program completion rate, and better self-management compared to patients attending CR based on a consultation program Empowerment, Motivation and Medical Adherence (EMMA).
Method A pragmatic cluster-controlled trial of two types of patient education LC and EMMA including ten primary healthcare settings and 514 patients (LC, n = 266; EMMA, n = 248) diagnosed with ischaemic heart disease discharged from hospital and referred to CR between August 1, 2018 and July 31, 2019. Adherence was defined as participation in ≥ 75% of provided sessions. Completion was defined as patients attended the final interview at the end of the 12-weeks programme. Patient Activation Measure (PAM) was used to obtain information on a person's knowledge, skills and confidence for self-management. PAM questionnaire was completed at baseline and 12-weeks follow-up. Multiple and Linear regression analyses adjusted for potential confounder variables and cluster effect were performed. Result Patients who followed CR based on LC had a higher adherence rate to educational and physical exercise sessions compared to patients who followed CR based on EMMA (p < 0.01). High-level of completion was found at the end of CR with no statistically significant between clusters (78.9% vs. 78.2%, p > 0.05). At 12-weeks, there was no statistical differences in PAM-score between clusters (p > 0.05). Conclusion This study indicates that the LC positively impacts adherence in CR compared to EMMA. We found non-significant difference in completing CR and in patient self-management between the two types of patient education. Future studies are needed to investigate if the higher adherence rate achieved by LC in primary healthcare settings translates into better health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02774-8.
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Affiliation(s)
- Charlotte Gjørup Pedersen
- Department of Public Health, Aarhus University, Aarhus, Denmark. .,DEFACTUM, Central Denmark Region, Aarhus, Denmark. .,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark
| | - Vibeke Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Hwang R, Peters R, Harmer E, Boyde M, Morris NR. Insight into a real-world experience with completion of cardiac rehabilitation. Int J Cardiol 2022; 360:5-6. [PMID: 35636575 DOI: 10.1016/j.ijcard.2022.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Rita Hwang
- Department of Physiotherapy, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia; School of Allied Health Sciences and Menzies Health Institute, Griffith University, Gold Coast, Australia.
| | - Robyn Peters
- Department of Cardiology, Princess Alexandra Hospital, Metro South Health, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Emma Harmer
- Department of Cardiology, Princess Alexandra Hospital, Metro South Health, Australia
| | - Mary Boyde
- Department of Cardiology, Princess Alexandra Hospital, Metro South Health, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Norman R Morris
- School of Allied Health Sciences and Menzies Health Institute, Griffith University, Gold Coast, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
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Pergialiotis V, Bellos I, Douligeris A, Thomakos N, Rodolakis A, Haidopoulos D. The impact of adjuvant hysterectomy on survival outcomes of patients with locally advanced cervical cancer: A network meta-analysis. Eur J Surg Oncol 2021; 48:261-267. [PMID: 34548217 DOI: 10.1016/j.ejso.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Various articles have addressed the impact of hysterectomy on survival outcomes of patients with locally advanced cervical cancer (LACC). This study was designed to evaluate whether treatment modalities that include hysterectomy as an option for the treatment of LACC patients are superior to standard chemo-radiotherapy. METHODS Literature search was performed using the Medline, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Clinicaltrials.gov databases. Observational (prospective and retrospective) and randomized trials that included adjuvant hysterectomy in at least one treatment group. A network meta-analysis was carried out in R 3.4.3 using the pcnetmeta package, which uses a Bayesian hierarchical model. The credibility of evidence was appraised with the Confidence In Network Meta-Analysis (CINeMA) tool. RESULTS Overall, 14 studies were included in the present systematic review that involved 2302 patients with LACC. Every potential combination of external beam radiotherapy, intracavitary brachytherapy, chemotherapy and surgery was considered to be eligible for inclusion. The results of the network meta-analysis suggested that the various treatment alternatives did not differ in terms of survival outcomes. Furthermore, the qualitative analysis revealed that hysterectomy was accompanied by considerable perioperative morbidity; therefore, rendering its addition to the treatment scheme of LACC patients inappropriate. CONCLUSIONS Patients with LACC do not seem to benefit substantially by the addition of hysterectomy to standard chemo-radiotherapy. Moreover, the operation is accompanied by substantial perioperative morbidity, thus, its implementation in clinical practice should be avoided.
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Affiliation(s)
- Vasilios Pergialiotis
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece; Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece.
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece
| | - Athanasios Douligeris
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Thomakos
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Haidopoulos
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
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Shubber Z, Ford N. Adherence to HIV post-exposure prophylaxis for children/adolescents who have been sexually assaulted: A systematic review of barriers, enablers, and interventions. Child Abuse Negl 2021; 116:104143. [PMID: 31522763 DOI: 10.1016/j.chiabu.2019.104143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 06/10/2023]
Abstract
Post-exposure prophylaxis (PEP) is a key intervention for preventing HIV acquisition, including following sexual assault. However, uptake and completion rates for HIV PEP are lowest following sexual assault, with only 40% reporting completing the 28-day course. We undertook a systematic review to assess barriers and enablers to adherence to PEP in children and adolescents following sexual assault and identify potential interventions. Five databases and one conference abstract library were searched using adapted search strategies to identify quantitative and qualitative studies reporting patient-reported barriers and enablers to PEP and randomized trials assessing interventions to improve PEP adherence and completion rates. All searches were conducted up to October 2016; the search was updated in PubMed up to 31 July 2018. 14 studies reported barriers and enablers to PEP adherence. The most commonly cited patient/caregiver reported barriers to PEP adherence/completion included side effects, forgetting, stigma/blame, being busy, poor knowledge, and mental health problems. The most commonly reported factors associated with PEP adherence/completion (reported across 7 studies) included health provider encouragement to take PEP (type of encouragement not described), perpetrator known to be HIV-positive, monetary support for transport, the victim of assault attending counseling, being reminded by family/peers to take PEP, and "one-stop" services offering both HIV testing and PEP at initial consultation. Three randomized trials provided limited evidence supporting the potential benefit of enhanced adherence support for HIV PEP; however, data for children were lacking. Despite low completion rates, there is limited research into causes of and interventions to improve adherence to PEP following sexual assault, and no direct evidence for children.
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Affiliation(s)
- Zara Shubber
- Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom
| | - Nathan Ford
- Department HIV & Global Hepatitis Programme, World Health Organization, Geneva, Switzerland.
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15
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Zaretskaya N. Zooming-in on higher-level vision: High-resolution fMRI for understanding visual perception and awareness. Prog Neurobiol 2021;:101998. [PMID: 33497652 DOI: 10.1016/j.pneurobio.2021.101998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 11/11/2020] [Accepted: 01/16/2021] [Indexed: 12/24/2022]
Abstract
One of the central questions in visual neuroscience is how the sparse retinal signals leaving our eyes are transformed into a rich subjective visual experience of the world. Invasive physiology studies, which offers the highest spatial resolution, have revealed many facts about the processing of simple visual features like contrast, color, and orientation, focusing on the early visual areas. At the same time, standard human fMRI studies with comparably coarser spatial resolution have revealed more complex, functionally specialized, and category-selective responses in higher visual areas. Although the visual system is the best understood among the sensory modalities, these two areas of research remain largely segregated. High-resolution fMRI opens up a possibility for linking them. On the one hand, it allows studying how the higher-level visual functions affect the fine-scale activity in early visual areas. On the other hand, it allows discovering the fine-scale functional organization of higher visual areas and exploring their functional connectivity with visual areas lower in the hierarchy. In this review, I will discuss examples of successful work undertaken in these directions using high-resolution fMRI and discuss where this method could be applied in the future to advance our understanding of the complexity of higher-level visual processing.
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Tuckerman K, Potts W, Ebrahimi M, Scholes C, Nelson M. Evolution of service metrics and utilisation of objective discharge criteria in anterior cruciate ligament reconstruction rehabilitation: a retrospective cohort study with historical control in a public hospital physiotherapy department. Arch Physiother 2020; 10:23. [PMID: 33317636 PMCID: PMC7737268 DOI: 10.1186/s40945-020-00093-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/24/2020] [Indexed: 01/06/2023] Open
Abstract
Background ACL reconstruction (ACLR) is a common procedure requiring rehabilitation in public hospital physiotherapy departments. The rate of re-rupture and reduced rates of return to sport following ACLR are concerning. Current guidelines recommend a progressive approach to rehabilitation based on objective criteria. The aim of this study was to determine whether a new public hospital model of care incorporating a phase-based program increased physiotherapist utilisation of objective outcome measures, improved service metrics including attendance and rehabilitation completion rates, and increased patient-reported activity and knee function. Methods Records from patients attending outpatient physiotherapy after ACL reconstruction (N = 132) were included in a retrospective chart review to assess utilisation of objective measures such as quadricep and hamstring strength assessment, patient attendance and rehabilitation completion. Phone followup (minimum 1 year) was conducted to retrieve patient-reported measures of knee function (IKDC) and activity (Tegner Activity Scale). Patients were categorised by rehabilitation model of care (contemporary - time based [N = 93] vs new - phase based [N = 39]) and logistic regression used to assess the influence of patient factors and model of care on outcomes. Results Compliance was equivalent between models of care and completion rates (formal discharge by therapist) were low (30–38%). The probability of a patient receiving objective strength assessment was associated with model of care, sex, BMI and number of sessions attended. The probability of a patient being recorded as discharged from the program was significantly associated with model of care, and duration and number of sessions. Conclusion Introduction of an updated model of care including a phase-based rehabilitation program increased physiotherapist utilisation of objective outcome measures in line with current ACLR rehabilitation recommendations, increased total rehabilitation duration and increased total number of sessions attended. Despite this, rehabilitation completion rates remained low, and self-reported activity and knee function remained equivalent. Level of evidence III, retrospective cohort study. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-020-00093-9.
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Affiliation(s)
- Kirby Tuckerman
- Department of Physiotherapy, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia
| | - Wendy Potts
- Department of Physiotherapy, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia
| | | | | | - Mark Nelson
- Department of Physiotherapy, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia.
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Brouwers RWM, Houben VJG, Kraal JJ, Spee RF, Kemps HMC. Predictors of cardiac rehabilitation referral, enrolment and completion after acute myocardial infarction: an exploratory study. Neth Heart J 2021; 29:151-7. [PMID: 33030659 DOI: 10.1007/s12471-020-01492-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
Background Despite proven clinical benefits, only a minority of patients complete outpatient cardiac rehabilitation (CR) after acute myocardial infarction (AMI). The main purpose of this study was to evaluate to what extent and at which time patients drop out of CR, and to assess which patient-related characteristics can predict dropout. Methods In a retrospective cohort study, we selected patients who had been hospitalised with an AMI in our centre in 2015 or 2016. Patients were selected pseudonymously based on reimbursement codes in the electronic health record. We extracted baseline characteristics and data on CR referral, enrolment and completion for each patient. Multivariable logistic regression was used to assess which characteristics predicted referral and dropout. Results The 666 patients included were predominantly male (66%), with a mean age of 69.0 years. Of the 640 eligible patients, 201 (31%) were not referred for CR. Enrolment after referral was 94%. Nonreferral was independently associated with older age, female sex, traveling distance, non-ST-elevation myocardial infarction (NSTEMI; as compared with STEMI), no coronary revascularisation and prior manifestations of coronary artery disease. Of the 414 enrolled patients, 24% did not complete their CR programmes (i.e. dropped out). Older age and worse exercise capacity at baseline were independently associated with dropout. The ability of the multiple regression models to predict nonreferral and noncompletion was good to fair, with an area under the receiver operating characteristic curves of 0.86 and 0.71, respectively. Conclusion The main reason for not participating in or not completing CR after AMI was nonreferral. To optimise CR utilisation, improvement of referral rates should be prioritised.
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Sensalire S, Karungi Karamagi Nkolo E, Nabwire J, Lawino A, Kiragga D, Muhire M, Kadama H, Katureebe C, Namuwenge P, Musinguzi J, Calnan J, Seyoum D. A prospective cohort study of outcomes for isoniazid prevention therapy: a nested study from a national QI collaborative in Uganda. AIDS Res Ther 2020; 17:28. [PMID: 32460788 PMCID: PMC7254658 DOI: 10.1186/s12981-020-00285-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection constitute a deadly infectious disease synergy disease and major public health problem throughout the world. The risk of developing active TB in people living with HIV (PLHIV) is 21 times higher than the rest of the world population. The overlap of latent TB infection and HIV infection has resulted in marked increases in TB incidence in countries with dual epidemics. Although antiretroviral therapy (ART) is the single most significant way to reduce incident TB in PLHIV, besides early ART initiation, isoniazid preventive therapy (IPT) is the key intervention to prevent TB among PLHIV. This prospective cohort and longitudinal study aimed to document; retention, adherence, development of active TB disease, possible adverse drug reactions and completion among patients initiated on IPT in Jan 2019. Methods This was both a prospective cohort and longitudinal study nested within a national quality improvement collaborative in which multiple quality improvement teams tested changes in care delivery to improve the delivery of IPT. The prospective cohort were HIV patients without TB disease initiated on a dosage of Isoniazid 300 mg/day for adults and 150 mg/day for children for a period of 6 months. Association statistics were used to describe patient characteristics and outcomes. Variables with p-value < 0.05 were used to determine linear by linear associations between patient characteristics assumed to influence both primary and secondary outcomes. Variables with a p-value < 0.05 were included in the logistical regression model. The final model included those factors that retained statistical significance. The odds ratios (OR) and adjusted OR (AOR) along with its 95% confidence interval were used to determine the power of relationship in determining the outcomes of interest. The model was tested for fitness using goodness-of-fit Hosmer–Lemeshow tests. Results The completion of IPT was at 89%. A significant proportion of patients adhered to treatment (89%) and kept their appointment schedules-retention (89%). All patients (100%) received IPT at each appointment visit. Only 4% of patients experienced side effects of isoniazid (INH) but none of them developed active TB at the end of the 6 month INH dose. Multivariate logistic regression analysis of covariates of IPT completion revealed a strong and statistical association between IPT completion and age, gender, retention and side effects of INH. Our multivariate model found that children below 15 years were less likely to complete INH than patients ≥ 15 years (AOR = 0.416, p = 0.230, df = 1). Female patients were 2 times more likely to complete INH dose than male patients (AOR = 1.598, p = 0.018). Patients who kept all their appointment schedules were 10 times more likely to complete IPT than those who missed one or more schedules (AOR = 10.726, p = 0.000, df = 1). We also found that patients who did not report any side effects associated with INH were 2 times more likely to complete INH (AOR = 1.958, p = 0.016, df = 1) than patients who reported one or more side effects. Conclusion Treatment completion is the end-point of the IPT initiation strategy in Uganda. With a completion rate of 89%, our results seem re-assuring and suggest that improvement collaborative is an effective approach to achieving results through combined efforts. The high rates of completion are encouraging indicators of progress in the implementation of collaborative activities in the study setting. However, such collaboratives would require periodic evaluation to prevent possible relapses in progress attained.
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Porter KJ, Thomson JL, Zoellner JM. Predictors of engagement and outcome achievement in a behavioural intervention targeting sugar-sweetened beverage intake among rural adults. Public Health Nutr 2020; 23:554-63. [PMID: 31796129 DOI: 10.1017/S1368980019003392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe relationships among baseline characteristics, engagement indicators and outcomes for rural participants enrolled in SIPsmartER, a behavioural intervention targeting sugar-sweetened beverage (SSB) intake. DESIGN A secondary data analysis. Bivariate analyses determined relationships among baseline characteristics (e.g. age, gender, race, education, income), engagement indicators (completion of 6-month health screening, class attendance, call completion) and SSB outcomes (SSB ounce reduction (i.e. US fluid ounces; 1 US fl. oz = 29·57 ml), reduced ≥12 ounces, achieved ≤8 ounce intake). Generalized linear models tested for significant effects of baseline characteristics on engagement indicators and of baseline characteristics and engagement indicators on SSB outcomes. SETTING South-west Virginia, USA, a rural, medically underserved region. PARTICIPANTS Participants' (n 155) mean age was 41 years; most were female (81 %), White (91 %) and earned ≤$US 20 000 per annum (61 %). RESULTS All final models were significant. Engagement models predicted 12-17 % of variance, with age being a significant predictor in all three models. SSB outcome models explained 5-70 % of variance. Number of classes attended was a significant predictor of SSB ounce reduction (β = -6·12, P < 0·01). Baseline SSB intake significantly predicted SSB ounce reduction (β = -0·90, P < 0·001) and achieved ≤8 ounce intake (β = 0·98, P < 0·05). CONCLUSIONS The study identifies several participant baseline characteristics that may impact engagement in and outcomes from a community-based intervention targeting SSB intake. Findings suggest greater attendance of SIPsmartER classes is associated with greater reduction in overall SSB intake; yet engagement variables did not predict other outcomes. Findings will inform the future implementation of SIPsmartER and research studies of similar design and intent.
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Noh CS, Kim HI, Choi H, Kim Y, Kim CH, Choi JH, Hyun IG, Baek MS. Completion rate of latent tuberculosis infection treatment in patients aged 65 years and older. Respir Med 2019; 157:52-8. [PMID: 31522030 DOI: 10.1016/j.rmed.2019.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/19/2019] [Accepted: 09/06/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There are insufficient data on the treatment of latent tuberculosis infection (LTBI) in elderly patients. We investigated the completion rate of treatment in elderly LTBI patients. METHODS A retrospective multicentre study was conducted at five university hospitals in South Korea. We reviewed the electronic medical records of patients aged 65 years and older who were diagnosed with LTBI via positive interferon-gamma release assay results between January 2016 and December 2018. Treatment completion was defined as ingestion of more than 80% of all prescribed medications without loss to follow-up. RESULTS During the study period, 127 LTBI patients aged 65 years and older visited outpatient department. Among them, 77 patients aged 65-78 years (median age, 69 years [interquartile range, 66-71 years]) who received LTBI treatment were analysed. Common reasons for IGRA testing in elderly patients were health-care worker (n = 33, 42.9%) and household contact with infectious TB patients (n = 18, 23.4%). The overall completion rate of LTBI treatment was 83.1% (n = 64), and the completion rate of 3-month isoniazid plus rifampin regimen was 88.4%. Adverse effects were reported in 23 patients (29.9%), and an increase in aminotransferase level was the most common adverse effect (n = 11, 14.3%). Three patients (3.9%) with the adverse effect discontinued treatment and 10 (13.0%) patients were lost to follow-up. CONCLUSIONS LTBI treatment in patients aged 65-78 years was relatively well tolerated. In LTBI treatment in elderly patients, the majority of discontinuation of treatment was due to loss to follow-up rather than adverse effects of anti-TB medications.
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Yang Y, Wang Y, Yang D, Dong S, Yang Y, Zhu X, Chen Y, Zhou Y, Jiang Q. Factors associated with uptake of Haemophilus influenzae type b vaccination in Shanghai, China. BMC Pediatr 2019; 19:8. [PMID: 30616637 PMCID: PMC6323772 DOI: 10.1186/s12887-018-1374-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/18/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Haemophilus influenzae type b (Hib) vaccine is effective in reducing the burden of Hib related diseases, but little is known about factors influencing the uptake of Hib vaccine. This study aimed to assess the uptake of Hib vaccination and its associated factors in Shanghai City, China. METHODS We used data from a retrospective cohort of 183,246 children born in 2012-2016 obtained from the Shanghai Immunization Program Information System, which provided information on the uptake of Hib vaccination. We conducted a cross-sectional study of 451 children to collect information on demographic and other factors that might be associated with Hib vaccination. RESULTS In the retrospective cohort study, the proportions of Hib dose-1 coverage, vaccination completion and timeliness were 67.7, 52.2 and 29.4%, respectively. These measures were better among local children and increased with birth year, while there were regional differences. Hib vaccine uptake was significantly associated with maternal occupation (non-health vs health workers, OR = 2.33, 95% CI: 1.32-4.13, P = 0.004) and caregivers' awareness of Hib (yes vs no, OR = 1.75, 95% CI: 1.12-2.74, P = 0.013). CONCLUSIONS We found low levels of coverage of dose-1 Hib vaccine, timeliness and completion, suggesting inadequate protection against Hib disease for children in Shanghai. Non-local children and those of health workers should be targeted for interventions. The inclusion of Hib vaccine into the national immunization program could help improve the uptake of Hib vaccines.
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Affiliation(s)
- Ya Yang
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Yingjian Wang
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Dongjian Yang
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Shurong Dong
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Yu Yang
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Xu Zhu
- China Office of United Nations Children’s Fund, Beijing, China
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Yibiao Zhou
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Qingwu Jiang
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
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Koedam TWA, Veltcamp Helbach M, Penna M, Wijsmuller A, Doornebosch P, van Westreenen HL, Hompes R, Bonjer HJ, Sietses C, de Graaf E, Tuynman JB. Short-term outcomes of transanal completion total mesorectal excision (cTaTME) for rectal cancer: a case-matched analysis. Surg Endosc 2019; 33:103-109. [PMID: 29967991 PMCID: PMC6336745 DOI: 10.1007/s00464-018-6280-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Local excision of early rectal tumors as a rectal preserving treatment is gaining popularity, especially since bowel cancer screening programs result in a shift towards the diagnosis of early stage rectal cancers. However, unfavorable histological features predicting high risk for recurrence within the "big biopsy" may mandate completion total mesorectal excision (cTME). Completion surgery is associated with higher morbidity, poorer specimen quality, and less favorable oncological outcomes compared to primary TME. Transanal approach potentially improves outcome of completion surgery for rectal cancer. The aim of this study was to compare radical completion surgery after local excision for rectal cancer by the transanal approach (cTaTME) with conventional abdominal approach (cTME). METHODS All consecutive patients who underwent cTaTME for rectal cancer between 2012 and 2017 were case-matched with cTME patients, according to gender, tumor height, preoperative radiotherapy, and tumor stage. Surgical, pathological, and short-term postoperative outcomes were evaluated. RESULTS In total, 25 patients underwent completion TaTME and were matched with 25 patients after cTME. Median time from local excision to completion surgery was 9 weeks in both groups. In the cTaTME and cTME groups, perforation of the rectum occurred in 4 and 28% of patients, respectively (p = 0.049), leading to poor specimen quality in these patients. Number of harvested lymph nodes was higher after cTaTME (median 15; range 7-47) than after cTME (median 10; range 0-17). No significant difference was found in end colostomy rate between the two groups. Major 30-day morbidity (Clavien-Dindo≥ III) was 20 and 32%, respectively (p = 0.321). Hospital stay was significantly longer after cTME. CONCLUSION TaTME after full-thickness excision is a promising technique with a significantly lower risk of perforation of the rectum and better specimen quality compared to conventional completion TME.
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Affiliation(s)
- T. W. A. Koedam
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands ,Postbus 7075, 1007 MB Amsterdam, The Netherlands
| | - M. Veltcamp Helbach
- 0000 0004 0398 026Xgrid.415351.7Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - M. Penna
- 0000 0004 0488 9484grid.415719.fDepartment of Colorectal Surgery, Churchill Hospital, Oxford, UK
| | - A. Wijsmuller
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - P. Doornebosch
- 0000 0004 0501 4532grid.414559.8Department of Surgery, IJsselland Hospital, Capelle a/d IJssel, The Netherlands
| | - H. L. van Westreenen
- 0000 0001 0547 5927grid.452600.5Department of Surgery, ISALA Hospital, Zwolle, The Netherlands
| | - R. Hompes
- 0000 0004 0488 9484grid.415719.fDepartment of Colorectal Surgery, Churchill Hospital, Oxford, UK
| | - H. J. Bonjer
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - C. Sietses
- 0000 0004 0398 026Xgrid.415351.7Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - E. de Graaf
- 0000 0004 0501 4532grid.414559.8Department of Surgery, IJsselland Hospital, Capelle a/d IJssel, The Netherlands
| | - J. B. Tuynman
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Garrud P, McManus IC. Impact of accelerated, graduate-entry medicine courses: a comparison of profile, success, and specialty destination between graduate entrants to accelerated or standard medicine courses in UK. BMC Med Educ 2018; 18:250. [PMID: 30400933 PMCID: PMC6219209 DOI: 10.1186/s12909-018-1355-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/18/2018] [Indexed: 05/29/2023]
Abstract
BACKGROUND Little research has compared the profile, success, or specialty destinations of graduates entering UK medical schools via accelerated, 4-yr, standard 5-yr and 6-yr programmes. Four research questions directed this investigation:- What are the success rates for graduates entering graduate-entry vs. undergraduate medicine courses? How does the sociodemographic and educational profile differ between these two groups? Is success - in medical school and foundation training - dependent on prior degree, demographic factors, or aptitude test performance at selection? What specialty do graduate entry medicine students subsequently enter? METHODS The data from two cohorts of graduates entering medical school in 2007 and 2008 (n = 2761) in the UKMED (UK Medical Education Database) database were studied: 1445 taking 4-yr and 1150 taking 5-yr medicine courses, with smaller numbers following other programmes. RESULTS Completion rates for degree programmes were high at 95%, with no significant difference between programme types. 4-yr entrants were older, less likely to be from Asian communities, had lower HESA (Higher Education Statistics Agency) tariff scores, but higher UKCAT (UK Clinical Aptitude Test) and GAMSAT (Graduate Medical School Admissions Test) scores, than 5-yr entrants. Higher GAMSAT scores, black or minority ethnicity (BME), and younger age were independent predictors of successful completion of medical school. Foundation Programme (FPAS) selection measures (EPM - educational performance measure; SJT - situational judgment test) were positively associated with female sex, but negatively with black or minority ethnicity. Higher aptitude test scores were associated with EPM and SJT, GAMSAT with EPM, UKCAT with SJT. Prior degree subject, class of degree, HESA tariff, and type of medicine programme were not related to success. CONCLUSIONS The type of medicine programme has little effect on graduate entrant completion, or EPM or SJT scores, despite differences in student profile. Aptitude test score has some predictive validity, as do sex, age and BME, but not prior degree subject or class. Further research is needed to disentangle the influences of BME.
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Affiliation(s)
- Paul Garrud
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT UK
| | - I. C. McManus
- Research Department for Medical Education, University College London, Gower Street, London, WC1E 6BT UK
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Harley M, Pit SW, Rees T, Thomas S. Completion rates and psychosocial intervention effectiveness in an Australian substance use therapeutic community. Subst Abuse Treat Prev Policy 2018; 13:33. [PMID: 30249292 PMCID: PMC6154821 DOI: 10.1186/s13011-018-0170-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 09/17/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Program attrition is a major problem in substance use treatment. It is not clear which client and treatment variables are related to successful completion. This study aimed to identify client variables associated with Therapeutic Community (TC) completion. A secondary aim was to investigate changes in entry and exit scores on psychosocial outcome measures. METHODS Retrospective quantitative analysis of data collected from 193 Australian TC residents, over 3.5 years. Variables measured included: demographics; Depression, Anxiety, Stress Score (DASS-21) and World Health Organisation Quality of Life 8 questions (WHOQOL-8). RESULTS Completion rates were 30.6%. High Money WHOQOL-8 scores, suggestive of minimal financial stressors, positively predicted completion. Multivariate analyses showed that negative predictors of completion were: amphetamine being primary substance of concern, aggression, high Relationship WHOQOL-8 scores, suggestive of positive relationships, and younger or older age. Those in the program demonstrated clinically significant psychological improvement and significant improvement in all quality of life scores over time. The degree of psychometric improvement was most pronounced in those who completed the course, with the exception of depression, stress, and money problems. CONCLUSION The findings provide an understanding of specific predictors of program completion which may help to identify high-risk clients and inform program improvement. Early attrition rates may be reduced by monitoring and supporting high-risk clients. Overall, psychometric improvement occurred amongst both completers and non-completers overtime but is most prominent amongst course completers, with the exception of depression, stress, and money problems. Future research could potentially focus on amphetamine users and shortened TC programs, focusing on acute psychosocial intervention.
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Affiliation(s)
| | - Sabrina Winona Pit
- Western Sydney University, University Centre for Rural Health, Sydney, Australia
- University of Sydney, University Centre for Rural Health, Sydney, Australia
- 61 Uralba Street, Lismore, NSW 2480 Australia
| | | | - Susan Thomas
- Mental health and behavioural science, Graduate Medicine, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
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Abstract
A quantitative computational theory of the operation of the hippocampus as an episodic memory system is described. The CA3 system operates as a single attractor or autoassociation network (1) to enable rapid one-trial associations between any spatial location (place in rodents or spatial view in primates) and an object or reward and (2) to provide for completion of the whole memory during recall from any part. The theory is extended to associations between time and object or reward to implement temporal order memory, which is also important in episodic memory. The dentate gyrus performs pattern separation by competitive learning to create sparse representations producing, for example, neurons with place-like fields from entorhinal cortex grid cells. The dentate granule cells generate, by the very small number of mossy fibre connections to CA3, a randomizing pattern separation effect that is important during learning but not recall and that separates out the patterns represented by CA3 firing as being very different from each other. This is optimal for an unstructured episodic memory system in which each memory must be kept distinct from other memories. The direct perforant path input to CA3 is quantitatively appropriate for providing the cue for recall in CA3 but not for learning. The CA1 recodes information from CA3 to set up associatively learned backprojections to the neocortex to allow the subsequent retrieval of information to the neocortex, giving a quantitative account of the large number of hippocampo-neocortical and neocortical-neocortical backprojections. Tests of the theory including hippocampal subregion analyses and hippocampal NMDA receptor knockouts are described and support the theory.
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Affiliation(s)
- Edmund T Rolls
- Oxford Centre for Computational Neuroscience, Oxford, England.
- Department of Computer Science, University of Warwick, Coventry, England.
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Deshmukh U, Oliveira CR, Griggs S, Coleman E, Avni-Singer L, Pathy S, Shapiro ED, Sheth SS. Impact of a clinical interventions bundle on uptake of HPV vaccine at an OB/GYN clinic. Vaccine 2018; 36:3599-605. [PMID: 29759380 DOI: 10.1016/j.vaccine.2018.05.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION HPV vaccine uptake is lowest among young adults. Little is known about the most effective way to decrease missed opportunities (MO) and increase uptake of the vaccine in this vulnerable population. OBJECTIVES To determine the impact of a clinical intervention bundle on the rate of MO and uptake of the vaccine among young adult women. METHODS From 2/2014 to 7/2015, an intervention bundle (designating physician and nurse champions, pre-screening patients' charts, empowering nurses to recommend immunization, providing no-cost vaccinations, placing prompts in clinic note templates, eliminating requirement for pre-vaccination pregnancy test) was implemented at an urban, hospital-based OB/GYN clinic. Medical records were reviewed for all vaccine-eligible (non-pregnant, 11-26 years) women seen between 2/2013 and 9/2016. Impact of the bundled interventions on the monthly rates of MO and vaccine uptake was estimated by analyzing immunization trends with an interrupted time-series model using counterfactual comparison groups in order to control for pre-existing trends. RESULTS There were 6,463 vaccine-eligible visits during our study period. The prevalence of women who had both completed and initiated the series was significantly higher, 20.3% and 29.7% respectively, in the last month, compared to their counterfactuals (p < 0.01). In the last study month, the rate of MO was significantly lower than its counterfactual (19.73 per 100 encounters lower, p < 0.01). Hispanic women had attributable reductions in their rates of MO that were twice that of White women. Statistically significant attributable reductions were also seen among Spanish speakers, publicly insured, and uninsured women. CONCLUSIONS Implementation of this intervention bundle effectively reduced the monthly rate of MO and increased the prevalence of women who had initiated and completed the HPV vaccine series. The reduction of MO was most drastic among Hispanic, publicly insured and uninsured women compared to White and privately insured.
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Widdice LE, Hoagland R, Callahan ST, Kahn JA, Harrison CJ, Pahud BA, Frey SE, Berry AA, Kotloff KL, Edwards KM, Mulligan MJ, Sudman J, Nakamura A, Bernstein DI. Caregiver and adolescent factors associated with delayed completion of the three-dose human papillomavirus vaccination series. Vaccine 2018; 36:1491-1499. [PMID: 29428177 DOI: 10.1016/j.vaccine.2017.12.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Delayed completion of human papillomavirus vaccination (4vHPV) series is common. We sought to identify factors associated with delay. METHODS This substudy was part of a large prospective, multi-site study recruiting 9-17 year old girls at the time of their third 4vHPV dose to assess immunogenicity associated with prolonged dosing intervals. At participating sites, parents/legal guardians (caregivers) of all enrolled girls (9-17 years old) and enrolled girls aged 14-17 years were approached for participation. Caregivers completed a questionnaire measuring adolescent and caregiver sociodemographic characteristics, caregiver attitudes and beliefs about on-schedule HPV vaccination and HPV vaccine safety, adolescent's health behaviors, barriers to accessing health care, provider office vaccination practices and a Rapid Estimate of Adult Literacy in Medicine (REALM). Participating girls completed a separate questionnaire measuring their attitudes and beliefs about on-schedule HPV vaccination and HPV vaccine safety. Delay was defined as receiving the third 4vHPV dose >12 months after the first. Bivariate, multinomial logistic regression and multivariate logistic regression analyses were used to identify factors predicting delayed completion. RESULTS Questionnaires were completed by 482 caregivers and 386 adolescents; 422 caregivers completed a REALM. Delayed 4vHPV dosing occurred in most adolescents (67%). In multivariate analyses, predictors of delayed completion included caregiver demographic factors (self-reported black vs. white race and high school or less education vs. college or more) and an interaction between caregiver's inability to get an immunization appointment as soon as needed and adolescent's type of insurance. CONCLUSIONS Caregiver's race and educational level, accessibility of immunization appointments, and adolescent's insurance type were found to be related to delays in completion of 4vHPV, but caregiver or adolescent attitudes and beliefs about on-schedule HPV vaccination or HPV vaccine safety were not. Therefore, interventions to improve adherence to recommended vaccination schedules could benefit from a focus on improving access to immunizations. ClinicalTrials.gov (NCT01030562).
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Affiliation(s)
- Lea E Widdice
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, United States.
| | - Rebecca Hoagland
- Cota Enterprises, Inc., 16570 46th Street, McLouth, KS, 66054 , United States.
| | - S Todd Callahan
- Division of Adolescent and Young Adult Health, Vanderbilt University, 719 Thompson Lane Suite 36300, Nashville, TN 37204, United States.
| | - Jessica A Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, United States.
| | - Christopher J Harrison
- Division of Pediatric Infectious Diseases, Children's Mercy Hospital Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States.
| | - Barbara A Pahud
- Division of Pediatric Infectious Diseases, Children's Mercy Hospital Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States.
| | - Sharon E Frey
- Division of Infectious Diseases, Allergy and Immunology, Saint Louis University, 1100 S. Grand Boulevard, St. Louis, MO 63104, United States.
| | - Andrea A Berry
- Division of Infectious Diseases and Tropical Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, United States.
| | - Karen L Kotloff
- Division of Infectious Diseases and Tropical Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, United States.
| | - Kathryn M Edwards
- Division of Pediatric Infectious Diseases, Vanderbilt Vaccine Research Program, D7227 Medical Center North, Vanderbilt University School of Medicine, Nashville, TN, United States.
| | - Mark J Mulligan
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court, Suite 200, Decatur, GA 30030, United States.
| | - Jon Sudman
- Kaiser Permanente Georgia, 200 Crescent Centre Parkway, Tucker, GA 30084, United States.
| | - Aya Nakamura
- The Emmes Corporation, 401 North Washington Street, Suite 700, Rockville, MD 20850, United States.
| | - David I Bernstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, United States.
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Karagkounis G, Squires MH 3rd, Melis M, Poultsides GA, Worhunsky D, Jin LX, Fields RC, Spolverato G, Pawlik TM, Votanopoulos KI, Levine EA, Schmidt C, Bloomston M, Cho CS, Weber S, Masi A, Berman R, Pachter HL, Staley CA, Newman E, Maithel SK, Hatzaras I. Predictors and Prognostic Implications of Perioperative Chemotherapy Completion in Gastric Cancer. J Gastrointest Surg 2017; 21:1984-92. [PMID: 28963709 DOI: 10.1007/s11605-017-3594-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 09/18/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Perioperative chemotherapy in gastric cancer is increasingly used since the "MAGIC" trial, while clinical practice data outside of trials remain limited. We sought to evaluate the predictors and prognostic implications of perioperative chemotherapy completion in patients undergoing curative-intent gastrectomy across multiple US institutions. METHODS Patients who underwent curative-intent resection of gastric adenocarcinoma between 2000 and 2012 in eight institutions of the US Gastric Cancer Collaborative were identified. Patients who received preoperative chemotherapy were included, while those who died within 90 days or with unknown adjuvant chemotherapy status were excluded. Predictors of chemotherapy completion and survival were identified using multivariable logistic regression and Cox proportional hazards. RESULTS One hundred sixty three patients were included (median age 63.3, 36.8% female). The postoperative component of perioperative chemotherapy was administered in 112 (68.7%) patients. Factors independently associated with receipt of adjuvant chemotherapy were younger age (odds ratio (OR) 2.73, P = 0.03), T3 tumors (OR 14.3, P = 0.04), lymph node metastasis (OR 5.82, P = 0.03), and D2 lymphadenectomy (OR 4.12, P = 0.007), and, inversely, postoperative complications (OR 0.25, P = 0.008). Median overall survival (OS) was 25.1 months and 5-year OS was 36.5%. Predictors of OS were preexisting cardiac disease (hazard ratio (HR) 2.7, 95% CI 1.13-6.46), concurrent splenectomy (HR 4.11, 95% CI 1.68-10.0), tumor stage (reference stage I; stage II HR 2.62; 95% CI 0.99-6.94; stage III HR 4.86, 95% CI 1.81-13.02), and D2 lymphadenectomy (HR 0.43, 95% CI 0.19-0.95). After accounting for these factors, adjuvant chemotherapy administration was associated with improved OS (HR 0.33, 95% CI 0.14-0.82). CONCLUSION Completion of perioperative chemotherapy was successful in two thirds of patients with gastric cancer and was independently associated with improved survival.
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Gallagher KE, Howard N, Kabakama S, Mounier-Jack S, Burchett HED, LaMontagne DS, Watson-Jones D. Human papillomavirus (HPV) vaccine coverage achievements in low and middle-income countries 2007-2016. ACTA ACUST UNITED AC 2017; 4:72-78. [PMID: 29179873 PMCID: PMC5710977 DOI: 10.1016/j.pvr.2017.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 05/15/2017] [Revised: 09/22/2017] [Accepted: 09/30/2017] [Indexed: 12/15/2022]
Abstract
Introduction Since 2007, HPV vaccine has been available to low and middle income countries (LAMIC) for small-scale ‘demonstration projects’, or national programmes. We analysed coverage achieved in HPV vaccine demonstration projects and national programmes that had completed at least 6 months of implementation between January 2007–2016. Methods A mapping exercise identified 45 LAMICs with HPV vaccine delivery experience. Estimates of coverage and factors influencing coverage were obtained from 56 key informant interviews, a systematic published literature search of 5 databases that identified 61 relevant full texts and 188 solicited unpublished documents, including coverage surveys. Coverage achievements were analysed descriptively against country or project/programme characteristics. Heterogeneity in data, funder requirements, and project/programme design precluded multivariate analysis. Results Estimates of uptake, schedule completion rates and/or final dose coverage were available from 41 of 45 LAMICs included in the study. Only 17 estimates from 13 countries were from coverage surveys, most were administrative data. Final dose coverage estimates were all over 50% with most between 70% and 90%, and showed no trend over time. The majority of delivery strategies included schools as a vaccination venue. In countries with school enrolment rates below 90%, inclusion of strategies to reach out-of-school girls contributed to obtaining high coverage compared to school-only strategies. There was no correlation between final dose coverage and estimated recurrent financial costs of delivery from cost analyses. Coverage achieved during joint delivery of HPV vaccine combined with another intervention was variable with little/no evaluation of the correlates of success. Conclusions This is the most comprehensive descriptive analysis of HPV vaccine coverage in LAMICs to date. It is possible to deliver HPV vaccine with excellent coverage in LAMICs. Further good quality data are needed from health facility based delivery strategies and national programmes to aid policymakers to effectively and sustainably scale-up HPV vaccination.
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Affiliation(s)
- Katherine E Gallagher
- London School of Hygiene and Tropical Medicine, Clinical Research Department, Keppel St, London WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania.
| | - Natasha Howard
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Keppel St, London WC1E 7HT, United Kingdom
| | - Severin Kabakama
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
| | - Sandra Mounier-Jack
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Keppel St, London WC1E 7HT, United Kingdom
| | - Helen E D Burchett
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Keppel St, London WC1E 7HT, United Kingdom
| | - D Scott LaMontagne
- PATH, Center for Vaccine Innovation and Access, PO Box 900922, Seattle, WA 98109, United States
| | - Deborah Watson-Jones
- London School of Hygiene and Tropical Medicine, Clinical Research Department, Keppel St, London WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
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Nobles J, Griffiths C, Pringle A, Gately P. Why consistent completion criterion are required in childhood weight management programmes. Public Health 2017; 152:79-85. [PMID: 28865288 DOI: 10.1016/j.puhe.2017.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/14/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Current research in the field of childhood weight management (WM) effectiveness is hampered by inconsistent terminology and criterion for WM programme completion, alongside other engagement-related concepts (e.g. adherence, dropout and attrition). Evidence reviews are not able to determine conclusive intervention effectiveness because of this issue. This study aims to quantify how various completion criterion impacts upon on: 1) the percentage of WM completers; 2) the standardised body mass index (BMI SDS) reduction; and 3) the predictors of WM completion. STUDY DESIGN A methodological, sensitivity analysis to examine how differential completion criterion affect programme outcomes and predictors. METHODS Secondary data of 2948 children were used. All children attended a MoreLife WM programme between 2009 and 2014. The completion criterion was incrementally adjusted by 10% (i.e. completer attends 10%, 20%, 30%... of sessions) for research aims 1-2, with the percentage of completers and change in BMI SDS calculated at each increment. For aim 3, the stability (strength, direction and significance) of the predictors were examined when using the completion criterion of four alternative studies against our previous study (completion ≥70% attendance). RESULTS The volume of programme completers decreased in a linear manner as the completion criterion became more stringent (i.e. 70-100% attendance). The change in BMI SDS conversely became incrementally greater. The strength, direction and significance of the predictors was highly dependent on the completion criterion; the odds ratio varied by 24.2% across a single predictor variable (delivery period). The degree of change is evidenced in the paper. CONCLUSIONS Inconsistent completion criterion greatly limits the synthesis of programme effectiveness and explains some of the inconsistency in the predictors of engagement. Standardised criterion for engagement-related terminology are called for.
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Affiliation(s)
- J Nobles
- Institute of Sport, Physical Activity and Leisure, Centre of Active Lifestyles, Leeds Beckett University, Headingley Campus, Leeds, LS6 3QS, UK; MoreLife (UK) Ltd., Churchwood Hall, Leeds Beckett University, Headingley Campus, Leeds, LS6 3QJ, UK.
| | - C Griffiths
- Institute of Sport, Physical Activity and Leisure, Centre of Active Lifestyles, Leeds Beckett University, Headingley Campus, Leeds, LS6 3QS, UK
| | - A Pringle
- Institute of Sport, Physical Activity and Leisure, Centre of Active Lifestyles, Leeds Beckett University, Headingley Campus, Leeds, LS6 3QS, UK
| | - P Gately
- Institute of Sport, Physical Activity and Leisure, Centre of Active Lifestyles, Leeds Beckett University, Headingley Campus, Leeds, LS6 3QS, UK; MoreLife (UK) Ltd., Churchwood Hall, Leeds Beckett University, Headingley Campus, Leeds, LS6 3QJ, UK
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Moody JA, Botham SJ, Dahill KE, Wallace DL, Hardwicke JT. Complications following completion lymphadenectomy versus therapeutic lymphadenectomy for melanoma - A systematic review of the literature. Eur J Surg Oncol 2017; 43:1760-1767. [PMID: 28756017 DOI: 10.1016/j.ejso.2017.07.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 04/22/2017] [Revised: 05/24/2017] [Accepted: 07/11/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Completion lymph node dissection (CLND) following a positive sentinel lymph node biopsy (SLNB) has been reported to be less morbid than lymphadenectomy for palpable disease (therapeutic lymph node dissection; TLND). The reporting of morbidity data can be heterogeneous, and hence no 'average' surgical complication rates of these procedures has been reported. This review aims to determine complications rates to inform patients undergoing surgery for metastatic melanoma. METHODS A systematic review of English-language literature from 2000 to 2017, reporting morbidity information about CLND and TLND for melanoma, was performed. The methodological quality of the included studies was performed using the methodological index for non-randomised studies (MINORS) instrument and Detsky score. Pooled proportions of post-operative complications were constructed using a random effects statistical model. RESULTS After application of inclusion and exclusion criteria, 18 articles progressed to the final analysis. In relation to TLND (1627 patients), the overall incidence of surgical complications was 39.3% (95% CI 32.6-46.2); including wound infection/breakdown 25.4% (95% CI: 20.9-30.3); lymphoedema 20.9% (95% CI: 13.8-29.1); and seroma 20.4% (95% CI: 15.9-25.2). For CLND (1929 patients), the overall incidence of surgical complications was 37.2% (95% CI 27.6-47.4); including wound infection/breakdown 21.6% (95% CI: 13.8-30.6); lymphoedema 18% (95% CI: 12.5-24.2); and seroma 17.9% (95% CI: 10.3-27). The complication rate was marginally lower for CLND but not to statistical significance. DISCUSSION This study provides information about the incidence of complications after CLND and TLND. It can be used to counsel patients about the procedures and it sets a benchmark against which surgeons can audit their practice.
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Affiliation(s)
- J A Moody
- GKT School of Medical Education, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - S J Botham
- Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - K E Dahill
- Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - D L Wallace
- Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - J T Hardwicke
- Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, United Kingdom; Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
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Shafran R, Wade TD, Egan SJ, Kothari R, Allcott-Watson H, Carlbring P, Rozental A, Andersson G. Is the devil in the detail? A randomised controlled trial of guided internet-based CBT for perfectionism. Behav Res Ther 2017; 95:99-106. [PMID: 28618299 DOI: 10.1016/j.brat.2017.05.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/15/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
An internet guided self-help cognitive-behavioural treatment (ICBT) for perfectionism was recently found to be effective (see this issue). Such studies stand in need of replication. The aim of this study was to report the outcomes and predictors of change when the treatment is delivered in a UK setting. A total of 120 people (Mean = 28.9 years; 79% female) were randomised to receive ICBT or wait-list control over 12 weeks (trial registration: NCT02756871). While there were strong similarities between the current study and its Swedish counterpart, there were also important differences in procedural details. There was a significant impact of the intervention on the primary outcome measure (Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale) and also on the Clinical Perfectionism Questionnaire (between group effect sizes d = 0.98 (95% CI: 0.60-1.36) and d = 1.04 (95% CI: 0.66-1.43) respectively using intent-to-treat analyses). Unlike the Swedish study, there was significant non-engagement and non-completion of modules with 71% of participants completing fewer than half the modules. The number of modules completed moderated the rate of change in clinical perfectionism over time. In conclusion, the study indicates the intervention is effective in a UK setting but highlighted the importance of procedural details to optimise retention.
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Affiliation(s)
- Roz Shafran
- University College London, England, United Kingdom.
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Young S, Das M, Gudjonsson GH. Reasoning and Rehabilitation cognitive skills programme for mentally disordered offenders: Predictors of outcome. World J Psychiatry 2016; 6:410-418. [PMID: 28078205 PMCID: PMC5183993 DOI: 10.5498/wjp.v6.i4.410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/24/2016] [Accepted: 10/24/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate factors predicting treatment completion and treatment outcome of the Reasoning and Rehabilitation Mental Health Programme (R&R2MHP) cognitive skills programme for mentally disordered offenders.
METHODS Secondary analysis of data previously obtained from 97 male patients who were sectioned and detained under the United Kingdom Mental Health Act in low, medium and high security hospitals and who had completed R&R2MHP. Predictors of treatment completion included background variables and five outcome measures: Four self-reported measures of violent attitudes, social problem-solving skills, reactive anger and locus of control and an objective measure of behaviour on the ward that was completed by staff. Completion of the 16 session programme, which was delivered on a weekly basis, was classified as ≥ 12 sessions.
RESULTS It was found that the R&R2MHP is appropriate for delivery to participants of different ages, ethnic background, and at different levels of security without the completion rate or treatment effectiveness being compromised. Participants taking oral typical psychotropic medication were over seven times more likely to complete the programme than other participants. Behavioural disturbance on the ward prior to commencing the programme predicted non-completion (medium effect size). As far as treatment completion was concerned, none of the background factors predicted treatment effectiveness (age, ethnic background, level of security, number of previous convictions and number of previous hospital admissions). The best predictor of treatment effectiveness was attitude towards violence suggesting that this should be the primary outcome measure in future research evaluating outcomes of the R&R2MHP cognitive skills program.
CONCLUSION The findings suggest that a stable mental state is a key factor that predicts treatment completion.
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Affiliation(s)
- Edmund T Rolls
- Oxford Centre for Computational Neuroscience, Oxford, United Kingdom; University of Warwick, Department of Computer Science, Coventry CV4 7AL, United Kingdom.
| | - Raymond P Kesner
- University of Utah, Department of Psychology, Salt Lake City, UT 84112, USA.
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Weiss T, Zhang D, Borse NN, Walter EB. Initiation & completion rates of hepatitis A vaccination among US pediatric populations born between 2005 and 2009. Vaccine 2015; 33:6871-7. [PMID: 26259541 DOI: 10.1016/j.vaccine.2015.07.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/01/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To estimate hepatitis A vaccine series initiation and completion rates, assess time to vaccination, identify missed opportunities for the hepatitis A vaccine series, and examine factors associated with hepatitis A vaccine series initiation and completion. METHODS We conducted a retrospective, observational study using three healthcare claims databases separately. The study population was comprised of children born between years 2005 and 2009 that were continuously enrolled for at least three and a half years from the date of birth. Every child was followed from date of birth for three and a half years for hepatitis A vaccination. RESULTS There were 93,735 eligible children from Clinformatics Data Mart, 202,513 from MarketScan Commercial, and 207,545 from MarketScan Medicaid. The overall hepatitis A vaccine series initiation rate was 63.8-79.4% and completion rate was 45.1-66.8% across the three databases. About 62.8-90.1% of the children who never initiated hepatitis A vaccine had at least one well visit from 1 year to three and a half years old. Children were more likely to initiate and complete the hepatitis A vaccine series if they were from more recent birth cohorts, from states with a hepatitis A vaccination recommendation prior to the ACIP universal recommendation, from states with daycare/school entry requirements, were enrolled in an HMO health plan, had pediatricians as primary providers, had more doctor's office/well visits and received MMR/Varicella vaccines. CONCLUSION In this study, approximately one in every three to five children remained unvaccinated against hepatitis A. Although the hepatitis A vaccine series initiation and completion improved from 2005 to 2009, vaccine coverage has stabilized in recent years. It is important for providers to identify every opportunity for hepatitis A vaccination and to assure that children get protection from this vaccine-preventable disease.
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Affiliation(s)
- Thomas Weiss
- Center for Observational and Real-World Effectiveness, Merck & Co., Inc., Kenilworth, NJ, USA.
| | - Dongmu Zhang
- Center for Observational and Real-World Effectiveness, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Emmanuel B Walter
- Duke Clinical Vaccine Unit, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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Lim YJ, Lee OY, Jeen YT, Lim CY, Cheung DY, Cheon JH, Ye BD, Song HJ, Kim JS, Do JH, Lee KJ, Shim KN, Chang DK, Park CH, Jang BI, Moon JS, Chun HJ, Choi MG, Kim JO. Indications for Detection, Completion, and Retention Rates of Small Bowel Capsule Endoscopy Based on the 10-Year Data from the Korean Capsule Endoscopy Registry. Clin Endosc 2015; 48:399-404. [PMID: 26473123 PMCID: PMC4604278 DOI: 10.5946/ce.2015.48.5.399] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/15/2014] [Accepted: 09/23/2014] [Indexed: 12/21/2022] Open
Abstract
Background/Aims Capsule endoscopy (CE) is widely used. However, CE has limitations including incomplete examination, inadequate bowel preparation, and retention. The aim of this study was to estimate the indications for and detection, completion, and retention rates of small intestine CE based on the 10-year data from the Korean Capsule Endoscopy Registry. Methods Twenty-four hospitals participated in this study. Clinical information, such as reasons for CE, method and quality of bowel preparation, and incomplete examination and capsule retention rates, was collected and analyzed. Results A total of 2,914 CEs were registered. The most common reason for CE was obscure gastrointestinal bleeding (59%). Significant lesions were detected in 66% of cases. Positive CE diagnosis occurred in 63% of cases. The preparation method did not significantly affect the quality of bowel preparation for CE. The overall incomplete rate was 33%, and was high in the elderly and those with poor bowel preparation. Capsule retention was 3% and high in patients with small bowel tumors and Crohn's disease and in children under 10 years of age. Conclusions CE is a valuable technique; while the overall detection rate is high, incompletion and retention rates are also relatively high. CE should be carefully considered in the elderly and children less than 10 years of age, as well as in patients with small bowel tumors and Crohn's disease.
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Affiliation(s)
- Yun Jeong Lim
- Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chi Yeon Lim
- Department of Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Dae Young Cheung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Jin Su Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyuk Do
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kwang Jae Lee
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Dong Kyung Chang
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol Hee Park
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong Seop Moon
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Hoon Jai Chun
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Oh Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
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Rolls ET. Pattern separation, completion, and categorisation in the hippocampus and neocortex. Neurobiol Learn Mem 2015; 129:4-28. [PMID: 26190832 DOI: 10.1016/j.nlm.2015.07.008] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/02/2015] [Accepted: 07/11/2015] [Indexed: 12/22/2022]
Abstract
The mechanisms for pattern completion and pattern separation are described in the context of a theory of hippocampal function in which the hippocampal CA3 system operates as a single attractor or autoassociation network to enable rapid, one-trial, associations between any spatial location (place in rodents, or spatial view in primates) and an object or reward, and to provide for completion of the whole memory during recall from any part. The factors important in the pattern completion in CA3 and also a large number of independent memories stored in CA3 include: a sparse distributed representation, representations that are independent due to the randomizing effect of the mossy fibres, heterosynaptic long-term depression as well as long-term potentiation in the recurrent collateral synapses, and diluted connectivity to minimize the number of multiple synapses between any pair of CA3 neurons which otherwise distort the basins of attraction. Recall of information from CA3 is implemented by the entorhinal cortex perforant path synapses to CA3 cells, which in acting as a pattern associator allow some pattern generalization. Pattern separation is performed in the dentate granule cells using competitive learning to convert grid-like entorhinal cortex firing to place-like fields, and in the dentate to CA3 connections that have diluted connectivity. Recall to the neocortex is achieved by a reverse hierarchical series of pattern association networks implemented by the hippocampo-cortical backprojections, each one of which performs some pattern generalization, to retrieve a complete pattern of cortical firing in higher-order cortical areas. New results on competitive networks show which factors contribute to their ability to perform pattern separation, pattern clustering, and pattern categorisation, and how these apply in different hippocampal and neocortical systems.
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Affiliation(s)
- Edmund T Rolls
- Oxford Centre for Computational Neuroscience, Oxford, England, United Kingdom; University of Warwick, Department of Computer Science, Coventry CV4 7AL, England, United Kingdom.
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Kumar A, Peixoto RD, Kennecke HF, Renouf DJ, Lim HJ, Gill S, Speers CH, Cheung WY. Effect of Adjuvant FOLFOX Chemotherapy Duration on Outcomes of Patients With Stage III Colon Cancer. Clin Colorectal Cancer 2015; 14:262-8.e1. [PMID: 26123496 DOI: 10.1016/j.clcc.2015.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/24/2015] [Accepted: 05/29/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Studies have demonstrated that patients with stage III colon cancer who receive adjuvant FOLFOX (5-fluorouracil and oxaliplatin) chemotherapy experience an improved disease-free (DFS) and overall survival (OS). However, the magnitude of benefit among patients who discontinue FOLFOX early is not well known. We sought to examine the rate of FOLFOX treatment completion, determine the factors associated with adherence, and explore the relationship between duration of FOLFOX treatment and survival. PATIENTS AND METHODS We analyzed patients diagnosed with stage III colon cancer from 2006 to 2010 and initiated at least 1 cycle of adjuvant FOLFOX at any 1 of 5 regional cancer centers in British Columbia. Logistic regression models were constructed to determine the clinical factors associated with treatment completion, which was defined as receipt of ≥ 10 cycles of FOLFOX. Kaplan-Meier methods and Cox regression that accounted for known prognostic factors were used to evaluate the relationship between early FOLFOX discontinuation and DFS and OS. RESULTS We identified 616 patients: median age of 62 years (range, 26-80), 321 (52%) men, 536 (87%) with T3/4 tumors, and 245 (40%) with N2 disease. Among them, 183 (30%) received < 10 and 433 (70%) received ≥ 10 cycles. Adjusting for covariates, female sex and the absence of obstruction or perforation were each associated with receiving ≥ 10 cycles of FOLFOX (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.12-2.32; P = .01 and OR, 1.82; 95% CI, 1.08-3.05; P = .02, respectively). In multivariate analyses, early discontinuation of FOLFOX did not affect DFS or OS (hazard ratio [HR], 1.16; 95% CI, 0.82-1.63; P = .40 and HR, 1.07; 95% CI, 0.70-1.61; P = .76, respectively). CONCLUSION Early discontinuation of FOLFOX was not associated with differences in survival outcomes, lending support to clinical trials that are under way to evaluate the efficacy of shorter durations of therapy.
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Malejczyk K, Gratrix J, Beckon A, Moreau D, Williams G, Kunimoto D, Ahmed R. Factors associated with non completion of latent tuberculosis infection treatment in an inner-city population in Edmonton, Alberta. Can J Infect Dis Med Microbiol 2014; 25:281-4. [PMID: 25371692 PMCID: PMC4211353 DOI: 10.1155/2014/349138] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A limited number of studies have been published that examine treatment completion rates and interventions used to increase treatment completion within an inner-city population. The purpose of the present study was to determine the rate of latent tuberculosis infection (LTBI) treatment completion in an inner-city population in Edmonton, Alberta, and to identify factors that correlated with treatment completion. A retrospective chart review was conducted involving patients who started LTBI treatment between January 1, 2005 and December 31, 2010 in Edmonton's inner city. A total of 77 patients started treatment and 57 (74%) patients completed LTBI treatment. Homelessness was the only variable that was significantly associated with incomplete treatment (OR 8.0 [95% CI 1.4 to 45.6]) and it remained significant when controlling for drug use (adjusted OR 6.5 [95% CI 1.1 to 38.8]). While the present study demonstrated treatment completion rates comparable with or better than those described in the general population, it highlighted the need for continued emphasis on interventions aimed at improving outcomes within homeless populations.
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Affiliation(s)
- Kathy Malejczyk
- Department of Laboratory Medicine, Medical Microbiology, Regina Qu’Appelle Health Region, Regina, Saskatchewan
| | - Jennifer Gratrix
- STI Centralized Services, University of Alberta, Edmonton, Alberta
| | - Avril Beckon
- Edmonton Tuberculosis Clinic, University of Alberta, Edmonton, Alberta
| | - Danusia Moreau
- Central TB Services, Alberta Health Services, University of Alberta, Edmonton, Alberta
| | - Gwenna Williams
- Edmonton Tuberculosis Clinic, University of Alberta, Edmonton, Alberta
| | - Dennis Kunimoto
- Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Rabia Ahmed
- Department of Medicine, University of Alberta, Edmonton, Alberta
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Krishnarajah G, Landsman-Blumberg P, Eynullayeva E. Rotavirus vaccination compliance and completion in a Medicaid infant population. Vaccine 2014; 33:479-86. [PMID: 24962753 DOI: 10.1016/j.vaccine.2014.06.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/04/2014] [Accepted: 06/11/2014] [Indexed: 11/18/2022]
Abstract
We examined completion and compliance rates of rotavirus (RV) vaccination according to the recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Food and Drug Administration approved Prescribing Information (PI) for Rotarix® (RV1, GlaxoSmithKline Vaccines) and RotaTeq® (RV5, Merck and Co.) among infants under one year of age covered by Medicaid programs. Healthcare claims data from state Medicaid programs that constituted the Truven Health MarketScan® Multi-State Medicaid Database were retrieved from May 2008-June 2012. Infants were grouped under PI and ACIP cohorts based on the dosing regimens followed. The overall compliance per PI (n=673,956) and ACIP (n=695,612) recommendations were 24.5% and 28.2%, respectively; completion rates were 30.3% and 32.6%, respectively. In the PI cohort, infants who received RV1 had significantly higher compliance as compared with infants who received RV5 (65.2% vs. 31.3%; p<0.0001); completion rates among infants receiving RV1 and RV5 were 65.3% and 46.4%, respectively (p<0.0001). In the ACIP cohort, compliance with RV1 was significantly higher than RV5 (68.8% vs. 45.9%; p<0.0001) as was the overall completion rate (73.5% vs. 48.8%; p<0.0001). While compliance is increasing year over year, overall compliance of RV vaccines is suboptimal, with over 40% of eligible infants unvaccinated in both populations. The 2-dose RV vaccine showed better completion rates and higher compliance than the 3-dose RV vaccine in the United States. Public health initiatives focusing on suboptimal compliance and completion rates of RV vaccination in the Medicaid population could improve these metrics, thereby offering protection against RV infection.
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Lindhiem O, Bennett CB, Trentacosta CJ, McLear C. Client preferences affect treatment satisfaction, completion, and clinical outcome: a meta-analysis. Clin Psychol Rev 2014; 34:506-17. [PMID: 25189522 DOI: 10.1016/j.cpr.2014.06.002] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [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: 12/19/2013] [Revised: 05/28/2014] [Accepted: 06/06/2014] [Indexed: 01/01/2023]
Abstract
We conducted a meta-analysis on the effects of client preferences on treatment satisfaction, completion, and clinical outcome. Our search of the literature resulted in 34 empirical articles describing 32 unique clinical trials that either randomized some clients to an active choice condition (shared decision making condition or choice of treatment) or assessed client preferences. Clients who were involved in shared decision making, chose a treatment condition, or otherwise received their preferred treatment evidenced higher treatment satisfaction (ESd=.34; p<.001), increased completion rates (ESOR=1.37; ESd=.17; p<.001), and superior clinical outcome (ESd=.15; p<.0001), compared to clients who were not involved in shared decision making, did not choose a treatment condition, or otherwise did not receive their preferred treatment. Although the effect sizes are modest in magnitude, they were generally consistent across several potential moderating variables including study design (preference versus active choice), psychoeducation (informed versus uninformed), setting (inpatient versus outpatient), client diagnosis (mental health versus other), and unit of randomization (client versus provider). Our findings highlight the clinical benefit of assessing client preferences, providing treatment choices when two or more efficacious options are available, and involving clients in treatment-related decisions when treatment options are not available.
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Kegel AF, Flückiger C. Predicting Psychotherapy Dropouts: A Multilevel Approach. Clin Psychol Psychother 2014; 22:377-86. [PMID: 24782040 DOI: 10.1002/cpp.1899] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 10/29/2013] [Revised: 03/12/2014] [Accepted: 03/18/2014] [Indexed: 11/10/2022]
Abstract
UNLABELLED The role of therapeutic processes in predicting premature termination of psychotherapy has been a particular focus of recent research. The purpose of this study was to contrast outpatients who completed therapy and those who dropped out with respect to their self-reported in-session experiences of self-esteem, mastery, clarification and the therapeutic alliance. The 296 patients with mixed disorders were treated with an integrative form of cognitive-behavioural therapy without pre-determined time limit (M = 20.2 sessions). Multilevel analyses indicated that patients who did not completetreatment reported, on average, lower levels of self-esteem, mastery and clarification and lower ratings of their therapeutic alliance in treatment in contrast to patients who completed therapy. Patient-reported change in self-esteem experiences over the course of treatment turned out to be the strongest predictor of dropout from psychotherapy or successful completion. When dropout occurred before the average treatment length was reached, patients reported fewer clarifying experiences as early as the first session and their ratings of the therapeutic alliance were characterized by an absence of positive development. Both of these aspects seem to be involved in patients' decisions to leave treatment early. The findings underscore the importance of the therapeutic process in understanding the mechanisms behind treatment dropout. KEY PRACTITIONER MESSAGE Analyses data from 296 patients at a private outpatient clinic in a routine practice setting (CBT). Completer/dropout definition: presence or absence of measurement battery at post-assessment. Focuses on change in therapy processes by investigating post-session reports. Finds that positive changes in self-esteem experiences is the most robust predictor of dropout, followed by ratings of clarification experiences and the global alliance. In line with recent dropout research, these process indicators might help to detect therapeutic situations that are connected with psychotherapy dropouts.
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Patel A, Stern L, Unger Z, Debevec E, Roston A, Hanover R, Morfesis J. Staying on track: a cluster randomized controlled trial of automated reminders aimed at increasing human papillomavirus vaccine completion. Vaccine 2014; 32:2428-33. [PMID: 24631099 DOI: 10.1016/j.vaccine.2014.02.095] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate whether automated reminders increase on-time completion of the three-dose human papillomavirus (HPV) vaccine series. METHODS Ten reproductive health centers enrolled 365 women aged 19-26 to receive dose one of the HPV vaccine. Health centers were matched and randomized so that participants received either routine follow-up (control) or automated reminder messages for vaccine doses two and three (intervention). Intervention participants selected their preferred method of reminders - text, e-mail, phone, private Facebook message, or standard mail. We compared vaccine completion rates between groups over a period of 32 weeks. RESULTS The reminder system did not increase completion rates, which overall were low at 17.2% in the intervention group and 18.9% in the control group (p=0.881). Exploratory analyses revealed that participants who completed the series on-time were more likely to be older (OR=1.15, 95% CI 1.01-1.31), report having completed a four-year college degree or more (age-adjusted OR=2.51, 95% CI 1.29-4.90), and report three or more lifetime sexual partners (age-adjusted OR=3.45, 95% CI 1.20-9.92). CONCLUSIONS The study intervention did not increase HPV vaccine series completion. Despite great public health interest in HPV vaccine completion and reminder technologies, completion rates remain low.
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Affiliation(s)
- Ashlesha Patel
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States; Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, 5th Floor, Chicago, IL 60612, United States.
| | - Lisa Stern
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Zoe Unger
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Elie Debevec
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
| | - Alicia Roston
- Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, 5th Floor, Chicago, IL 60612, United States.
| | - Rita Hanover
- Westport Compass, 3011 S. Plateau, Salt Lake City, UT 84109, United States.
| | - Johanna Morfesis
- Planned Parenthood Federation of America, 434 West 33rd Street, New York, NY 10001, United States.
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