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Montgomery, Kelsey B., Britany A. Hollenquest, Adam T. Lucy, Charles A. Banks, Vanessa Anne Eulo, and Kristy Kummerow Broman. "Evaluation of delays to multidisciplinary treatment of soft tissue sarcomas at a tertiary cancer center." JCO Oncology Practice 19, no. 11_suppl (November 2023): 62. http://dx.doi.org/10.1200/op.2023.19.11_suppl.62.
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62 Background: Management of soft tissue sarcomas often requires coordinated multidisciplinary care including radiation, medical, and surgical oncology. Delays in the multidisciplinary evaluation and treatment may lead to poorer outcomes. Coordination of care through a multidisciplinary clinic (MDC) offering access to all three specialties during the same clinic visit may reduce time from initial evaluation to treatment. Methods: Adult patients treated for soft tissue sarcoma at an NCI-designated comprehensive cancer center following the opening of a sarcoma MDC in November 2021 to May 2023 were included. Patients were either seen in the sarcoma MDC or separately by oncologic providers (usual care). The primary outcome was delay in treatment initiation, defined as greater than 21 days from initial consultation to first treatment. Reasons for delay were abstracted. Descriptive statistics and bivariate analyses were performed. Results: Among 147 patients, 20 were (13.6%) seen in MDC and 127 (86.4%) by usual care. Initial treatments were surgery (46.9%), radiation (30.6%), or systemic therapy (22.4%). Median time to treatment was 34 days (IQR 14-57 days), which differed by treatment modality (surgery 34 days, radiation 37 days, systemic 18 days). There were no significant differences in time to treatment for MDC patients (33 days, IQR 25-44) versus usual care (34 days, IQR 13-57) (p=0.93). However, a significantly higher proportion of MDC patients received multiple modalities of treatment (75.0% vs 48.8% usual care, p=0.011), with a longer average time to treatment in the multi- versus single-modality groups (41 vs 22 days, p<0.001). Among patients requiring multimodal therapy, median time to treatment was 33 days for MDC patients versus 44 days for usual care (p=0.07). MDC patients were also much more likely to receive radiation (90.0% MDC vs 45.6% usual care, p=0.001). Delays in care (n=76, 51.7% of cohort) were seen in 66.7% (12/18) of MDC patients versus 58.3% (63/108) of usual care patients. The most common reasons for delay were need for additional imaging (29.7%) or preoperative testing (18.8%). Conclusions: In this single-center study, no improvement in time to treatment was seen following the opening of a sarcoma multidisciplinary clinic, likely explained by higher proportion of MDC patients receiving multiple treatment modalities. Primary reasons for delay could be anticipated prior to initial evaluation and represent an opportunity for more active case review prior to in-person evaluation to reduce delays in sarcoma treatment.
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Onukwugha, Eberechukwu, Nicholas J. Petrelli, Kathleen M. Castro, James F. Gardner, Jinani Jayasekera, Olga Goloubeva, Ming T. Tan, et al. "ReCAP: Impact of Multidisciplinary Care on Processes of Cancer Care: A Multi-Institutional Study." Journal of Oncology Practice 12, no. 2 (February 2016): 155–56. http://dx.doi.org/10.1200/jop.2015.004200.
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QUESTION ASKED: What is the relationship between the level of implementation of multidisciplinary care (MDC) and various processes of cancer care (eg, time to treatment receipt, evaluation for enrollment onto a clinical trial) among community cancer centers serving patients diagnosed with colon, rectal, or lung cancer? There is limited generalizable evidence on this topic. It is important to answer this question using data that can generalize across cancer patients, the majority of whom receive treatment in a community cancer center. SUMMARY ANSWER: Focusing on the time to receipt of cancer-directed treatment as one key process of cancer care in this patient population, we found that the answer to our question depended on the MDC assessment area and tumor site ( Table 1 ). Among patients with colon cancer, higher MDC levels of physician engagement (ie, a higher level of physician engagement at the institutional level) were associated with a shorter time to treatment receipt, whereas higher MDC levels of case planning were associated with a longer time to treatment receipt. Among patients with rectal cancer, higher MDC levels of physician engagement were associated with a shorter time to cancer-directed treatment receipt, whereas higher MDC levels of evaluation for enrollment onto clinical trials were associated with a longer time to treatment receipt. Among patients with lung cancer, there was no association between the MDC areas of assessment and the time to cancer-directed treatment receipt. [Table: see text] METHODS: We collected data for patients receiving care at 14 National Cancer Institute (NCI) community cancer centers. We characterized the NCI community cancer centers according to their level of MDC implementation across seven MDC assessment areas and over time. Using statistical regression models, we investigated the relationship between the level of MDC implementation and various process measures, including time to treatment receipt, clinical trial evaluation, receipt of multimodality treatment, and adherence to treatment guidelines published by the National Comprehensive Cancer Network. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: In the absence of a validated MDC assessment tool, the NCI community cancer centers used a nonvalidated tool. Additional institutional-level data would have been useful for characterizing norms and practices that may have differed across cancer centers and potentially explained variation in care processes. Although we controlled for patient demographic characteristics, baseline data were not available to document patient comorbidity or performance status level. To the extent that cancer centers at higher levels of MDC implementation may have been more likely to treat clinically complex patients, the inability to control for potential confounding bias caused by patient case mix may have influenced the study results. REAL-LIFE IMPLICATIONS: MDC models are important decision-making forums in current oncology practice. They involve oncologists in generating a comprehensive and coordinated plan of care for patients. Although MDC is purported to offer benefits to patients, there is limited generalizable evidence regarding the benefit to individuals receiving care at community cancer centers in the United States. Across various care processes that are important for characterizing cancer care, this study’s results indicate that changes in the level of MDC implementation could differentially affect the process of care, depending on the MDC area of assessment and the cancer site. In addition, the study results can be used to generate hypotheses for future studies among individuals diagnosed with colon, rectal, or lung cancer.
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Simpong, Nicodemus Larbi, Charity Tenu Afefa, Leander Yimpuri, Betty Akum, Afia Safo, Simon-Junior Edziah, David Larbi Simpong, and Patrick Adu. "Establishing pregnancy-specific haematological reference intervals in Ghana; a three-center cross-sectional study." PLOS ONE 18, no. 2 (February 3, 2023): e0274422. http://dx.doi.org/10.1371/journal.pone.0274422.
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Background Abnormal intra-pregnancy haematological variables are associated with adverse feto-maternal outcomes. However, the reference intervals (RIs) employed in sub-Saharan Africa to inform clinical decisions are generally imported. Since RIs are influenced by age, geographical location, and race, we hypothesized that context specific RIs should be established in Ghana to contextualize intra-pregnancy decision making. Methods This cross-sectional study retrospectively retrieved data of 333 pregnant women with no known clinically determined intra-pregnancy complications; 22 participants in their first trimester (T1; 1–13 weeks), 177 in their T2 (14–27 weeks), and 132 in T3 (28–41 weeks). RIs for haematological parameters were non-parametrically determined at 2.5th and 97.5th percentiles in accordance with CLSI guidance document EP28-A3c. Two-sample comparisons were undertaken using Wilcoxon rank-sum tests whereas more than two-sample comparisons were undertaken using Kruskal-Wallis test. Statistical significance was set at p <0.05 under the two-tailed assumptions. Results In accordance with WHO trimester-specific haemoglobin cutoffs, anaemia prevalence was a moderate (T1: 36.4%; 8/22 & T2: 31.6%; 56/177) to severe (T3:68.0%; 90/132) public health problem. Additionally, 9.3% (31/333) individuals had high gestational haemoglobin levels (Hb >13.0 g/dL). Moreover, haemoglobin (T2: 8.6–14.3 vs T3: 7.5–13.6 g/dL), MCH (T2: 22.5–69.8 vs T3: 21.6–31.9 pg), MCHC (T2: 30.2–51.8 g/L vs T3: 30.5–37.9 g/L), TWBC (T2: 4.0–13.4 vs T3: 4.1–13.0 x 109/L) required trimester specific RIs, compared to RBC (2.8–5.1 x 1012/L), MCV (66.2–100.2 fL), and platelet counts (106.3–388.3 x 109/L) that each required combined reference intervals. Conclusions The intra-pregnancy haematological RIs determined have appreciable lower limits; there is the need to determine context-specific thresholds for haematological variables predictive of positive and/or adverse maternal and infant health outcomes.
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McCahill, Laurence E., Sunil Konduri, Alan T. Davis, Mary May, Coralyn Martinez, Wendy K. Taylor, and Gerald P. Wright. "Quality of gastrointestinal cancer care at a community hospital under the paradigm of multidisciplinary care." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 133. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.133.
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133 Background: Benefits of MDC have been established for other cancers but not GI malignancies. Benefits of GI NDC cancer care for underserved populations is yet to be quantified. Our GI-MDC was established to provide efficient, evidenced-based, high quality cancer care to patients of all ethnic and socioeconomic backgrounds. Methods: We prospectively identified underserved patients in seven categories. A GI nurse navigator (NN) contacted patients, coordinated appointments /diagnostic studies and prepared for prospective case evaluation and weekly multidisciplinary GI clinic. Health care efficiency/quality data was abstracted by an R.N. quality analyst. Outcomes were compared between underserved and non-underserved populations. Percentages were compared using Chi square and medians by Mann-Whitney U test. Results: From Jan 2010-July 2011, 208 patients were evaluated, with 137 confirmed new cancers, clinically estimated as Stage I=31, II=30, III=26, and IV=47. Among underserved patients, categories included age >80(n=26), public aid (n=28), uninsured (n=12), mental disability/impairment (n=15), incarcerated/institutionalized (n=4), and language barrier (n=2), more then one category could be selected. Outcomes are listed in the Table. Conclusions: A model of GI cancer care including a GI NN, treatment planning conference, and MDC clinic is feasible in a community cancer center. Preliminary data demonstrates small differences between underserved and non underserved patient populations. This model of health care may help to reduce disparities in cancer care. [Table: see text]
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Bomar, Kaitlin, Nicole Vickery, Meagan Duggan, Tina Redenz, Tracey Lukker, Kristin Jensen, Eugene Paciarelli, Terra Dillard, Robert D. Siegel, and Hal E. Crosswell. "The Bon Secours St. Francis Cancer Survivorship Program: A model for community-based multidisciplinary survivorship care." Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): 45. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.45.
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45 Background: In 1974, Giulio D' Angio,MD, stated “Cure Is Not Enough” and the concept of Survivorship was ignited. Multidisciplinary survivorship clinics have since become a mainstay of many pediatric cancer programs; few such clinics exist in adult cancer programs, especially in community practice. We report on the development of a survivorship care plan and a community-based clinic designed to provide guideline-driven after care for cancer survivors. Methods: An overview of the vision and mission of the Bone Secours St. Francis Cancer Center Survivorship Program is provided. Descriptive analysis of the components and metrics of success are provided, in the context of accrediting organizations requirements for current and future goals for survivorship care. Results: BSSF, which is a non-academic, community-based cancer program, and receives over 1300 referrals annually from a referral population of 1.32 million in 10 counties. St. Francis , accredited by both the Commission on Cancer and National Accreditation Program for Breast Centers, has been providing cancer‐related services to the Upstate South Carolina region for a decade. The survivorship program at St. Francis is a STAR‐certified program and is a patient‐centered service provided in a comprehensive and coordinated multidisciplinary team approach, including integrated psychologic care. A custom survivorship care plan was developed and efforts, including successes and barriers, to implementation of plans for all cancer survivors in accordance with CoC and NAPBC goals are addressed. Conclusions: The BSSF Cancer Center Survivorship Program has developed a practical, yet comprehensive SCP, which is risk-adapted and guideline-driven in order to provide customized survivorship education and monitoring. The MDC provides comprehensive evaluations and recommendations in order to maximize health and well-being of patients navigating life after cancer diagnosis and treatment. Our efforts have demonstrated that survivorship clinics of this nature can be established and successful in a non-academic community setting.
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Morel, Adeline, Margaux Jacobs, Angelique Da Silva, Djelila Allouache, Ioana Hrab, Carine Segura, Maud Villemin, et al. "Abstract P4-12-05: Benefit of multidisciplinary consultation at initiation of oral antineoplastic agents in metastatic breast cancer patients." Cancer Research 82, no. 4_Supplement (February 15, 2022): P4–12–05—P4–12–05. http://dx.doi.org/10.1158/1538-7445.sabcs21-p4-12-05.
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Abstract INTRODUCTION: The management of cancer patients changed in the recent years with increased in the number of oral antineoplastic agents (OANA) prescriptions. Recent guidelines encouraged improvement of information and patient education, and the coordination between health care professionals to secure and optimize the management of these drugs. To cope with current recommendations, a multidisciplinary consultation (MDC) for initiation of OANA was initiated at François Baclesse comprehensive cancer center in Caen, France. OBJECTIVE: The aim of this study was to evaluate the benefit of the MDC before the initiation OANA in patients with metastatic breast cancer. MDC consisted of a medical oncologist, hospital pharmacist, and oncology nurse consultations. Primary endpoint was the rate of hospitalizations. Secondary endpoints were treatment discontinuation and of adverse events rate. MATERIALS AND METHODS: We conducted a retrospective single center study comparing patients receiving MDC to the population with a single medical visit. RESULTS: A total of 482 patients were included in this study between January 2017 and December 2019 (329 patients had only a consultation with a medical oncologist before initiation of OANA and 153 had the MDC). A statistically significant decrease in the rate of hospitalizations for toxicity was found in the group of patients with MDC 3.9% (n=6) vs 18.5% (n = 61) in the group without MDC (p < 0.001). A significant decrease in treatment interruption rate for toxicity was found in the group of patients with MDC 11% (n = 16) vs 26% (n=86) (p < 0.001). Adverse events rate was not statistically significant between the two groups CONCLUSION: A statistically significant decrease in hospitalizations and rate of treatment interruption for toxicity was observed after initiation of MDC in patients with a metastatic breast cancer treated with an OANA. This process should be generalized for a better security in the management of the OANA. Citation Format: Adeline Morel, Margaux Jacobs, Angelique Da Silva, Djelila Allouache, Ioana Hrab, Carine Segura, Maud Villemin, Clémence Boscher, Alison Johnson, Charlotte Ceintre, Rose-Marie Charles, François Lahaye, Justine Lequesne, Fabienne Divanon, Christelle Levy, Georges Emile. Benefit of multidisciplinary consultation at initiation of oral antineoplastic agents in metastatic breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-05.
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Aoyama, Takashi, Osamu Imataki, Akifumi Notsu, Takashi Yurikusa, Koki Ichimaru, Masanori Tsuji, Kanako Yoshitsugu, Masafumi Fukaya, Terukazu Enami, and Takashi Ikeda. "Examination of a nutritional treatment pathway according to pretreatment health status and stress levels of patients undergoing hematopoietic stem cell transplantation." PLOS ONE 17, no. 8 (August 1, 2022): e0271728. http://dx.doi.org/10.1371/journal.pone.0271728.
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Introduction This study aimed to validate hematopoietic stem cell transplantation (HSCT) treatment via a tailored nutritional pathway in myeloablative conditioning (MAC), determine its efficacy in terms of remission, and explore associations between clinical outcomes and nutritional indicators. Methods We included patients who underwent MAC for HSCT at the Shizuoka Cancer Center Stem Cell Transplantation between 2015 and 2019. We evaluated outcomes from the day before treatment initiation (transplant date: day 0) to day 42. Results Among the 40 MAC cases (participant characteristics: 20/40 males, mean age of 52 years, and mean body mass index of 21.9 kg/m2), we found that the percent loss of body weight and loss of skeletal muscle mass were correlated with the basal energy expenditure rate (BEE rate; r = 0.70, p<0.001 and r = 0.49, p<0.01, respectively). Based on the receiver operating characteristics curves, the cutoff value for the BEE rate in terms of weight loss was 1.1. Salivary amylase levels did not significantly change during the treatment course. Continuous variables, including oral caloric intake and performance status, showed statistically significant correlations with nutrition-related adverse events during treatment (r = −0.93, p<0.01 and r = 0.91, p<0.01, respectively). Skeletal muscle mass before treatment initiation was an independent predictive variable for reduced 2-year survival (p = 0.04). Conclusion Our results support the validity of a safe nutritional pathway with a BEE rate of 1.1 for HSCT patients pretreated with MAC. Specifically, we found that this pathway could prevent weight loss in response to nutrition-related adverse events. Skeletal muscle mass before treatment was identified as an independent risk factor for reduced 2-year survival.
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Lyznicki, James, Italo Subbarao, Georges C. Benjamin, and James J. James. "Developing a Consensus Framework for an Effective and Efficient Disaster Response Health System: A National Call to Action." Disaster Medicine and Public Health Preparedness 1, S1 (September 2007): S51—S54. http://dx.doi.org/10.1097/dmp.0b013e31814622e2.
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ABSTRACTEighteen national organizations, representing medicine, dentistry, nursing, hospital systems, public health, and emergency medical services, have worked together to create a framework for a national and regional disaster response health system that is scalable, multidisciplinary, and seamless, and based on an all-hazards approach. In July 2005 and June 2006 the American Medical Association (AMA) and the American Public Health Association (APHA) convened the AMA/APHA Linkages Leadership Summit, with funding from the Centers for Disease Control and Prevention under the Terrorism Injuries: Information Dissemination and Exchange (TIIDE) program. As cofacilitators, James J. James, MD, DrPH, MHA, director of the AMA Center for Public Health Preparedness and Disaster Response, and Georges Benjamin, MD, FACP, FACEP(E), APHA executive director, met with leaders from 16 national medical, dental, hospital, nursing, hospital systems, public health, and emergency medical services organizations in Chicago (2005) and New Orleans (2006) to deliberate the deficiencies in the medical and public health disaster response system and the lack of necessary linkages between key components of this system: the health care, emergency medical services, and public health sectors. The goal was to reach consensus on a set of overarching recommendations to improve and sustain health system preparedness and to combine each organization's advocacy expertise and experience to promote a shared policy agenda. The full summit report contains 53 consensus-based recommendations, which will serve as the framework for a coordinated national agenda for strengthening health system preparedness for terrorism and other disasters. The 9 most overarching critical recommendations from the report are highlighted here. Although the summit report presents important perspectives on the subject of preparedness for public health emergencies, we must understand that preparedness is a process and that these recommendations must be reviewed and refined continually over time. (Disaster Med Public Health Preparedness. 2007;1(Suppl 1):S51–S54)
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Nah, Eun-Hee, Yong Jun Choi, Seon Cho, Hyeran Park, Suyoung Kim, Eunjoo Kwon, and Han-Ik Cho. "Changes in nonalcoholic fatty liver disease and M2BPGi due to lifestyle intervention in primary healthcare." PLOS ONE 19, no. 2 (February 29, 2024): e0298151. http://dx.doi.org/10.1371/journal.pone.0298151.
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Background A healthy lifestyle is the most important method for managing nonalcoholic fatty liver disease (NAFLD). Mac-2-binding protein glycosylated isomer (M2BPGi) has been suggested as a biomarker for NAFLD. This study aimed to determine the efficacy of personalized lifestyle interventions on NAFLD remission. Methods This single-arm intervention study recruited participants with NAFLD who underwent health checkups at seven health-promotion centers in five South Korean cities. Fatty liver diagnosis was based on ultrasonography (US). The 109 individuals were recruited for personalized lifestyle interventions of hypocaloric diets and exercise. The participants attended the lifestyle intervention programs once per month for the first 3 months, and once every 3 months for the subsequent 6 months. In addition to sessions through center visits, phone-based intervention and self-monitoring at 4-, 5-, 7-, and 8-month were provided during the 9-month intervention period. And phone-based self-monitoring were also provided monthly during the 3-month follow-up period. The primary outcome was NAFLD remission at month 12 as measured on US and magnetic resonance elastography. The secondary outcomes were the changes in metabolic factors and M2BPGi. Results The 108 individuals (62 males and 46 females; age 51.1±12.4 years, mean±standard deviation) were finally analyzed after the 12month intervention. Body mass index, waist circumference (WC), blood pressure, blood lipids (total cholesterol, triglycerides, and HDL-C), and fasting blood sugar levels were improved relative to baseline (all P<0.05). Fatty liver at or above the moderate grade according to US was decreased at month 12 relative to baseline (67.6% vs 50.9%) (P = 0.002). M2BPGi levels decreased during the 12-month study period (P<0.001). M2BPGi levels were moderately correlated with hepatic fat fraction by magnetic resonance imaging (r = 0.33, P = 0.05). WC (OR = 0.82, 95% CI = 0.67–1.00, P = 0.05) and HDL-C (OR = 1.17, 95% CI = 1.03–1.32, P = 0.014) were associated with remission of fatty liver in the multivariate analysis. Conclusion The personalized lifestyle intervention was effective in improving fatty liver and metabolic factors, but not hepatic stiffness, in NAFLD. Trial registration ICTRP, cris.nih.go.kr (KCT0006380).
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Bankole, A., T. Kazmi, A. Strazanac, W. Scheuing, and J. Fleming. "AB1559-HPR ESTABLISHING A MULTIDISCIPLINARY CLINIC TO IMPROVE THE QUALITY OF CARE FOR PATIENTS WITH INTERSTITIAL LUNG DISEASE." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1879.2–1880. http://dx.doi.org/10.1136/annrheumdis-2022-eular.2477.
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BackgroundPatients with interstitial lung disease related to rheumatic disease (ILD-RD) often need to see multiple specialties to establish the diagnosis and for management. Suh care is better provided in a multidisciplinary clinic (MDC) and setting up such a MDC involves significant cost, time and buy in from stakeholders. In our center, we approached starting a MDC as a multiple phased project. Phase 1: confirm improved patient outcomes when multiple specialties are involved in providing care to these patients. Phase 2: application for an internal grant for a prospective pilot clinic and phase 3: the establishment of a permeant MDC. We report the results of our phase 1 analysis.ObjectivesThe primary aim of this study was to determine if involvement of our pulmonary and cardiology colleagues in the care of patients with ILD-RD seen in the rheumatology clinic results in improvement in the evaluation and treatment of these patients.MethodsThis is a retrospective, single center, hospital-affiliated outpatient study. All patients seen in the rheumatology clinic with a diagnosis of ILD-RD between January 1 2018 and December 31 2019 were eligible for enrollment. A list of patients was generated by the technology service group using relevant international classification of diseases codes. These records were reviewed and those meeting the inclusion and exclusion criteria were enrolled.A review of the 1574 charts generated confirmed 41 patients with ILD-RD. Demographic data, as well as disease related data including serological testing, disease manifestation and treatment choices was obtained. Continuous variables were analyzed using T-test or Mann-Whitney U test. Categorical variables were analyzed using Chi-square Tests or Fisher’s exact tests. Statistical analysis was performed using SAS9.4, and p value <0.05 was considered statistically significant.ResultsPatients seen by more than one specialty were more likely to have had a more extensive evaluation for ILD and its complications. The cause of the ILD-RD did not have an impact on the tests performed or the number of specialist seen.There was a significantly more glucocorticoids monotherapy use in scleroderma related ILD, but disease-modifying antirheumatic drugs were more commonly used in non-scleroderma ILD patients.Table 1.DemographicsNon-scleroderma ILD (N = 27)Scleroderma ILD (N = 14)p-valueAge at diagnosis72.8 (10.2)70.5 (13.7)0.55Female70.4% (19/27)71.4% (10/24)0.99Race0.69 Caucasian77.8% (21)85.7% (12) African American22.2% (6)14.3% (14)PAH17.4% (4/23)23.1% (3/13)0.69PFT87.5% (21/24)92.9% (13/14)0.99CT Chest100% (24/24)100% (14/14)Right HCC30.4% (7/23)21.4% (3/14)0.71Number of specialists0.31 18.3% (2)14.3% (2) 237.5% (9)57.1% (8) 34.2% (13)28.6% (4)Medication<0.01 None0% (0)14.3% (2) GC7.4% (2)42.9% (6) GC + DMARDs88.9% (24)42.9% (6) DMARDs3.7% (1)0% (0)ConclusionOur data suggests that a MDC for RD-ILD results in a more thorough investigation and treatment, and this will likely lead to improvements in patient outcomes. Based on these findings, our rheumatology group is seeking internal funding for a pilot clinic evaluating prospectively the benefits of an ILD MDC.References[1]Leeftink AG, Bikker IA, Vliegen IMH, Boucherie RJ. Multi-disciplinary planning in health care: a review. Health Syst (Basingstoke). 2018;9(2):95-118. Published 2018 Feb 27.[2]Chaudhuri N, Spencer L, Greaves M, Bishop P, Chaturvedi A, Leonard C. A Review of the Multidisciplinary Diagnosis of Interstitial Lung Diseases: A Retrospective Analysis in a Single UK Specialist Centre. J Clin Med. 2016;5(8):66.[3]Murali Mohan BV, Tousheed SZ, Manjunath PH, Ravichandra MR, Ranganatha R, Annapandian VM, Kumar MH, Sagar C. Multidisciplinary team obviates biopsy in most patients with diffuse parenchymal lung diseases-A retrospective study from India. Clin Respir J. 2021 Jul;15(7):761-769.Disclosure of InterestsNone declared
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Skachkova, T. S., M. N. Zamyatin, O. A. Orlova, N. A. Yumtsunova, N. N. Lashenkova, V. S. Fomina, V. G. Gusarov, et al. "Monitoring Methicillin-Resistant Staphylococcus Strains in the Moscow Medical and Surgical Center using Molecular-Biological Methods." Epidemiology and Vaccinal Prevention 20, no. 1 (March 13, 2021): 44–50. http://dx.doi.org/10.31631/2073-3046-2021-20-1-44-50.
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Relevance. Staphylococci are one of the most common pathogens in the etiological structure of nosocomial infections. Methicillinresistant staphylococci are resistant to the main groups of antibiotics and are one of bacteria that pose the greatest threat to human health according to the World Health Organization. The introduction of modern molecular biological methods in the monitoring of methicillin-resistant staphylococci is necessary for the rapid and accurate identification of microorganisms, monitoring the epidemiological situation and studying the need for anti-epidemic measures. Aims. Аnalysis of the results of monitoring methicillinresistant staphylococcus strains using molecular biological methods in a multidisciplinary hospital in Moscow for one year. Materials and methods. Single-center observational study with a one-year follow-up period (December 2016 to December 2017). The research included a molecular-biological analysis of biological material from 240 patients with signs of infection and washings samples (n=250) from the objects of the hospital environment. The whole genome sequencing was carried out for 24 samples, isolated from patients with different forms of staphylococcal infection and washings from a hospital environment. DNA detection of methicillin-resistant strains was performed using the «AmpliSens®MRSA-screen-titer-FL» reagent kit. Sequencing was performed on an Illumina HiSeq1500 instrument using the IlluminaHiSeq PE RapidClusterKit v2 and IlluminaHiSeqRapid SBS Kit v2. Results. DNA of methicillin-resistant staphylococci were detected in 6.3% of blood samples from patients with signs of infection and in 42.4% of washings from the objects of the hospital environment. The results of PCR of washing samples showed that DNA of methicillin-resistant coagulase-negative staphylococci were detected much more often than MRSA (p <0.001). DNA of methicillin-resistant staphylococci were detected more often in the intensive care and intensive care units compared with the hematology and surgical departments (p <0.001). The examine samples of Staphylococcus aureus belonged to 6 different sequence types (ST-5, ST-7, ST-8, ST-22, ST-30 and ST-5555) and 8 spatypes (t008, t021, t091, t1062, t12437, t1544, t223, t4573). As a result of monitoring, an isolate with a new allelic profile was found. Today it has been assigned the number ST5555. The predominant type of staphylococcal mec cassette was the type IV SCCmec cassette. Conclusion. Due to the widespread distribution of methicillin-resistant strains and the identification of epidemiologically significant genetic lines of staphylococci, it is necessary to conduct regular monitoring, take measures to limit the spread of such strains and introduce modern molecular biological methods for quick and accurate identification.
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KMPD, Jayasundara, and Hewamalage A. "An assessment of the inclusive early childhood development program (IncluDe) in Kandy district, Sri Lanka a case study." International Journal of Family & Community Medicine 8, no. 2 (2024): 60–64. http://dx.doi.org/10.15406/ijfcm.2024.08.00351.
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Sri Lanka has identified the importance of providing quality and effective health care to all women, children, and families. In 1968, the Ministry of Health established the Family Health Bureau (FHB) to conduct the Maternal and Child Health (MCH) program nationally. The FHB's Inclusive Early Childhood Development Program (IncluDe), which will be phased across all districts, aims to systematically screen all Sri Lankan children to detect developmental delays and disabilities as early as possible and intervene through a multidisciplinary team approach to improve their quality of life. The purpose of this study is to evaluate the IncluDe program in the Kandy district and to prioritize the issues that need to be addressed to establish a comprehensive, sustainable program to serve the district's children with disabilities. Data collection was done by Key Informant Interviews, Focus Group Discussions, Team discussions, Observation visits to study settings, and review of secondary data. Numerous issues were identified across the program's service settings (Screening program of the children, Services of Child Development Intervention Center (CDIC), and specialized referrals at Tertiary Care Hospitals). Improving the comprehensiveness of care given at CDIC at rehabilitation hospital Digana, addressing the training needs of health staff, fulfilling the human resource requirement, and establishing a monitoring and evaluation mechanism of the program were among the priority problems. After conducting an in-depth analysis, recommendations were made to enhance the comprehensiveness of care provided at CDIC. The study reveals the importance of parallel development of all facets of the IncluDe program to provide adequate care to children with developmental delays and disabilities in the Kandy district. In conclusion, the Inclusive Early Childhood Development Program in Kandy District, Sri Lanka needs urgent attention in implementing measures to achieve its objectives successfully.
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Friedman, Eliot Lawrence, Paul Morris, Margaret Currens, Kathleen M. Castro, Steven B. Clauser, Irene Prabhu Das, Angela Carrigan, and Silvana Rivero. "Evolution of multidisciplinary care: Experience of the National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP)." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 67. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.67.
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67 Background: A key aim of the NCCCP is to develop and improve the quality of multidisciplinary care (MDC). An assessment tool with nine key elements relevant to MDC structure and operations was developed to assess MDC maturity and set goals for continued quality improvement at individual sites and across the network. Methods: 14 NCCCP sites self-reported MDC assessments for lung, breast, and colorectal cancer in June 2010, 2011, and 2012 using an online reporting tool. Each site evaluated their level of maturity (level 1 = no MDC, level 5 = highly integrated MDC) in nine elements integral to the MDC process. Qualitative review of sites’ responses was also conducted. Results: MDC improvement was most evident in four of nine elements; case planning (CP), physician engagement (PE), integration of care coordination (ICC), and quality improvement (QI). The number of sites at level 3 or greater is reported in the table below. Integration of primary care providers and increased organizational support contributed to improved CP. PE was related to conditions of participation, insuring involvement of appropriate physicians in the MDC. The network focus on patient navigation was demonstrated by increase of ICC. Improvement in QI was related to increased participation of sites in physician and hospital quality initiatives (i.e., QOPI and RQRS), and an NCCCP project aimed at increasing referrals to genetics for patient with breast and colon cancer. Conclusions: The maturity of MDC reflected focused work of the Quality of Care sub-committee of the NCCCP. The efforts of working groups in patient navigation, genetics and physician conditions of participation was made evident in the improved performance in MDC’s for three of the four most common malignancies seen in the United States. We hope that this work will provide a blueprint for other health systems that wish to incorporate multidisciplinary care into their cancer programs. [Table: see text]
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Nimer, Jenna, Oliver S. Eng, Blase N. Polite, Chih-Yi Liao, Grace Lee, Lindsay Alpert, Namrata Setia, et al. "Regional appendix cancer multidisciplinary case conference: Improving access and care of a rare disease." JCO Oncology Practice 19, no. 11_suppl (November 2023): 63. http://dx.doi.org/10.1200/op.2023.19.11_suppl.63.
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63 Background: Appendiceal cancers (AC) are a group of rare tumors that lack well-established guidelines. Care for ACs need multi-disciplinary teams. Excellence in hyperthermic intraperitoneal chemotherapy (HIPEC) and complete cytoreductive surgeries (CRS) is needed. This is challenging in community settings. Here we share our experience in establishing a regional multidisciplinary case conference (MCC) to improve access and care of this rare disease. Methods: University of Chicago Medical Center's (UCMC) experts in pathology, radiology, nutrition, surgical oncology and medical oncology collaborated to form the peritoneal MCC. We consulted our legal and physician access teams to develop a compliant system through which referring providers may submit their cases including imaging, pathology and medical history. Referring providers attended the conference via a secure virtual platform. To bridge scientific collaborations we created a continuous medical education (CME)-based curriculum. With UCMC survey lab’s help, we developed and distributed an anonymous digital survey to assess the impact of this MCC. Results: The peritoneal MCC was established in May of 2020 with consistent participation of surgical oncology experts in HIPEC and peritoneal disease management, medical oncology, radiology, pathology, and gastroenterology with expertise in nutrition. Cases were referred internally and from our regional network. Between May 2020 and June 2022, 614 unique clinical cases were discussed. Our team invited 37 referring providers to join this conference. From February 1st 2021 to June 2022, more than 40 different educational lectures were presented. There were 30 respondents to the survey where the majority were from UCMC. Of those who were non-UCMC (n=8), 62.5% practiced in urban setting and 7.5% in suburban, rural or small-town setting. 62.5% of non-UCMC respondents were community-based providers, and 37.5% worked at academic centers. 45.8% of providers attending had more than 5 years of experience. 100% of the respondents reported improved confidence in treating their patients as a result of participation in this conference. 94.1% reported at least moderate improvement in the quality of their care. 93.3% of the respondents noted that the care plan of their patients changed as a result of participation in this MCC. Conclusions: Virtual MCC was feasible and reported to be beneficial in management of a rare disease like AC. Such conferences can lead to improvement in the quality of care by improving access to centers with expertise. Participating providers gain knowledge and feel more confident in taking care of their patients. In future, we aim to include more centers. Consideration on how to include patients may also prove beneficial.
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Alvarez, Kiara, Yesenia Marroquin, Luis Sandoval, and Cindy Carlson. "Integrated Health Care Best Practices and Culturally and Linguistically Competent Care: Practitioner Perspectives." Journal of Mental Health Counseling 36, no. 2 (April 1, 2014): 99–114. http://dx.doi.org/10.17744/mehc.36.2.480168pxn63g8vkg.
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Practitioners in two federally qualified health centers (FQHCs) were interviewed to explore how their organizations carried out best practices in cultural and linguistic competence (CLC) when integrating mental health services into primary care. Archival data and data from interviews with eight clinical service providers were analyzed using exploratory cross-case synthesis. To highlight best practices in integrated health care (IHC), clinical, systemic, and organizational themes were identified: patient-centered care for underserved populations, building and sustaining a successful multidisciplinary team, and increasing capacity and adapting to changing circumstances. CLC did not emerge as a distinct interview theme, though it was present in subthemes and was discussed by both mental health and medical practitioners as central to effective healthcare delivery. The results underscore the need for culturally-tailored research and training that examines how IHC can best serve diverse groups and communities.
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Fangazio, Marco, Erik Ladewig, Karen Gomez, Laura Garcia-Ibanez, Rahul Kumar, Julie Teruya-Feldstein, Davide Rossi, et al. "Genetic mechanisms of HLA-I loss and immune escape in diffuse large B cell lymphoma." Proceedings of the National Academy of Sciences 118, no. 22 (May 28, 2021): e2104504118. http://dx.doi.org/10.1073/pnas.2104504118.
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Fifty percent of diffuse large B cell lymphoma (DLBCL) cases lack cell-surface expression of the class I major histocompatibility complex (MHC-I), thus escaping recognition by cytotoxic T cells. Here we show that, across B cell lymphomas, loss of MHC-I, but not MHC-II, is preferentially restricted to DLBCL. To identify the involved mechanisms, we performed whole exome and targeted HLA deep-sequencing in 74 DLBCL samples, and found somatic inactivation of B2M and the HLA-I loci in 80% (34 of 42) of MHC-INEG tumors. Furthermore, 70% (22 of 32) of MHC-IPOS DLBCLs harbored monoallelic HLA-I genetic alterations (MHC-IPOS/mono), indicating allele-specific inactivation. MHC-INEG and MHC-IPOS/mono cases harbored significantly higher mutational burden and inferred neoantigen load, suggesting potential coselection of HLA-I loss and sustained neoantigen production. Notably, the analysis of >500,000 individuals across different cancer types revealed common germline HLA-I homozygosity, preferentially in DLBCL. In mice, germinal-center B cells lacking HLA-I expression did not progress to lymphoma and were counterselected in the context of oncogene-driven lymphomagenesis, suggesting that additional events are needed to license immune evasion. These results suggest a multistep process of HLA-I loss in DLBCL development including both germline and somatic events, and have direct implications for the pathogenesis and immunotherapeutic targeting of this disease.
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Palo, Subrata Kumar, Shubhankar Dubey, Sapna Negi, Mili Roopchand Sahay, Kripalini Patel, Swagatika Swain, Bijaya Kumar Mishra, et al. "Effective interventions to ensure MCH (Maternal and Child Health) services during pandemic related health emergencies (Zika, Ebola, and COVID-19): A systematic review." PLOS ONE 17, no. 5 (May 10, 2022): e0268106. http://dx.doi.org/10.1371/journal.pone.0268106.
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Introduction Ensuring accessible and quality health care for women and children is an existing challenge, which is further exacerbated during pandemics. There is a knowledge gap about the effect of pandemics on maternal, newborn, and child well-being. This systematic review was conducted to study maternal and child health (MCH) services utilization during pandemics (Zika, Ebola, and COVID-19) and the effectiveness of various interventions undertaken for ensuring utilization of MCH services. Methodology A systematic and comprehensive search was conducted in MEDLINE/PubMed, Cochrane CENTRAL, Embase, Epistemonikos, ScienceDirect, and Google Scholar. Of 5643 citations, 60 potential studies were finally included for analysis. The included studies were appraised using JBI Critical appraisal tools. Study selection and data extraction were done independently and in duplicate. Findings are presented narratively based on the RMNCHA framework by World Health Organization (WHO). Results Maternal and child health services such as antenatal care (ANC) visits, institutional deliveries, immunization uptake, were greatly affected during a pandemic situation. Innovative approaches in form of health care services through virtual consultation, patient triaging, developing dedicated COVID maternity centers and maternity schools were implemented in different places for ensuring continuity of MCH care during pandemics. None of the studies reported the effectiveness of these interventions during pandemic-related health emergencies. Conclusion The findings suggest that during pandemics, MCH care utilization often gets affected. Many innovative interventions were adopted to ensure MCH services. However, they lack evidence about their effectiveness. It is critically important to implement evidence-based appropriate interventions for better MCH care utilization.
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Ali, Mohammad, Md Abu Bakar Siddiq, Nujaim Khan Pranto, Naheean Hossain Amran, Marium Akter, Marjan Akter Munny, Md Imran Hossain, Saffat Sabbir Khan, and Md Murad Hossain Mehedi. "Prevalence and predictors of musculoskeletal health complaints among sedentary, monotonous urban workers: A survey in Bangladesh." PLOS ONE 18, no. 4 (April 21, 2023): e0282922. http://dx.doi.org/10.1371/journal.pone.0282922.
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Background Monotonous and sedentary work is significantly associated with the worst health of workers. There is a scarcity of data investigating the musculoskeletal health of sedentary workers working in low-income and middle-income settings. This study aimed to measure the prevalence and predictors of musculoskeletal health complaints (MHC) among Bangladeshi shopkeepers. Methods This cross-sectional study was conducted in Dhaka, Bangladesh. Data from 1553 Bangladeshi shopkeepers aged 18 years and above were analyzed. MHC was measured using the musculoskeletal subscale of the subjective health complaints scale. The descriptive analysis helped to compute MHC prevalence and compare the prevalence across groups. Regression analysis revealed the predictors of MHC for the shopkeepers. Results The prevalence of MHC among shopkeepers was 58.0%. The prevalence of low back pain was the highest (55.5%), followed by neck pain (48.0%) and upper back pain (43.5%). Regression analysis identified sex (aOR 1.301, CI 0.996 to 1.700), age (aOR 1.405, CI 1.047 to 1.886), body mass index (aOR 0.495, CI 0.397 to 0.617), and substance abuse (aOR 1.998, CI 1.136 to 3.514) as independent predictors of MHC among the shopkeepers. Furthermore, significantly higher odds of MHC have been found among tobacco users (OR 1.234, CI 1.009 to 1.510). Conclusion This study revealed a high prevalence of MHC and unhealthy lifestyles among shopkeepers in Bangladesh. Shopkeepers should be provided with better health literacy to follow healthy lifestyles and prevent MHC among this cohort.
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Warburton, Karen M., and Amit A. Shahane. "Mental Health Conditions Among Struggling GME Learners: Results From a Single Center Remediation Program." Journal of Graduate Medical Education 12, no. 6 (December 1, 2020): 773–77. http://dx.doi.org/10.4300/jgme-d-20-00007.1.
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ABSTRACT Background Graduate medical education (GME) learners may struggle with clinical performance during training. A subset of these trainees has mental health conditions (MHCs). Objective To characterize the MHCs that underlie poor trainee performance and their relationship to specific clinical performance deficit (CPD). Methods At the University of Virginia (UVA), GME learners not meeting appropriate milestones, or who request help, have the option to self-refer or be referred to COACH (Committee on Achieving Competence Through Help). A physician remediation expert assesses the learner and identifies a primary CPD. If there is concern for an MHC, referral is made to a psychologist with expertise in working with trainees. All learners are offered remediation for the CPD. Using descriptive statistics, we tracked the prevalence of MHC and their correlation with specific CPDs. Results Between 2016 and 2019, COACH assessed 7% (61 of 820) of GME learners at UVA. Thirty-eight percent (23 of 61) had an MHC associated with the CPD. Anxiety was the most common MHC (48%), followed by depression (17%), cognitive dysfunction (17%), adjustment disorder (13%), and other (4%). Professionalism was the most identified CPD among learners with MHCs (52%). Of remediated learners, 47% have successfully finished remediation, 21% were terminated or voluntarily left their program, and 32% are still being remediated (83% of whom are in good standing). Conclusions MHCs were identified in nearly 40% of struggling learners referred to a centralized remediation program. Professionalism is the most identified CPD among learners with MHCs.
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Kato, Zenichiro, Joel N. H. Stern, Hironori K. Nakamura, Kazuo Kuwata, Naomi Kondo, and Jack L. Strominger. "Positioning of autoimmune TCR-Ob.2F3 and TCR-Ob.3D1 on the MBP85–99/HLA-DR2 complex." Proceedings of the National Academy of Sciences 105, no. 40 (September 29, 2008): 15523–28. http://dx.doi.org/10.1073/pnas.0807338105.
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Since the first determination of structure of the HLA-A2 complex, >200 MHC/peptide structures have been recorded, whereas the available T cell receptor (TCR)/peptide/MHC complex structures now are <20. Among these structures, only six are TCR/peptide/MHC Class II (MHCII) structures. The most recent of these structures, obtained by using TCR-Ob.1A12 from a multiple sclerosis patient and the MBP85–99/HLA-DR2 complex, was very unusual in that the TCR was located near the N-terminal end of the peptide-binding cleft of the MHCII protein and had an orthogonal angle on the peptide/MHC complex. The unusual structure suggested the possibility of a disturbance of its signaling capability that could be related to autoimmunity. Here, homology modeling and a new simulation method developed for TCR/peptide/MHC docking have been used to examine the positioning of the complex of two additional TCRs obtained from the same patient (TCR-Ob.2F3 or TCR-Ob.3D1 with MBP85–99/HLA-DR2). The structures obtained by this simulation are compatible with available data on peptide specificity of the TCR epitope. All three TCRs from patient Ob including that from the previously determined crystal structure show a counterclockwise rotation. Two of them are located near the N terminus of the peptide-binding cleft, whereas the third is near the center. These data are compatible with the hypothesis that the rotation of the TCRs may alter the downstream signaling.
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Yeo, Zack Zhishen, and Lidia Suárez. "Validation of the mental health continuum-short form: The bifactor model of emotional, social, and psychological well-being." PLOS ONE 17, no. 5 (May 18, 2022): e0268232. http://dx.doi.org/10.1371/journal.pone.0268232.
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The Mental Health Continuum-Short Form (MHC-SF) is aimed at measuring the three dimensions of mental health; emotional, social, and psychological well-being. The purpose of the current study was to evaluate the psychometric properties of the MHC-SF within the context of Singapore and Australia. A total of 299 Singaporeans or permanent residents (59.2% female; mean age = 24.26, SD = 6.13) and 258 Australians or permanent residents (69% female; mean age = 23.95, SD = 8.66) completed the study. Confirmatory factor analyses were used to assess the structural validity of the MHC-SF. Internal consistency reliability was assessed via the Cronbach’s α and MacDonald’s ω reliability coefficients. Concurrent validity was examined against the World Health Organisation-Five Well-Being Index, discriminant validity using the Hospital Anxiety and Depression Scale, and criterion validity using a self-rated question of “Please rate your averaged level of mental health over the past month”, all via Pearson’s correlations. A bifactor model of the MHC-SF, where each item loaded on a general factor and simultaneously on their respective uncorrelated group factors, yielded the best fit to the data across both samples. Further investigations demonstrated that the general well-being factor accounted for majority of variances of the MHC-SF. Internal consistency reliability, concurrent validity, discriminant validity, and criterion validity were all demonstrated. In conclusion, the current study provided support for the bifactor model of MHC-SF and demonstrated evidence of good psychometrics across both samples. The results highlighted the unidimensionality of the measure, suggesting that it is more informative to interpret the aggregated score than scores of independent factors standalone.
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Marbaugh, Amy, Thomas Asfeldt, Amanda Kramar, and Lorna Lucas. "Creating an optimal care coordination model for patients with lung cancer on Medicaid." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 273. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.273.
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273 Background: The Association of Community Cancer Centers (ACCC) created an Optimal Care Coordination Model (OCCM), which provides a comprehensive self-assessment tool designed to orient cancer programs to achieving patient-centered, multidisciplinary care. The OCCM is designed to help cancer programs, regardless of resources, location, or population, improve care for lung cancer patients, especially those on Medicaid. Methods: An environmental scan was conducted in early 2016 with a focus on coordination of care after lung cancer diagnosis to improve experiences and outcomes for Medicaid beneficiaries. Five ACCC Cancer Program Members each hosted 2-day site visits in mid-2016. Interview sessions were conducted to explore effective practices and current care models for patients with lung cancer insured by Medicaid. Key problems in care coordination were identified, as well as local solutions that had been put in place to overcome these barriers. The NCI Community Cancer Centers Program’s (NCCCP) Multidisciplinary Care (MDC) Assessment Tool was the foundational template to create the OCCM. The MDC Tool included 7 assessment areas that were identified as impactful to establishing multidisciplinary care and includes a Level 1-5 evaluation matrix. Results: The beta version of the OCCM was created in early 2017. The number of Assessment Areas was expanded to better capture current care coordination philosophies; (1) Patient Access to Care; (2) Prospective Multidisciplinary Case Planning; (3) Financial, Transportation, and Housing; (4) Management of Comorbid Conditions; (5) Care Coordination; (6) Treatment Team Integration; (7) Electronic Health Records (EHR) and Patient Access to Information; (8) Survivorship Care; (9) Supportive Care; (10) Tobacco Cessation; (11) Clinical Trials; (12) Physician Engagement; (13) Quality Measurement and Improvement. Conclusions: Seven ACCC Cancer Program Members are currently validating the model by each implementing at least one program-specific quality improvement project focused on an Assessment Area over a 12-month time period. All programs are collecting extensive data to determine the extent their program improved within an assessment area. Final results will be available for dissemination in 2019.
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Ośmiałowska, Edyta, Weronika Misiąg, Mariusz Chabowski, and Beata Jankowska-Polańska. "Coping Strategies, Pain, and Quality of Life in Patients with Breast Cancer." Journal of Clinical Medicine 10, no. 19 (September 28, 2021): 4469. http://dx.doi.org/10.3390/jcm10194469.
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Introduction: Each year, around 16,500 women in Poland are diagnosed with breast cancer, the second most common cause of death in women. In Poland, nearly 70,000 women live with breast cancer diagnosed within the last 5 years. Quality of life (QoL) research is particularly important in cancer patients, as it provides knowledge on their psychological and physical health, as well as the environment in which the patients function, all of which is essential to implementing multidisciplinary care involving the best use of the appropriate methods. Carrying the burden of cancer is a major challenge for patients. The strategy that patients use to cope with breast cancer significantly affects their quality of life. The purpose of the study is to assess the impact of coping strategies on the QoL in breast cancer patients. Material and Methods: The prospective study included a group of 202 women who had undergone surgical treatment for breast cancer at the Lower Silesian Cancer Center and who reported for follow-up appointments at the Oncology Clinic and the Surgical Oncology Clinic. For the study, we used the: EORTC QLQ-C30 cancer questionnaire, EORTC QLQ-BR23 module, Mental Adjustment to Cancer (Mini-MAC) scale, visual analog scale (VAS) for pain intensity, as well as the patients’ medical records, hospital records, and our own survey form. Results: The mean patient age was 53 years. Most patients had been diagnosed with cancer between one and two years before. In the women studied, there was a negative association between QoL and the choice of a destructive strategy for coping with cancer, and a positive one between QoL and a constructive coping strategy. Severe pain caused by the disease and its treatment significantly decreased the patients’ QoL in multiple domains. Conclusions: Patients choosing constructive strategies obtained higher QoL scores, while greater reliance on destructive coping strategies was associated with significantly worse QoL. In all functioning domains, higher levels of pain were associated with poorer QoL and more severe symptoms associated with the disease and its treatment.
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Riduansyah, Riduansyah. "Analisis Kualitas Pelayanan pada Layanan Tes Kesehatan di Klinik Mulawarman Health Center Universitas Mulawarman dengan Menggunakan Metode Service Quality (Servqual)." JOURNAL OF INDUSTRIAL AND MANUFACTURE ENGINEERING 4, no. 1 (May 24, 2020): 28–36. http://dx.doi.org/10.31289/jime.v4i1.3011.
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Klinik Mulawarman Health Center (MHC) sebagai salah satu perusahaan jasa layanan kesehatan harus bisa menjaga dan meningkatkan kualitas layanan agar dapat menghadapi persaingan. Penelitian ini bertujuan untuk mengukur kualitas pelayanan dan memberikan usulan perbaikan kualitas jasa tes kesehatan di klinik MHC. Pengukuran kualitas layanan menggunakan metode Service Quality (SERVQUAL), merupakan metode pengukuran kualitas pelayanan yang dapat mengetahui aspek kualitas pelayanan yang perlu mendapat perbaikan dan mampu menerjemahkan ekspektasi konsumen yang masih belum terakomodir. Responden pada penelitian ini yaitu mahasiswa-mahasiswi Fakultas Teknik Universitas Mulawarman angkatan 2018. Berdasarkan hasil penelitian, didapatkan nilai rata-rata gap 1 sebesar – 0,5, gap 2 sebesar -0,3, gap 3 sebesar 0,1, gap 4 sebesar -0,4 dan gap 5 sebesar -0,7, artinya konsumen masih kurang puas terhadap pelayanan jasa klinik yang kurang memahami ekspektasi konsumen, spesifikasi kualitas jasa dan penyampaian jasa. Analisis Importance Performance Analisis (IPA) digunakan untuk mengetahui perbaikan apa saja yang akan diberikan berdasarkan variabel yang perlu mendapatkan perbaikan. Usulan perbaikan yang diberikan yaitu memberikan pelatihan kepada sumber daya manusia MHC agar dapat lebih baik dalam melayani konsumen yang datang ke klinik MHC.
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Trivedi, Ranak, Fernanda Rossi, Sarah Javier, Liberty Greene, Sara Singer, Megan Vanneman, Mary Goldstein, and Donna Zulman. "Association Between Mental Health Conditions and Care Fragmentation: A National Study of High-Risk Older Veterans." Innovation in Aging 4, Supplement_1 (December 1, 2020): 373. http://dx.doi.org/10.1093/geroni/igaa057.1202.
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Abstract Fragmented healthcare causes information loss, duplicative tests, and unwieldy self-care regimens. These challenges may be amplified among older, high-risk patients with co-occurring mental health conditions (MHC). We compared healthcare fragmentation for chronic physical conditions among Veterans with and without MHC (depression, PTSD, schizophrenia, bipolar disorder, anxiety, personality disorder, or psychosis based on ICD-9 codes). Sample included Veterans who were □65y, at high risk for 1-year hospitalization, and had □4 non-MHC visits during FY14. Visits were covered by Veterans Affairs (VA), VA-purchased care (both from VA Corporate Data Warehouse), or Medicare Parts A/B (claims data from VA Information Resource Center). Outcomes were two fragmentation measures calculated in FY15: 1) non-mental health provider count, where a higher number indicates more fragmentation, and 2) Usual Provider of Care (UPC), the proportion of care with the most frequently seen provider, where a higher number indicates less fragmentation. We used Poisson regression and GLM with binomial distribution and logit link to test the association between MHC status and fragmentation, controlling for sociodemographic characteristics (e.g., age), medical comorbidity, and driving distance to VA. Of the 125,481 Veterans included, 47.3% had 1+ MHC. Compared to older, high-risk Veterans without MHC, those with MHC saw fewer providers (pseudo R2 = 0.02) and had a higher UPC (more concentrated care; OR = 1.07). Within the VA, older, high-risk Veterans with MHC do not experience greater healthcare fragmentation. Further research is needed to determine if this is due to different needs, underuse, or appropriate use of healthcare across the groups.
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Briseño, Carlos G., Ansuman T. Satpathy, Jesse T. Davidson, Stephen T. Ferris, Vivek Durai, Prachi Bagadia, Kevin W. O’Connor, Derek J. Theisen, Theresa L. Murphy, and Kenneth M. Murphy. "Notch2-dependent DC2s mediate splenic germinal center responses." Proceedings of the National Academy of Sciences 115, no. 42 (October 2, 2018): 10726–31. http://dx.doi.org/10.1073/pnas.1809925115.
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CD4+ T follicular helper (TFH) cells support germinal center (GC) reactions promoting humoral immunity. Dendritic cell (DC) diversification into genetically distinct subsets allows for specialization in promoting responses against several types of pathogens. Whether any classical DC (cDC) subset is required for humoral immunity is unknown, however. We tested several genetic models that selectively ablate distinct DC subsets in mice for their impact on splenic GC reactions. We identified a requirement for Notch2-dependent cDC2s, but not Batf3-dependent cDC1s or Klf4-dependent cDC2s, in promoting TFH and GC B cell formation in response to sheep red blood cells and inactivated Listeria monocytogenes. This effect was mediated independent of Il2ra and several Notch2-dependent genes expressed in cDC2s, including Stat4 and Havcr2. Notch2 signaling during cDC2 development also substantially reduced the efficiency of cDC2s for presentation of MHC class II-restricted antigens, limiting the strength of CD4 T cell activation. Together, these results demonstrate a nonredundant role for the Notch2-dependent cDC2 subset in supporting humoral immune responses.
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Vita, Randi J., Apurva Mody, James A. Overton, Soren Buus, Stephen T. Haley, Richard A. Willis, Alessandro Sette, Vamsee Mallajosyula, Bjoern Peters, and John D. Altman. "The Minimal Information about MHC Multimers (MIAMM)." Journal of Immunology 208, no. 1_Supplement (May 1, 2022): 173.02. http://dx.doi.org/10.4049/jimmunol.208.supp.173.02.
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Abstract The Minimal Information about MHC Multimers (MIAMM, miamm.lji.org) is a recently established data standard to be applied to publications utilizing these reagents. Available at miamm.lji.org, we explain how to easily represent multimer reagents in a standardized format using ontology terminology. Additionally, we provide a free, publicly available Multimer Validation Tool. This tool helps users adopt this new data standard and was proven to be generally applicable to real life use cases by its validation of the data present in the NIH Tetramer Core Facility and the nearly 18,500 multimer assays in the Immune Epitope Database (IEDB). As the scientific public adopts MIAMM, the quality, reproducibility, and annotatability of MHC multimer reagent data in the scientific literature will be improved. Funding: JDA, RAW, and DLL acknowledge support from the contract for the NIH Tetramer Facility (75N93020D00005) from the Yerkes National Primate Research Center (P51OD011132), and the Emory Center for AIDS Research (P30AI050409). RV, JAO, AM, and BP acknowledge support from National Institutes of Health grant R24 HG010032. RV, JAO, AM, BP, and AS acknowledge support from National Institutes of Health contract 75N93019C00001
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Contreras, Sandra, Lorena Porras-Javier, Bonnie T. Zima, Neelkamal Soares, Christine Park, Alpa Patel, Paul J. Chung, and Tumaini R. Coker. "Development of a Telehealth-Coordinated Intervention to Improve Access to Community-Based Mental Health." Ethnicity & Disease 28, Supp (September 6, 2018): 457–66. http://dx.doi.org/10.18865/ed.28.s2.457.
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Objective: To develop an intervention to improve the mental health referral and care process for children referred by primary care providers (PCPs) to community mental health clinics (MHCs) using a community partnered approach.Design: A Project Working Group (PWG) with representatives from each partner organization met monthly for 6 months.Setting: Multi-site federally qualified health center (FQHC) and two community MHCs in Los Angeles county.Participants: 26 stakeholders (14 FQHC clinic providers/staff, 8 MHC providers/staff, 4 parents) comprised the PWG.Data Sources: Qualitative interviews, PWG meeting notes, intervention processes and workflow reports.Intervention: The PWG reviewed qualitative data from stakeholders (interviews of 7 parents and 13 providers/staff). The PWG met monthly to identify key transition points where access to and coordination of care were likely compromised and to develop solutions.Results: Three critical transition points and system solutions were identified: 1) Parents refuse initial referral to the MHC due to stigma regarding mental health services. Solution: During initial referral, parents watch a video introducing them to the MHC. 2) Parents don’t complete the MHC’s screening after referral. Solution: A live videoconference session connecting parents at the FQHC with MHC staff ensures completion of the screening and eligibility process. 3) PCPs reject transfer of patients back to primary care for ongoing psychotropic medication management. Solution: Regularly scheduled live videoconferences connect PCPs and MHC providers.Conclusions: A community partnered approach to care design utilizing telehealth for care coordination between clinics can potentially be used to address key challenges in MHC access for children.Ethn Dis. 2018;28(Suppl 2):457-466; doi:10.18865/ed.28.S2.457.
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Henkhaus, Michelle E., Sophia A. Hussen, Devon N. Brown, Carlos del Rio, Michelle R. Fletcher, Marxavian D. Jones, Amulya Marellapudi, and Ameeta S. Kalokhe. "Barriers and facilitators to use of a mobile HIV care model to re-engage and retain out-of-care people living with HIV in Atlanta, Georgia." PLOS ONE 16, no. 3 (March 11, 2021): e0247328. http://dx.doi.org/10.1371/journal.pone.0247328.
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Novel strategies to re-engage and retain people living with HIV (PLWH) who are out of care are greatly needed. While mobile clinics have been used effectively for HIV testing and linkage, evidence guiding their use in providing HIV care domestically has been limited. To guide the development of a mobile HIV clinic (MHC) model as a strategy to re-engage and retain PLWH who are out of care, we aimed to explore stakeholder perceptions of barriers and facilitators to MHC implementation and use. From June 2019-July 2020, we conducted 41 in-depth interviews with HIV clinic providers, administrators, staff, legal authorities, and community advisory board members, PLWH, AIDS service organizations and city officials in Atlanta, Georgia, and domestic and international mobile health clinics to explore barriers and facilitators to use of MHCs. Interviews were transcribed, coded and thematically analysed. Barriers raised include potential for: breach of confidentiality with resulting heightened stigmatization, fractured continuity of care, safety concerns, staffing challenges, and low community acceptance of MHC presence in their locality. Participants provided suggestions regarding appropriate exterior design, location, timing, and co-delivery of non-HIV services that could facilitate MHC acceptance and address the concerns. In identifying key barriers and facilitators to MHC use, this study informs design and implementation of an MHC as a novel strategy for re-engaging and retaining PLWH who are out of care.
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Lesinskienė, Sigita, Virginija Karalienė, Kamilė Pociūtė, and Rokas Šambaras. "Possible Mental Health Interventions for Family Members of a Close Relative Who Has Suicidal Thoughts or Committed Suicide: A Pilot Project at a Mental Health Center." Journal of Clinical Medicine 13, no. 7 (March 31, 2024): 2032. http://dx.doi.org/10.3390/jcm13072032.
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Background: Suicides are an actual issue, especially in Lithuania, where, despite significant efforts, the number of suicides remains very high. In cases of suicide, society painfully loses its members, and the relatives of the person who committed suicide, engaged in self-harm, or attempted suicide face many negative experiences. Methods: The purpose of this article is to describe the pilot project applied for 2 years in the Mental Health Center (MHC) in the city of Vilnius, Lithuania, in organizing and providing services to people whose relatives committed suicide or attempted suicide or self-harm. This prevention and early intervention program, organized by an interdisciplinary team at an MHC, appeared appropriate, effective, and well-attended. Program clients could participate anonymously and have the opportunity to choose the time and the right services for themselves from the offered program services package. Results: Providing the possibility for family members to receive flexible mental health services at the primary center increased the attractiveness of the program and reduced stigma. Conclusions: The program results demonstrated the applicability of the implementation of such an initiative as a relevant possibility when providing complex help for the relatives of self-harming and/or suicidal people.
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Baker, Lisa, and Rob Lees. "Parental Mental Illness and Coping: An Exploratory Survey." Canadian Journal of Family and Youth / Le Journal Canadien de Famille et de la Jeunesse 6, no. 1 (February 14, 2014): 115–33. http://dx.doi.org/10.29173/cjfy21486.
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The prevalence of Mental Health Concerns (MHC) among parents whose children are accessing services from a mental health outpatient center was explored, along with what helps and hinders the coping of those parents identified as having diagnosed or suspected MHC. Participants were selected based on interviews with their child’s mental health clinician who identified 71% of the selected families as having at least one parent with diagnosed or suspected MHC. Semi-structured phone interviews with 28 participants in those families were then conducted. Given the diversity and problem with language depicting mental illness, MHC was the rubric adopted for this paper as it was believed to be less of a problematic label. A qualitative research design provided a deeper understanding into the resources that parents utilize to help them cope, the challenges that make it more difficult for them to do well, and the supports they wish they had. There was a high correlation between clinician perception and participant self-report in indicating the presence of MHC. Resources revealed as helpful to parent coping included the assistance of counselling and medical professionals, community and family supports, and medication. Hindrances to parent coping included lack of finances, parenting stress, and difficulties related to MHC. Parents wished there were more services and supports available across professional and community domains. Findings may provide insight for family centered, integrative program ideas and supports that will increase family coping when both parents and children are dealing with MHC.
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Barrett, Monica, Sarah Ward, and Michelle Colvard. "Pharmacist-led telemental health transitions of care clinic improves antidepressant medication continuity posthospitalization." Mental Health Clinician 10, no. 6 (November 1, 2020): 381–84. http://dx.doi.org/10.9740/mhc.2020.11.381.
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Abstract A pharmacist-led telemental health transitions of care clinic was created at a Veterans Affairs Medical Center to improve continuity of psychiatric medication therapy following discharge from an acute psychiatric hospitalization. This was a single-center, multi-site, retrospective cohort study (historical cohort). The primary study objective was to determine the impact of a post-discharge pharmacist-led telemental health transitions of care clinic on improving antidepressant adherence rates after an acute psychiatric hospitalization. Secondary objectives included evaluation of rates of readmission to psychiatric hospitals, time to first mental health provider follow-up, and characterization of various pharmacist interventions made during the clinic visit. Pilot study results support that a pharmacist-led telemental health transitions of care clinic can improve antidepressant adherence after psychiatric hospital discharge and reduce time to postdischarge follow-up with a mental health provider. Patients enrolled in the clinic were more likely to maintain a medication possession ratio >0.8 within 90 days of discharge when compared to a historical control (100% vs 43%, P = .035). The clinic also improved time to first mental health provider follow-up as seen by a statistically significant improvement in the number of patients seen within 14 days of discharge by a mental health provider (100% vs 43%, P = .035). Results highlight the valuable role of psychiatric pharmacists in delivery of transitions of care services and support the expansion of current roles to improve outcomes after psychiatric hospitalizations.
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Leach, Molly, Guadalupe Garcia, and Nicole Ganzer. "Implementation and evaluation of a pharmacist-run mental health treatment clinic via clinical video telehealth." Mental Health Clinician 6, no. 3 (January 1, 2016): 159–64. http://dx.doi.org/10.9740/mhc.2016.05.159.
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Abstract Introduction: The Veterans Health Administration is extending its mental health services to reach those in rural areas who find it difficult to travel to a Veterans Affairs Medical Center (VAMC). This project aimed to outline implementation of a Pharmacy Mental Health Clinical Video Telehealth (MHCVT) clinic for veterans. Secondary endpoints were to assess patient satisfaction with MHCVT, describe the potential benefits of this clinic regarding travel saved, and summarize no-show rates. Methods: Veterans received mental health disease state medication management from a mental health clinical pharmacy specialist via clinical video telehealth (CVT) in place of an in-clinic appointment and were asked to complete a satisfaction survey after the initial CVT appointment. Data collected from all veterans enrolled in the CVT clinic from September 8, 2014, through March 23, 2015 included: patient demographics, service connection percentage, number of CVT visits, travel miles saved, travel reimbursement, no-show rate, and documentation of medication management therapy. Results: As of March 23, 2015, there were 22 veterans enrolled in the MHCVT clinic, of whom, 19 completed their appointments. Of the 48 potential encounters, 7 were considered a no-show (17%). On average veterans saved 34 travel miles per visit with cumulative savings of 1432.6 miles. Of those who were eligible to receive travel reimbursement (n = 13), the medical center potentially saved $674.50 in a 7-month period. Overall clinic satisfaction per survey (n = 14) was 100% (strongly agreed or agreed). A majority (93%) would recommend the clinic to other veterans. Conclusions: This project successfully implemented a MHCVT pilot clinic. The veterans were satisfied with the services. The 41 clinic visits resulted in a potential cost savings. Expansion of this clinic in the future will expand more mental health resources to veterans.
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Xu, Chuang, Michelle Ann Gill, Gagan Bajwa, Yaming Xue, Adam Pallazo, Jacques Banchereau, and John E. Connolly. "Respiratory syncytial virus blocks MHC Class-II surface translocation in human myeloid dendritic cell (B127)." Journal of Immunology 178, no. 1_Supplement (April 1, 2007): LB26—LB27. http://dx.doi.org/10.4049/jimmunol.178.supp.b127.
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Abstract Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in infants and young children. Antigen presentation by dendritic cells (DCs) is critical for the establishment of antiviral immunity and DCs are frequent target of viral immune evasion. Here we show that primary blood mDCs exposed in vitro to RSV failed to upregulate MHC Class-II. Similar results were observed in mDCs isolated from the nasal mucosa of RSV infected infants. MHC Class-II levels remained low despite the apparent upregulation of other markers of DC maturation such as MHC Class-I, CD83, CD86 and CD40. This inhibition could not be explained by the reduced bio-synthesis of MHC Class-II as class II transactivator (CIITA) level remained unchanged and the total cellular HLA-DR was comparable to flu exposed mDC. Furthermore, SDS stability assay showed similar level of MHC Class-II peptide complex between the two viral treatments, indicating RSV exposure did not block Class-II loading. Consistent with the reduced surface expression, confocal microscopy demonstrated a selective blockade of MHC Class-II surface translocation by RSV. These results demonstrate that RSV blocks DC antigen presentation by inhibiting Class-II peptide complex transport to the surface and suggest a mechanism of viral immune evasion. This work is supported by grants from Baylor Health Care Systems Foundation, the Children’s Medical Center of Dallas Foundation to MG, and the National Institutes of Health (K08 AI059379-02 to MG, U19 AIO57234 to JB).
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Hancock, Meaghan, Scott Hansen, Daniel Malouli, Emily Marshall, Collette Hughes, Kurt T. Randall, David Morrow, et al. "RhCMV/SIV tropism modulation programs unconventional CD8+ T cell priming and vaccine efficacy." Journal of Immunology 208, no. 1_Supplement (May 1, 2022): 64.18. http://dx.doi.org/10.4049/jimmunol.208.supp.64.18.
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Abstract Strain 68-1 rhesus cytomegalovirus (RhCMV) vectors expressing simian immunodeficiency virus (SIV) antigens demonstrate a vaccine efficacy where 50–60% of vaccinated rhesus macaques are protected from SIV challenge. Intriguingly, RhCMV/SIV vectors elicit CD8+ T cells recognizing epitopes presented by MHC-II and MHC-E instead of MHC-Ia. We are studying how these unconventional T cell responses are elicited and contribute to the efficacy against SIV challenge. Here we utilize host microRNA (miRNA)-mediated vector tropism restriction to show that MHC-II- and MHC-E-restricted responses are primed by directly infected, non-overlapping cell types in rhesus macaques. Targeting essential RhCMV genes with myeloid cell-selective miR-142-3p eliminated MHC-E-restricted CD8+ T cell priming, yielding an exclusively MHC-II-restricted response, whereas endothelial cell-selective miR-126-3p targeting eliminated MHC-II-restricted CD8+ T cell priming, yielding an exclusively MHC-E-restricted response. Incorporation of both restriction elements reverts CD8+ T cell responses back to conventional MHC-Ia restriction. Using these otherwise isogenic vectors we show that although they demonstrate similar overall immunogenicity, only the vectors programmed to elicit MHC-E-restricted CD8+ T cell responses provided protection against SIV challenge. The MHC-E-only RhCMV/SIV vaccine efficacy did not exceed that of the parental 68-1 RhCMV/SIV vectors (that elicits both MHC-II and MHC-E responses) indicating that while the MHC-II-restricted CD8+ T cell responses are neutral to overall vaccine efficacy, an additional component of 68-1 RhCMV/SIV-induced immunity contributes to overall vaccine efficacy. This work was supported by the National Institute of Allergy and Infectious Diseases (NIAID) grants UM1 AI124377 and U19 AI128741 to LJP; the Oregon National Primate Research Center Core grant from the National Institutes of Health, Office of the Director (P51 OD011092); contracts from the National Cancer Institute (# HHSN261200800001E) to JDL; and the Bill and Melinda Gates Foundation grant OPP1107409.
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Grossman, Paige C., David A. Schneider, Robert Kirkpatrick, Stephen N. White, and Lindsay M. W. Piel. "Expansion of Proteome-wide Coxiella burnetii Comparative T-cell Epitope Prediction to Include Small Ruminant Hosts." Journal of Cellular Immunology 5, no. 5 (December 22, 2023): 143–61. http://dx.doi.org/10.33696/immunology.5.180.
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Background: Coxiella burnetii is the causative agent of Q fever, a human disease that can be acquired from livestock. Diseases caused by this organism have caused great losses in livestock and human health. No vaccine is approved for use in the United States, and formalin-inactivated whole-cell vaccines pose a significant manufacturing risk for biocontainment. A subunit vaccine using recombinant peptides from C. burnetii would be safer and less resource-intensive to produce. This study used reverse vaccinology to expand our prediction sets of T-cell epitopes for the major histocompatibility complex (MHC) Class I and II alleles of cattle, sheep, and goats. Thereafter, the present results were compared with those from our previous prediction sets for mice and humans. Results: Small ruminant breed representation for the United States was ensured by querying whole genome sequences on the National Center for Biotechnology Information database. Consequently, twenty-two sheep MHC Class I, seventeen goat MHC Class I, and one goat MHC Class II alleles were added to the analyses, resulting in a total of fifty-six sheep MHC Class I, eighteen goat MHC Class II, and twenty-seven goat MHC Class II alleles. Predicted interactions of C. burnetii proteome-derived peptides with each MHC allele were categorized as strong, weak, or non-binding based on bioinformatic scores. Interspecies comparisons resulted in 256 peptides of interest for MHC Class II presentation and 766 peptides of interest for MHC Class I presentation. Of these, 51 peptides were predicted to bind with both classes of MHC alleles, of which 33 were newly identified. Conclusion: The high scoring T-cell epitope predictions identified in this study provide grounds for prioritizing subunit candidates to further develop a safe and perhaps broadly effective C. burnetii vaccine.
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Parikh, Mamta, Ekaette E. Ebong, Erin Harris, and Brittany Barnes. "Evaluation of clinical pharmacy services within the primary care–mental health integration model at the Tuscaloosa Veterans Affairs Medical Center." Mental Health Clinician 6, no. 5 (September 1, 2016): 260–65. http://dx.doi.org/10.9740/mhc.2016.09.260.
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Abstract Introduction: The purpose of this review is to evaluate the direct delivery of health care to veterans before and after incorporating clinical pharmacy services within primary care mental health integration (PCMHI) at the Tuscaloosa Veterans Affairs Medical Center. Prior to establishing the role of the clinical pharmacy specialist (CPS) within PCMHI, the primary care providers deferred all mental health assessments to specialty mental health. As the demands of the service grew exponentially, assistance from clinical pharmacy was critical. Methods: A randomized, computer-generated list of 114 patients selected for the retrospective chart review was used to evaluate clinical outcomes in patients enrolled in the PCMHI clinic 1 year preincorporation and postincorporation of CPS. Outcome measures included the number of patients discharged from the PCMHI clinic upon achieving therapeutic goals or discharged to specialty mental health due to therapeutic failure or adverse drug events with first- and second-line psychotropic agents. Results: When contrasting the end points, there was a 60% increase in the number of patients who achieved therapeutic goal and a 32% decrease in the number of patients discharged to specialty mental health clinic postincorporation of CPS into PCMHI as compared to preincorporation of CPS (P = .024). Discussion: The results support the significance of CPS in the PCMHI in providing pharmacotherapy, patient education, and medication monitoring for managing psychiatric conditions, such as depression, anxiety, and insomnia. In addition, patients had greater accessibility to medication and frequent monitoring and follow-up, ultimately improving patient outcomes.
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Rashed, Amera Bekhatroh, Seham Shehata Mostafa, Nevin Adel Amer Amer, Shimaa AbdElhady Badawy, Afaf Abdelmalek Hussein, and Hanan E. Nada. "Effect of smartphone application-assisted nursing intervention on breastfeeding self-efficacy of postpartum women with multiple sclerosis." Fizjoterapia Polska 23, no. 5 (December 31, 2023): 57–68. http://dx.doi.org/10.56984/8zg20b3c3.
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Objective. This study aimed to study the effect of mobile application-assisted nursing intervention on exclusive breastfeeding-self efficacy of postpartum multiple sclerosis women.. Materials and Methods: The researchers utilized a quasi-experimental research design (case-control). The study was conducted at the maternal and child health centers (MCH) at Shebin El-Kom, Menoufia Governorate, Egypt. A purposive sample of 50 multiple sclerosis postpartum women was the target population of the present study. Three instruments were used for data collection. A structured interviewing questionnaire, breastfeeding self-efficacy scale and relation between breastfeeding and postpartum multiple sclerosis relapse questionnaire. Results and discussion: There was a statistically significant difference between both groups regarding self-management during postpartum period. The improvements were related to mothers’ relationships with their health care providers and knowledge and information about multiple sclerosis during this transitional phase, which indicated that the nursing intervention had positive effect on postpartum women with multiple sclerosis. Conclusion: Postpartum women with multiple sclerosis have a satisfactory level of breastfeeding self-efficacy after mobile application-assisted nursing intervention. Hence conducting a multidisciplinary program to monitor and support mothers with MS improves self-management during the postpartum period.
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Stefan, Teodora Cristina, Nicole Elharar, and Guadalupe Garcia. "Implementation and evaluation of Parkinson disease management in an outpatient clinical pharmacist–run neurology telephone clinic." Mental Health Clinician 8, no. 3 (May 1, 2018): 159–62. http://dx.doi.org/10.9740/mhc.2018.05.159.
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Abstract Parkinson disease (PD) is a progressive, debilitating neurodegenerative disease that often requires complex pharmacologic treatment regimens. Prior to this clinic, there was no involvement of a clinical pharmacy specialist (CPS) in the outpatient neurology clinic at the West Palm Beach Veterans Affairs Medical Center. This was a prospective, quality-improvement project to develop a clinical pharmacist–run neurology telephone clinic and evaluate pharmacologic and nonpharmacologic interventions in an effort to improve the quality of care for patients with PD. Additionally, the CPS conducted medication education groups to 24 patients with PD and their caregivers, if applicable, at this medical center with the purpose of promoting patient knowledge and medication awareness. Medication management was performed via telephone rather than face to face. Only patients with a concomitant mental health diagnosis for which they were receiving at least one psychotropic medication were included for individual visits due to the established scope of practice of the CPS being limited to mental health and primary care medications. Data collection included patient and clinic demographics as well as pharmacologic and nonpharmacologic interventions made for patients enrolled from January 6, 2017, through March 31, 2017. A total of 49 pharmacologic and nonpharmacologic interventions were made for 10 patients. We successfully implemented and evaluated a clinical pharmacist–run neurology telephone clinic for patients with PD. Expansion of this clinic to patients with various neurological disorders may improve access to care using an innovative method of medication management expertise by a CPS.
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Kaigle, Allie, Ranya Sawan-Garcia, and Anthony Firek. "Approach to the provision of transgender health care in a veteran population." Mental Health Clinician 7, no. 4 (July 1, 2017): 176–80. http://dx.doi.org/10.9740/mhc.2017.07.176.
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Abstract Transgender patients often experience health disparities, including higher rates of psychiatric comorbidity, tobacco and substance use disorders, higher suicide risk, and reduced access and initiation of medical and mental health services. In 2011, the Department of Veterans Affairs (VA) health care system released a directive outlining the provision of transgender health care services. Since 2011, the number of transgender veterans seeking services has increased. To address these health care disparities and ensure competent comprehensive medical and mental health care for this population, an interprofessional team collaborated to develop the first formalized Transgender Healthcare Clinic at the VA Loma Linda Medical Center. The team consisted of an endocrinologist, primary care provider, clinical pharmacist, psychologist, and social worker. Each member of the team plays a key role in the management of mental and medical health care for transgender veterans. After implementation of the Transgender Healthcare Clinic and its respective model for appointments, access to gender transition–related health care has improved and expanded. Although the role of the clinical pharmacist is well established in this clinic, the addition of a psychiatric pharmacist to the transgender health care team could improve patient care through the integration of an expert understanding of behavioral and pharmacologic aspects facing transgender individuals. The psychiatric pharmacist is trained with the unique skill set required to address these concerns and facilitate the optimal management of co-occurring mental illnesses commonly seen in this patient population. Further research focusing on the integration of psychiatric pharmacists into transgender health care teams is needed.
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Huszthy, Peter Csaba, Ramakrishna Prabhu Gopalakrishnan, Johanne Tracey Jacobsen, Ole Audun Werner Haabeth, Geir Åge Løset, Ranveig Braathen, Karl Schenck, Anders Aune Tveita, Ludvig Andre Munthe, and Bjarne Bogen. "B cell receptor ligation induces display of V-region peptides on MHC class II molecules to T cells." Proceedings of the National Academy of Sciences 116, no. 51 (December 3, 2019): 25850–59. http://dx.doi.org/10.1073/pnas.1902836116.
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The B cell receptors (BCRs) for antigen express variable (V) regions that are enormously diverse, thus serving as markers on individual B cells. V region-derived idiotypic (Id) peptides can be displayed as pId:MHCII complexes on B cells for recognition by CD4+T cells. It is not known if naive B cells spontaneously display pId:MHCII in vivo or if BCR ligation is required for expression, thereby enabling collaboration between Id+B cells and Id-specific T cells. Here, using a mouse model, we show that naive B cells do not express readily detectable levels of pId:MHCII. However, BCR ligation by Ag dramatically increases physical display of pId:MHCII, leading to activation of Id-specific CD4+T cells, extrafollicular T–B cell collaboration and some germinal center formation, and production of Id+IgG. Besides having implications for immune regulation, the results may explain how persistent activation of self-reactive B cells induces the development of autoimmune diseases and B cell lymphomas.
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Daniel, Nicole M., Kim Walsh, Henry Leach, and Lauren Stummer. "Implementation of a QTc-interval monitoring protocol by pharmacists to decrease cardiac risk in at-risk patients in an acute care inpatient psychiatric facility." Mental Health Clinician 9, no. 2 (March 1, 2019): 82–87. http://dx.doi.org/10.9740/mhc.2019.03.082.
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Abstract Introduction Many medications commonly prescribed in psychiatric hospitals can cause QTc-interval prolongation, increasing a patient's risk for torsades de pointes and sudden cardiac death. There is little guidance in the literature to determine when an electrocardiogram (ECG) and QTc-interval monitoring should be performed. The primary end point was improvement of the appropriateness of ECGs and QTc-interval monitoring of at-risk psychiatric inpatients at Barnabas Health Behavioral Health Center (BHBH) and Monmouth Medical Center (MMC) following implementation of a standardized monitoring protocol. The secondary end point was the number of pharmacist-specific interventions at site BHBH only. Methods Patients who met the inclusion criteria were assessed using a standardized QTc-prolongation assessment algorithm for ECG appropriateness. A retrospective analysis of a control group (no protocol) from January 1, 2016, to July 17, 2017, was compared with a prospective analysis of the intervention group (with protocol) from December 11, 2017, to March 11, 2018. Results At BHBH, appropriate ECG utilization increased 25.5% after implementation of a standardized protocol (P = .0172) and appropriate omission of ECG utilization improved by 26% (P < .00001). At MMC, appropriate ECGs decreased by 5%, and appropriate ECG omissions increased by 28%, neither of which were statistically significant (P = 1.0 and P = .3142, respectively). There was an increase in overall pharmacist monitoring. Discussion The study demonstrated that pharmacist involvement in ECG and QTc-interval monitoring utilizing a uniform protocol may improve the appropriateness of ECG and QTc-interval monitoring in patients in an acute care inpatient psychiatric hospital.
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Furtado, Fabiana Barcelos, Amanda Piveta Schnepper, Lucas Gabriel Ribeiro, Lauana Fogaça De Almeida, Carlos Magno Castelo Branco Fortaleza, Raul Borges Guimarães, Claudia Pio Ferreira, et al. "COVID-19 diagnosis and SARS-CoV-2 viral load in hospitalized patients versus people with Flu-Like Syndrome." Brazilian Journal of Development 9, no. 2 (February 7, 2023): 6644–54. http://dx.doi.org/10.34117/bjdv9n2-034.
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At the beginning of the pandemic, the Brazilian Public Health System (SUS) did not to test all suspects cases of COVID-19, thus, hospitalized individuals, health professionals, and symptomatic contacts were prioritized. Contrary to the criteria adopted by the government, the municipality of Botucatu chose to test all people who manifested flu-like syndrome. We aimed to investigate whether positive cases for COVID-19 were more frequent in patients seeking diagnosis via SUS or in the group of people seeking diagnosis via Municipal Health Center and whether the viral load was expressed differently in hospitalized patients (HP) compared to mild symptoms (MHC). Results showed that there were no differences in the percentage between the groups. Regarding the viral load, significant differences were found between the samples from HP and MHC (3-10 days of symptoms), with HP presenting a lower viral load. The results provide significant information about the viral load at different time-lapses.
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Jensen, Aimee N., Candace M. Beam, Amber R. Douglass, Jennifer E. Brabson, Michelle Colvard, and Jennifer Bean. "Description of a pharmacist-led clinical video telehealth group clinic for opioid overdose prevention and naloxone education." Mental Health Clinician 9, no. 4 (July 1, 2019): 294–97. http://dx.doi.org/10.9740/mhc.2019.07.294.
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Abstract To achieve the nationwide goal of reducing opioid-related deaths, a clinical pharmacy specialist–led clinical video telehealth (CVT) clinic was created at a Veterans Affairs medical center (VAMC) to deliver opioid overdose prevention and naloxone education to at-risk patients. The purpose of this innovative practice was to improve access to this potentially life-saving intervention to patients across urban and rural areas. This study is a single-center, descriptive analysis of adult patients across 2 VAMC campuses and 4 community-based outpatient clinics from July 11, 2016, through December 31, 2016. The purpose of this innovative practice was to increase access to overdose education and naloxone distribution (OEND) to at-risk patients across urban and rural areas. Patient-specific factors were also examined among those receiving naloxone through the CVT clinic compared to other prescribers. During the first 6 months from the initiation of the clinic, 1 pharmacist prescribed 21% of the health care system's naloxone. These patients identified by the pharmacist-led CVT clinic were more likely to be considered high-risk due to concomitant use of opioids and benzodiazepines. In conclusion, the pharmacist-led CVT group clinic has been an efficient strategy to extend OEND services to high-risk patients beyond central, urban areas.
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Ganzer, Nicole, Brandon Utter, Beth DeJongh, Michael Behrens, Guadalupe Garcia, and Rebecca Graham. "Re-implementation of a pharmacist-managed metabolic syndrome clinic in an outpatient mental health clinic setting." Mental Health Clinician 5, no. 1 (January 1, 2015): 57–62. http://dx.doi.org/10.9740/mhc.2015.01.057.
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Introduction: Second-generation antipsychotics (SGA) are often prescribed prior to first-generation antipsychotics (FGA) for mental health disorders by reason of proposed improved tolerability. Patients on SGA are not always appropriately screened for metabolic parameters in the clinical setting. A metabolic clinic was previously established for a limited time period at the West Palm Beach Veterans Affairs Medical Center (WPB VAMC) with beneficial outcomes. Re-implementation expanded the clinic to assess the impact when patients were referred from outpatient mental health and primary care providers. The objectives of this quality improvement initiative were to evaluate pharmacologic and nonpharmacologic interventions and compare the patient load preexpansion and postexpansion of the metabolic clinic. Methods: Patients receiving SGA at the WPB VAMC who met the criteria for metabolic syndrome were referred to the metabolic clinic. Preclinic data variables collected include demographics, social history, SGA, and assessment for presence of hypertension, diabetes, or dyslipidemia. Pharmacologic and nonpharmacologic intervention variables were collected throughout clinic involvement. The patient load post clinic expansion was reported. Results: Of the 17 patients evaluated, 88.2% had hypertension, 94.1% had dyslipidemia, and 88.2% had diabetes mellitus. The average number of components of metabolic syndrome was 3.7 out of 5 possible components. Most patients were taking risperidone (47.1%). An average of 1.5 medication interventions were made per patient. Only 28 patients were referred during reimplementation phase. Discussion: Metabolic syndrome commonly occurs in patients receiving SGA. Appropriately trained clinical pharmacists can help fill a gap in care by providing the recommended monitoring criteria and interventions for patients taking SGA.
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Platten, Michael, Lukas Bunse, Antje Wick, Theresa Bunse, Lucian Le Cornet, Inga Harting, Felix Sahm, et al. "A vaccine targeting mutant IDH1 in newly diagnosed glioma." Nature 592, no. 7854 (March 24, 2021): 463–68. http://dx.doi.org/10.1038/s41586-021-03363-z.
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AbstractMutated isocitrate dehydrogenase 1 (IDH1) defines a molecularly distinct subtype of diffuse glioma1–3. The most common IDH1 mutation in gliomas affects codon 132 and encodes IDH1(R132H), which harbours a shared clonal neoepitope that is presented on major histocompatibility complex (MHC) class II4,5. An IDH1(R132H)-specific peptide vaccine (IDH1-vac) induces specific therapeutic T helper cell responses that are effective against IDH1(R132H)+ tumours in syngeneic MHC-humanized mice4,6–8. Here we describe a multicentre, single-arm, open-label, first-in-humans phase I trial that we carried out in 33 patients with newly diagnosed World Health Organization grade 3 and 4 IDH1(R132H)+ astrocytomas (Neurooncology Working Group of the German Cancer Society trial 16 (NOA16), ClinicalTrials.gov identifier NCT02454634). The trial met its primary safety endpoint, with vaccine-related adverse events restricted to grade 1. Vaccine-induced immune responses were observed in 93.3% of patients across multiple MHC alleles. Three-year progression-free and death-free rates were 0.63 and 0.84, respectively. Patients with immune responses showed a two-year progression-free rate of 0.82. Two patients without an immune response showed tumour progression within two years of first diagnosis. A mutation-specificity score that incorporates the duration and level of vaccine-induced IDH1(R132H)-specific T cell responses was associated with intratumoral presentation of the IDH1(R132H) neoantigen in pre-treatment tumour tissue. There was a high frequency of pseudoprogression, which indicates intratumoral inflammatory reactions. Pseudoprogression was associated with increased vaccine-induced peripheral T cell responses. Combined single-cell RNA and T cell receptor sequencing showed that tumour-infiltrating CD40LG+ and CXCL13+ T helper cell clusters in a patient with pseudoprogression were dominated by a single IDH1(R132H)-reactive T cell receptor.
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Conca, Walter, Mayyadah Alabdely, Faisal Albaiz, Michael Warren Foster, Maha Alamri, Morad Alkaff, Futwan Al-Mohanna, Nicolaas Nagelkerke, and Reem Saad Almaghrabi. "Serum β2-microglobulin levels in Coronavirus disease 2019 (Covid-19): Another prognosticator of disease severity?" PLOS ONE 16, no. 3 (March 1, 2021): e0247758. http://dx.doi.org/10.1371/journal.pone.0247758.
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β2-microglobulin (β2-m), a 11.8 kDa protein, pairs non-covalently with the α3 domain of the major histocompatibility class (MHC) I α-chain and is essential for the conformation of the MHC class I protein complex. Shed β2-m is measurable in circulation, and various disorders are accompanied by increases in β2-m levels, including several viral infections. Therefore, we explored whether β2-m levels could also be elevated in Coronavirus disease 2019 (Covid-19) and whether they predict disease severity. Serum β2-m levels were measured in a cohort of 34 patients infected with SARS-CoV-2 on admission to a tertiary care hospital in Riyadh, Saudi Arabia, as well as in an approximately age-sex matched group of 34 uninfected controls. Mean β2-m level was 3.25±1.68 mg/l (reference range 0.8–2.2 mg/l) in patients (mean age 48.2±21.6) and 1.98±0.61 mg/l in controls (mean age 48.2±21.6). 17 patients (mean age 36.9± 18.0) with mean β2-m levels of 2.27±0.64 mg/l had mild disease by WHO severity categorization, 12 patients (mean age 53.3±18.1) with mean β2-m levels of 3.57±1.39 mg/l had moderate disease, and five patients (of whom 2 died; mean age 74.4±13.8) with mean β2-m levels of 5.85±1.85 mg/l had severe disease (P < = 0.001, by ANOVA test for linear trend). In multivariate ordinal regression β2-m levels were the only significant predictor of disease severity. Our findings suggest that higher β2-m levels could be an early indicator of severity of disease and predict outcome of Covid-19. As the main limitations of the study are a single-center study, sample size and ethnicity, these results need confirmation in larger cohorts outside the Arabian Peninsula in order to delineate the value of β2-m measurements. The role of β2-m in the etiology and pathogenesis of severe Covid-19 remains to be elucidated.
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Erwin, William J., Courtney Goodman, and Tammy Smith. "Effectiveness of a direct-to-consumer written health education program in the reduction of benzodiazepine and sedative-hypnotic use in an elderly population at a single Veterans Affairs medical center." Mental Health Clinician 8, no. 3 (May 1, 2018): 100–104. http://dx.doi.org/10.9740/mhc.2018.05.100.
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Abstract Introduction: The use of benzodiazepines and sedative-hypnotics in the elderly is associated with a significant risk of delirium, falls, fractures, cognitive impairment, and motor vehicle accidents. This quality improvement project applies a direct-to-consumer intervention to an elderly veteran population to reduce the use of these medications. Methods: Patients aged 75 and older currently taking a benzodiazepine and/or a sedative-hypnotic were included in the project. Direct-to-consumer education intervention letters were mailed to patients within 30 days of their next appointment. Their providers were emailed a questionnaire after the patient's appointment. Providers were asked if the letter prompted a conversation regarding medication use, whether the provider initiated discussion regarding a taper, and whether a specific taper plan was developed. Medical records were reviewed to determine if a reduction in dose or discontinuation occurred. Results: Fifty-nine direct-to-consumer education letters were mailed to the patients. Follow-up questionnaires were e-mailed to 44 providers, and 27 providers responded. Twenty-two percent of patients had their benzodiazepine and/or sedative hypnotic dose reduced or discontinued after their follow-up appointment. Sixty-seven percent of veterans initiated a conversation with their provider regarding their medication with 74% of providers discussing dose reduction. Fifty-six percent of recipients developed a specific taper plan with their provider. Discussion: The data from this project suggests that direct-to-consumer patient education can reduce the exposure to benzodiazepines and sedative-hypnotics in an elderly veteran population. More data is needed on larger populations to further explore the benefit of direct-to-consumer interventions.
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Kakoschke, Naomi, Craig Hassed, Richard Chambers, and Kevin Lee. "The importance of formal versus informal mindfulness practice for enhancing psychological wellbeing and study engagement in a medical student cohort with a 5-week mindfulness-based lifestyle program." PLOS ONE 16, no. 10 (October 21, 2021): e0258999. http://dx.doi.org/10.1371/journal.pone.0258999.
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Purpose Medical students commonly experience elevated psychological stress and poor mental health. To improve psychological wellbeing, a 5-week mindfulness-based lifestyle course was delivered to a first-year undergraduate medical student cohort as part of the core curriculum. This study investigated the effects of the program on mental health, perceived stress, study engagement, dispositional mindfulness, and whether any improvements were related to amount of formal and/or informal mindfulness practice. Methods Participants were first year undergraduate medical students (N = 310, 60% female, M = 18.60 years) with N = 205 individuals completing pre and post course questionnaires in a 5-week mindfulness-based lifestyle intervention. At pre- and post-intervention, participants completed the Mental Health Continuum-Short Form, the Perceived Stress Scale, the Utrecht Work Engagement Scale for Students, the Freiburg Mindfulness Inventory, and the Mindfulness Adherence Questionnaire. Results Mental health, perceived stress, study engagement, and mindfulness all improved from pre- to post-intervention (all p values < .001). Improvements on these outcome measures were inter-related such that PSS change scores were negatively correlated with all other change scores, FMI change scores were positively correlated with MHC-SF and UWES-S change scores, the latter of which was positively correlated with MHC-SF change scores (all p values < .01). Finally, observed improvements in all of these outcomes were positively related to informal practice quality while improved FMI scores were related to formal practice (all p values < .05). Conclusions A 5-week mindfulness-based program correlates with improving psychological wellbeing and study engagement in medical students. These improvements particularly occur when students engage in informal mindfulness practice compared to formal practice.
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Gibbons, A. "Women's health issues take center stage at the IOM." Science 258, no. 5083 (October 30, 1992): 733. http://dx.doi.org/10.1126/science.1439775.
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