Artigos de revistas sobre o tema "Augusta, Ga. Board of Health"
Siga este link para ver outros tipos de publicações sobre o tema: Augusta, Ga. Board of Health.
Crie uma referência precisa em APA, MLA, Chicago, Harvard, e outros estilos
Veja os 50 melhores artigos de revistas para estudos sobre o assunto "Augusta, Ga. Board of Health".
Ao lado de cada fonte na lista de referências, há um botão "Adicionar à bibliografia". Clique e geraremos automaticamente a citação bibliográfica do trabalho escolhido no estilo de citação de que você precisa: APA, MLA, Harvard, Chicago, Vancouver, etc.
Você também pode baixar o texto completo da publicação científica em formato .pdf e ler o resumo do trabalho online se estiver presente nos metadados.
Veja os artigos de revistas das mais diversas áreas científicas e compile uma bibliografia correta.
1
Vernon, Marlo M., Samantha Jones, Steven Coughlin, Justin X. Moore, Vahe Heboyan e Martha Tingen. "Abstract B034: Cancer Health Awareness through Screening and Education (CHANGE): Community health engagement". Cancer Epidemiology, Biomarkers & Prevention 32, n.º 1_Supplement (1 de janeiro de 2023): B034. http://dx.doi.org/10.1158/1538-7755.disp22-b034.
Texto completo da fonteResumo:
Abstract Purpose The goal of the CHANGE project is to provide a sustainable model of evidence-based cancer awareness through education – with an emphasis on prevention and early detection behaviors. Methods: Residents of a public housing community were invited to participate in a 4-week education program on breast, prostate, and colorectal cancer, including modifiable risk factors of obesity and tobacco use, screening eligibility, and participation in clinical trials. Each session was led by trained research staff, and lasted approximately one hour. A community site survey was also conducted among 20% of the residents to evaluate community cancer knowledge and screening behaviors. A community advisory board was established to support program implementation and advise on choosing a cancer risk-reducing environmental change. Results: 14 adult participants (7 men and 7 women, 86% African American) completed baseline measurements. 10 participants received a relevant health history notification, which means they were positive for one of the following which put them in the "higher risk" category: Due for one of the following screenings Breast, Colorectal or Prostate; Had family history of cancer; Tobacco use; Overweight/obese - 1 male was referred to the GCC Tobacco Cessation Program. All eligible participants were navigated to local cancer screening providers and will be followed up at 3 months.Community site survey results indicated a need for improved access to fresh fruits and vegetable access. Community advisory board participants and community resources collaborated to provide locally grown fresh fruits and vegetables to the public housing community's internal market. 1 Discussion: This sample represents those most at risk for cancer in the Augusta, GA area. This project will impact health equity by emphasizing a comprehensive approach to care through community environmental change and individual changes in knowledge and risk-reducing behaviors. Additional sites will be enrolled in the program through the end of 2022. Citation Format: Marlo M. Vernon, Samantha Jones, Steven Coughlin, Justin X. Moore, Vahe Heboyan, Martha Tingen. Cancer Health Awareness through Screening and Education (CHANGE): Community health engagement [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B034.
2
Dorigo, Oliver, Walead Ebrahimizadeh, Barry Kennedy, Lisa MacDonald, Stephan Fiset, Jeannine Villella, OZA Amit et al. "353 Identification of potential response predictors to maveropepimut-S (DPX-Survivac), a novel T cell activating immunotherapy, in patients with advanced recurrent ovarian cancer". Journal for ImmunoTherapy of Cancer 9, Suppl 2 (novembro de 2021): A380. http://dx.doi.org/10.1136/jitc-2021-sitc2021.353.
Texto completo da fonteResumo:
BackgroundEpithelial ovarian cancer (OvCa) is the most lethal of gynecological malignancies. The high mortality is related to a late diagnosis with over 75% being at an advanced stage, high recurrence rates, and ultimately resistance to chemotherapy. Previous studies have consistently demonstrated a strong association between higher tumor T cell infiltration and improved survival in OvCa patients supporting the potential clinical utility of T cell activating immunotherapy approaches. Maveropepimut-S (MVP-S, formerly named DPX-Survivac) is a T cell activating immunotherapy which is a formulation of the proprietary drug delivery platform DPX™ with immunogenic T-cell epitopes derived from the tumor-associated antigen survivin. MVP-S in combination with intermittent low-dose cyclophosphamide has been shown to induce robust and durable antigen-specific T cell responses and anti-tumor clinical activity in recurrent OvCa patients. The current study presents translational data aimed at identifying tumor tissue-based predictive biomarkers for response to treatment with MVP-S.MethodsBaseline and on-treatment tumor biopsies were collected from patients treated with MVP-S primed with immune-modulating low dose cyclophosphamide. Multiplex-immunohistochemistry (mIHC, Akoya Biosciences) and RNAseq analyses (Personalis Inc.) were used to analyze the tumor immune environment and identify potential response predictors to MVP-S.ResultsTwenty-two patients with advanced, recurrent OvCa were enrolled in this study. mIHC analysis demonstrated that higher baseline CD3+CD8+ T cell infiltration in tumor tissue was significantly associated with anti-tumor clinical activity of MVP-S defined as >10% on-treatment tumor regression. Pathway enrichment analyses using the differentially expressed genes associated with anti-tumor clinical activity confirmed these findings. In addition, we identified B cell pathway genes to be significantly upregulated in patients with >10% on-treatment tumor regression. mIHC analyses of paired biopsies available for one subject with clinical response (PR) demonstrated that MVP-S treatment induced increased T and B cell infiltration in the on-treatment biopsy compared to the baseline biopsy. These findings suggest that immunogenic tumors are more susceptible to the MVP-S treatment, in line with its mechanism of action. Pathway enrichment analyses further revealed that upregulation of genes or pathways related to immune-suppression (e.g. WNT pathway) or immune evasion/exclusion (CD276, Arg2) were significantly associated with lack of anti-tumor activity indicative of potential mechanism of primary resistance.ConclusionsCollectively, these results provide insight for possible response predictors to MVP-S based therapyTrial RegistrationNCT02785250Ethics ApprovalThe protocol and patient-informed consent form received approval by Institutional Review Boards. Written informed consent was obtained from all patients. REBs: Comite d’ethique de la recherche du CHUM (Montreal, Canada); Western Institutional Review Board 20161075 (Augusta, GA, USA); FWA #00002505 (NEW YORK, NY, USA); FWA00000161, IRB00000471 (Portland, Oregon, USA); University Health Network REB (Toronto, Canada); FWA00000935, FWA00000934 (Standford, CA, USA); Health Research Ethics Board of Alberta, (Edmonton, Canada)
3
Eram, Uzma, Nema Usman e Najam Khalique. "Study of Risk Factors in Patients of Pelvic Inflammatory Diseases". Saudi Journal of Medicine 7, n.º 9 (24 de setembro de 2022): 514–19. http://dx.doi.org/10.36348/sjm.2022.v07i09.009.
Texto completo da fonteResumo:
Number of risk factors has been associated with pelvic inflammatory disease, such as age, previous sexually transmitted infection, previous PID, multiple sexual partners, or an intrauterine contraceptive device. Women who use an intrauterine device for contraception are at least 2-4 times more likely to develop PID than non-users. Women who have had PID are twice as likely to develop the infection as those who have never had it. A history of a prior uncomplicated gonococcal infection is more common among women with PID than among women without disease. The present cross- sectional study was conducted in J.N. Medical College and Hospital (J.N.M.C.H.), Aligarh Muslim University, Aligarh. Permission for doing the study was taken by the Board of Studies in the Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. The study was carried out for a period of one year, from 1st August 2001 to 31st July 2002. The present study was carried out among ever married females in the reproductive age group of 15 to 49 years. Women, who gave positive history of PID, were asked to give their consent for the study. Their refusal was taken as exclusion criteria. Females with PID who were menstruating or who had taken antibiotic within the previous month were also excluded from the study. A total of 350 ever married females were selected from the Gynaecology OPD of J.N. Medical College Hospital (n=170), Urban Health Training Centre (n=100) and Rural Health Training Centre (n=80).A detailed clinical history and clinical examination were recorded on a pre-formed and pre tested proforma. All the females under study were subjected to per vaginal examination. The percentage of those female was more who used any cloth during menstruation. Out of 350 patients, 7.4% ga ve history of T.B, 24% gave history of previous episodes of PID, 12.0% gave history of MTPs/D&Cs. 5.1% had adopted IUCDs as a method of family planning.1.71% cases gave history of removal of IUCDs because of some complications. 75.0% of 80 cases (who adopted family planning) used IUCDs, OCPs and ligation. IUCDs, OCPs, ligation and irregular use of condoms probably increase chances of PID.
4
El Rassi, Fuad, Martha Arellano, Leonard T. Heffner, Edmund K. Waller, Elliott F. Winton, Kevin Ward e H. Jean Khoury. "Incidence and Geographic Distribution of Adult Acute Lymphoblastic Leukemia in the State of Georgia". Blood 120, n.º 21 (16 de novembro de 2012): 4309. http://dx.doi.org/10.1182/blood.v120.21.4309.4309.
Texto completo da fonteResumo:
Abstract Abstract 4309 We investigated an apparent increase in acute lymphoblastic leukemia (ALL) referral from north Georgia to Emory University Hospital, a tertiary care center located in Atlanta, Georgia. Cases reported between 1999 and 2008 to the Georgia Comprehensive Cancer Registry (GCCR) and the national Surveillance Epidemiology and End Results (SEER) cancer registry were analyzed. Age-adjusted incidence rates were calculated for all counties and public health regions within the state of Georgia and compared to national rates calculated using SEER 17 data for those ages 20 and above. Cases of adult acute myeloid leukemia (AML) served as control for health referral patterns, completeness of data collection and healthcare availability. The associations between geographic residence and acute leukemia were analyzed using Poisson regression analysis, and additional models were created to control for the effects of race and ethnicity. The age-adjusted incidence rate of adult ALL (0.8/100,000) and AML (4.6/100,000) for the state of Georgia were comparable to the national rates (0.9/100,000 and 5.2/100,000 respectively). Overall, the rate of ALL observed in parts of the North Georgia region (1.1 (95% CI 0.8, 1.5) were similar when compared to the rest of the state; and not affected after adjusting for race. We conclude that the higher number of cases of ALL cases referred from North Georgia is likely related to a physician-related referral pattern rather than an increased incidence. Age-adjusted incidence rate of ALL by state and public health region and rate ratios comparing the rate of ALL within each region to the pooled rates demonstrated in all other Georgia public health regions. Region of Georgia (GA) Rate SE Lower CI Upper CI Count Pop GA: Clayton (Jonesboro) 1.1 0.3 0.6 1.8 17 1,715,865 GA: DeKalb 0.8 0.1 0.5 1.1 37 5,111,685 GA: Fulton 0.6 0.1 0.4 0.8 37 6,565,834 GA: Northwest (Rome) 0.9 0.1 0.6 1.2 35 3,962,399 GA: North Georgia (Dalton) 0.9 0.2 0.6 1.4 23 2,632,276 GA: North (Gainesville) 1.1 0.2 0.8 1.5 41 3,723,276 GA: Cobb-Douglas 0.8 0.1 0.5 1.1 38 5,357,377 GA: Gwinnett 0.7 0.1 0.5 1 38 5,712,772 GA: LaGrange 0.8 0.1 0.5 1.1 37 4,818,090 GA: South Central (Dublin) 0.3 0.2 0.1 0.9 4 1,009,356 GA: North Central (Macon) 0.7 0.1 0.4 1 24 3,476,472 GA: East Central (Augusta) 0.7 0.2 0.4 1.1 20 3,017,677 GA: West Central (Columbus) 0.6 0.2 0.3 1 14 2,492,172 GA: South (Valdosta) 0.3 0.1 0.1 0.8 5 1,638,741 GA: Southwest (Albany) 0.9 0.2 0.5 1.3 22 2,500,405 GA: Coastal (Savannah) 0.8 0.2 0.6 1.2 29 3,568,163 GA: Northeast (Athens) 0.9 0.2 0.6 1.3 26 2,903,745 GA: All Georgia 0.8 0 0.7 0.8 463 62,540,286 Rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P25–1130) standard; Confidence intervals (Tiwari mod) are 95% for rates. Disclosures: Waller: Outsuka: Research Funding.
5
Min, Gi June, Byung Sik Cho, Sung-Soo Park, Silvia Park, Young-Woo Jeon, Seung-Hwan Shin, Seung-Ah Yahng et al. "Geriatric Assessment Predicts Non-Fatal Toxicities and Survival for Intensively Treated Elderly Acute Myeloid Leukemia: A Prospective Study". Blood 138, Supplement 1 (5 de novembro de 2021): 222. http://dx.doi.org/10.1182/blood-2021-151776.
Texto completo da fonteResumo:
Abstract Introduction Geriatric assessment (GA) typically refers to a multidimensional evaluation designed to evaluate an older person's functional ability, physical health, cognition, psychological health, nutritional status, and social support. The purpose of GA is to develop time-efficient and straightforward tools to evaluate multiple patient characteristics, which may be predictive of treatment outcomes of elderly acute myeloid leukemia (eAML) patients treated with intensive chemotherapy. Given that there have been few prospective studies with conflicting results, we performed a single-center prospective observational cohort study (#KCT0002172) investigating the prognostic value of multiparameter GA domains for eAML patients' tolerance and survival outcomes after intensive chemotherapy. Patients and methods Newly diagnosed eAML patients aged over 60 years who received intensive chemotherapy (n=105) were prospectively enrolled between November 2016 and December 2019. The median age was 64 years (range, 60-75), and they were all considered fit for intensive chemotherapy, with adequate performance and organ function. All the enrolled patients were administered various questionnaires for pretreatment GA and functional evaluation, which included evaluation for social and nutritional support, cognition, depression, distress, and physical function. Results Of the 105 enrolled patients, 93% had an Eastern Cooperative Oncology Group performance score of 1 and received intensive chemotherapy. Among them, between 32.4% and 69.5% of patients met the criteria for impairment on each GA domain. Physical impairment measured by the Short Physical Performance Battery (SPPB) was significantly associated with non-fatal toxicities of Grade III-IV severe infection (odds ratio (OR) 3.000, 95% confidence interval (CI), 1.159-7.788, p=0.024) and acute renal failure (OR 3.891, 95% CI, 1.329-11.39, p=0.013). Cognitive dysfunction measured by the Mini-Mental Status Examination- Korean version of CERAD Assessment Packet was significantly associated with a higher risk of Grade III-IV infection (OR 2.667, 95% CI, 1.025-6.939, p=0.044) and prolonged hospitalization (OR 4.208, 95% CI, 1.485-4.229, p=0.005). Reduced physical function measured by the SPPB and depressive symptoms measured by the Korean version of Short form Geriatric Depressive Scale (SGDS-K) were predictive of worse overall survival (OS; hazard ratio (HR) 1.917, 95% CI, 1.074-3.420, p=0.027 and HR 1.902, 95% CI, 1.005-3.602, p=0.048). SPPB impairment was also significantly related to higher treatment-related mortality (TRM; HR 2.023, 95% CI, 11.057-3.874, p=0.033). Furthermore, gait or sit-and-stand speed, a component of SPPB, was the single most powerful tool to predict survival outcomes of both OS (HR 2.766, 95% CI, 1.471-5.200, p=0.002 and HR 3.615, 95% CI, 1.868-6.999, p<0.001) and TRM (HR 2.461, 95% CI, 1.233-4.913, p=0.011 and HR 3.814, 95% CI, 1.766-8.237, p<0.001). We reconfirmed the prognostic value of preexisting survival prediction models, Wheatley index scores, and web-based AML scores, contrasting to the lack of significance of Ferrara criteria. The addition of SPPB/SGDS-K or gait (or sit-and-stand) speed/SGDS-K improved the predictability of the Wheatley index and web-based AML scores with 69% and 90% relative increases in predictive power for survival, respectively. Conclusions We prospectively demonstrated the prognostic value of physical and psychological assessment by GA for survival outcomes in intensively treated eAML patients. Gait or sit-and-stand speed was the single most powerful tool to identify frailty and predict survival outcomes. The prognostic value of preexisting survival prediction models, Wheatley index scores, and AML scores was reconfirmed.. The addition of measures for physical function and depression improved the predictability of those prediction models for survival. Cognitive and physical impairment were able to identify non-fatal toxicities during intensive chemotherapy in eAML patients. Our data will facilitate the incorporation of GA measures into validated survival prediction models to determine initial treatment for eAML patients in routine clinical care and clinical trials. Further studies are warranted to determine the best ways to adjust the care provided for frail patients to improve treatment tolerance and outcomes. Disclosures Kim: Novartis: Research Funding; BMS: Research Funding; Pfizer: Research Funding; ILYANG: Research Funding; Takeda: Research Funding. Lee: Alexion, AstraZeneca Rare Disease: Honoraria, Membership on an entity's Board of Directors or advisory committees. Kim: AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AIMS Biosciense: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; AML-Hub: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Astellas: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BL & H: Research Funding; BMS & Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Boryung Pharm Co.: Consultancy; Daiichi Sankyo: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Handok: Consultancy, Honoraria; LG Chem: Consultancy, Honoraria; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria; Pintherapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sanofi Genzyme: Honoraria, Speakers Bureau; SL VaxiGen: Consultancy, Honoraria; VigenCell: Consultancy, Honoraria.
6
Lawal, Folake J., Arni S. R. Srinivasa Rao e Jose A. Vazquez. "1010. Effective Management of HIV in Rural Georgia Using Telemedicine". Open Forum Infectious Diseases 7, Supplement_1 (1 de outubro de 2020): S533. http://dx.doi.org/10.1093/ofid/ofaa439.1196.
Texto completo da fonteResumo:
Abstract Background The increasing incidence of HIV and lack of care in rural areas contributes to the ongoing epidemic. The dearth of specialized health services within remote communities and access of this population to available services poses a challenge to HIV care. Telemedicine (TM) is a potential tool to improve HIV care in these remote communities, but little is known about its effectiveness when compared to traditional (face-to-face) (F2F) care. The objective of this study is to examine the effectiveness of HIV care delivered through TM, and compare to F2F care. Methods This is a retrospective chart review of all HIV positive patients who attended either the F2F clinic (Augusta, GA) or the TM clinic (Dublin, GA) between May 2017 to April 2018. Data extracted included demographics, CD4 count, HIV PCR, co-morbidities, dates of clinic attendance, HIV resistance mutations and ART changes. Viral suppression and gain in CD4 counts were compared. T-test was conducted to test differences in characteristics and outcomes between the two groups. Results 385 cases were included in the study (52.5% black, 82% females, F2F=200, TM=185). Mean CD4 count in the TM group was statistically higher (643.9 cells/mm3) than the F2F group (596.3 cells/mm3) (p< 0.001). There was no statistically significant difference in mean HIV viral load (F2F= 416.8 cp/ml, TM=713.4 cp/ml, p=0.3) and rates of year-round viral control (F2F= 73% vs TM = 77% p= 0.54). 38 patients achieved viral suppression during the study period (F2F= 24, TM =14) with a mean change of -3.34 x 104 vs -1.24 x 104, respectively. The difference in mean change was not statistically significant by Snedacor’s W Statistics. This indicates there was no significant difference between the two populations in terms of mean viral suppression among patients who were otherwise not suppressed before the study period. Conclusion To achieve an HIV cure, HIV care is required to extend to rural areas of the country and the world. Through delivery of care using TM, trained specialists can target communities with little or no health care. Moreover, use of TM achieves target outcome measures comparable to F2F clinics. Increase in the use of TM will improve the access to specialty HIV care and help achieve control of HIV in rural communities. Disclosures All Authors: No reported disclosures
7
Henneberg, Maciej. "Race Differences in Intelligence: An Evolutionary Analysis. By Richard Lynn. Pp 322+xiii. (Washington Summit Publishers, Augusta, GA, USA, 2006.) $17.95, ISBN 978-1-59368-020-6, hardback; ISBN 978-1-59368-021-3, paperback." Journal of Biosocial Science 38, n.º 6 (9 de outubro de 2006): 844–45. http://dx.doi.org/10.1017/s0021932006221539.
Texto completo da fonte
8
Reis, Zilma Silveira Nogueira, Rodney Nascimento Guimarães, Maria Albertina Santiago Rego, Roberta Maia de Castro Romanelli, Juliano de Souza Gaspar, Gabriela Luiza Nogueira Vitral, Marconi Augusto Aguiar dos Reis et al. "Prematurity detection evaluating interaction between the skin of the newborn and light: protocol for the preemie-test multicentre clinical trial in Brazilian hospitals to validate a new medical device". BMJ Open 9, n.º 3 (março de 2019): e027442. http://dx.doi.org/10.1136/bmjopen-2018-027442.
Texto completo da fonteResumo:
IntroductionRecognising prematurity is critical in order to attend to immediate needs in childbirth settings, guiding the extent of medical care provided for newborns. A new medical device has been developed to carry out the preemie-test, an innovative approach to estimate gestational age (GA), based on the photobiological properties of the newborn’s skin. First, this study will validate the preemie-test for GA estimation at birth and its accuracy to detect prematurity. Second, the study intends to associate the infant’s skin reflectance with lung maturity, as well as evaluate safety, precision and usability of a new medical device to offer a suitable product for health professionals during childbirth and in neonatal care settings.Methods and analysisResearch protocol for diagnosis, singlegroup, singleblinding and singlearm multicenter clinical trial with a reference standard. Alive newborns, with 24 weeks or more of pregnancy age, will be enrolled during the first 24 hours of life. Sample size is 787 subjects. The primary outcome is the difference between the GA calculated by the photobiological neonatal skin assessment methodology and the GA calculated by the comparator antenatal ultrasound or reliable last menstrual period (LMP). Immediate complications caused by pulmonary immaturity during the first 72 hours of life will be associated with skin reflectance in a nested case–control study.Ethics and disseminationEach local independent ethics review board approved the trial protocol. The authors intend to share the minimal anonymised dataset necessary to replicate study findings.Trial registration numberRBR-3f5bm5.
9
Bowman, Amauri, Sydney Taylor, Pritam Bora, Hongyan Xu, Leigh Wells, Latanya Bowman, Nadine Barrett et al. "Demographic Features of a Mixed Urban/Rural Adult Sickle Cell Population:Opportunities and Challenges for Improving Health Care". Blood 126, n.º 23 (3 de dezembro de 2015): 5594. http://dx.doi.org/10.1182/blood.v126.23.5594.5594.
Texto completo da fonteResumo:
Abstract Improvements in pediatric care since the 1970s as a result of Comprehensive Sickle Cell Centers, newborn screening, and prophylactic penicillin has led to an increase in life expectancy for patients with sickle cell disease (SCD) and has resulted in an increase in the number of adults with progressive end-organ damage/dysfunction. The inability of the U.S. Health Care system to adequately address the needs of this increasing patient population, along with stereotyping of SCD patients, has inevitably led to disparities in care, with an ever increasing disease burden and cost of care. Recognition of these issues has led U.S. Federal Health Care and Biomedical Research agencies (CDC, NIH, HRSA) to develop and implement programs to tackle this growing problem. Recently, NHLBI and NIMHD issued an RFA (HL-16-010) to address through implementation science the unmet health care needs of adolescents and adults (ages ≥15 years) with SCD. This program seeks to improve the health care and outcomes of this population through rigorous implementation of evidence-based guidelines. This initiative prompted us to analyze the demographic characteristics of the adult SCD population served by the GRU Sickle Cell Center, in an effort to better understand the opportunities and challenges posed by this initiative. The GRU Sickle Cell Center has been in existence since 1972, and serves ~1500 pediatric and adult SCD patients through its clinical program. Although based at the GRU campus in Augusta, GA (the second largest metropolitan area in the state with a population of >540,000), the Center has operated extensive outreach activities in rural south Georgia for the last 30 years, covering both pediatric and adult patients. The adult program holds monthly or every other month clinics in 5 sites in central, eastern, and southern Georgia. As of 2015, the Center has 580 active adult patients (>18 years). Fifty six percent are female and 44% male. Over half (54%) are followed at the Augusta clinic, and the remaining 46% in primarily rural outreach sites. The distribution of different genotypes is as follows: SS 392 (69%), SC 114 (20%), S-β+-thal 37 (6%), S-β0-thal 16 (3%) and others 11 (2%). The median age of the male patients is 31 (17-82), whereas for females is 34 (18-68). The median age for SS patients is 32 (17-65), and for SC is 34 (19-71). Overall, 62% of the population is in the 18-40 age group. Only 10% of the patients are >50. There is an age dependent increase in the proportion of female patients (70.6% > 61). Similarly, the proportion of SC patients increases to 56.3%, while SS decreases to 31.3% among subjects >61 years of age. Fifty-one percent of all patients (mostly SS) were prescribed hydroxyurea (HU). However, as reported earlier (Chand et al, ASH poster, 2014), only 59.9% had an adequate response; 26.3% were non-adherent, and 13.9% were on suboptimal doses. These data show that the adult SCD population in Georgia is young, with median age in the lower 30s. It also confirms the well-known observations that SC genotype and female gender are overrepresented in the older age groups. The opportunities to improve the health of this patient population in the next 5-10 years include: the existing outreach infrastructure, the partnership forged between the GRU Sickle Cell Center and some primary care practices (Family Medicine) and Hematology/Oncology practices in various outreach sites, and the implementation of an emergency department fast track pathway to treat vaso-occlusive crises in two of these outreach sites. The challenges, on the other hand, are persisting barriers to adequate/appropriate use of HU, partnering with community providers in the provision of appropriate pain management, implementation of evidence based transfusion practices in outlying hospitals and implementation of long-term evidence based health maintenance and primary care. Disclosures No relevant conflicts of interest to declare.
10
Vernon, Marlo M., Samantha Jones, Justin X. Moore, Steve S. Coughlin, Vahe Heboyan, Shakirah Clarke, Barbara Idun e Martha S. Tingen. "Abstract 1020: Cancer health awareness through screening and education (CHANGE): Understanding community experience accessing cancer care". Cancer Research 82, n.º 12_Supplement (15 de junho de 2022): 1020. http://dx.doi.org/10.1158/1538-7445.am2022-1020.
Texto completo da fonteResumo:
Abstract INTRODUCTION. Incidence and mortality rates for breast, prostate, and colorectal cancers all exceed national rates in Georgia and are higher among African Americans (AAs). Ensuring culturally competent and equitable health care delivery relies on creating an educated and engaged health care team. Patient stories are powerful examples of community-learned experiences and can be used to educate better providers and health care students who serve diverse populations, particularly when communicating risk and prevention of cancer. The goal of the CHANGE project is to provide a sustainable model of evidence-based cancer awareness through education - with an emphasis on prevention and early detection behaviors. We will develop a health disparities and culturally competent cancer care e-Learning curriculum for health care professionals, hematology-oncology fellows, residents, and medical students at the Medical College of Georgia. METHODS. Thirty community members and stakeholders (93% AA, 76% female, all adults) were recruited through public housing, healthcare clinics and providers, and community organizations. Vignettes describing patient access and care interactions were used in semi-structured interviews to guide conversations about experiences accessing care, attitudes towards cancer prevention, and community cancer beliefs. Interviews were recorded, professionally transcribed, and content analyzed using NVivo 12.0 by two independent raters. RESULTS. Three common themes emerged: accessibility of healthcare (transportation, finances, and difficulties in scheduling were primary barriers); cancer myths and cultural norms (no interpersonal discussion of cancer, seen as “taboo,” cancer will spread if cut into and cancer is contagious); and experience of racial bias in health care (historical racial bias and systemic racism; receipt of treatment and care perceived to be different due to race; lack of AA providers). CONCLUSION. This sample adequately represented those most at risk for cancer in Augusta, GA area. Their shared experiences will be used to design and inform an e-learning curriculum, in conjunction with education on health disparities across the state and specific to the local community. This will provide a comprehensive approach to provider education that will begin to improve patient care satisfaction and health outcomes. Citation Format: Marlo M. Vernon, Samantha Jones, Justin X. Moore, Steve S. Coughlin, Vahe Heboyan, Shakirah Clarke, Barbara Idun, Martha S. Tingen. Cancer health awareness through screening and education (CHANGE): Understanding community experience accessing cancer care [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1020.
11
Zhou, Chenglong, Jun Li, Xiaochu Wu, Xinhao Qi e Fei Liu. "Clinical evaluation of the reference intervals for diabetes in Chinese geriatric population: a cross-sectional cohort study protocol". BMJ Open 14, n.º 1 (janeiro de 2024): e076011. http://dx.doi.org/10.1136/bmjopen-2023-076011.
Texto completo da fonteResumo:
IntroductionDiabetes mellitus (DM) is an important health issue that affects the ageing population. China has the largest geriatric population and the largest number of diabetes cases in the world. This poses a significant challenge for healthcare providers and policymakers. Haemoglobin A1C (HbA1c), which is one of the diagnostic criteria for diabetes, is affected by many factors such as pregnancy, age, race and anaemia. Glycated albumin (GA) is not influenced by factors that affect HbA1c concentrations, although it has been used in the diagnosis of diabetes in a few people. The aim of this study protocol is to determine reference intervals (RIs) of HbA1c and GA for the diagnosis of older adults with diabetes in China and to assess the optimal cut-off values for these parameters from a health economic perspective.Methods and analysisThis cross-sectional survey study will recruit 1278 community-dwelling older adults aged 60–89 in Chengdu City. The data collection process will involve a questionnaire survey, a comprehensive physical examination and the collection of blood samples for laboratory testing. Data analyses will be conducted on the pooled sample and stratified by gender, age or other demographic features if necessary. Rates will be compared using the χ2 test or Fisher test and receiver operating characteristic (ROC) curves will be used to identify the most effective threshold values for HbA1c and GA for diagnosing diabetes among older adults in China.Ethics and disseminationThe study protocol was approved by the ethics review board of the Bioethics Subcommittee of West China Hospital, Sichuan University (Approval No. 1705 in 2022). The study’s results will be disseminated through peer-reviewed journals and scientific conferences.Trial registration numberChiCTR2300070831
12
Folger, Lian V., Pratik Panchal, Michelle Eglovitch, Rachel Whelan e Anne CC Lee. "Diagnostic accuracy of neonatal foot length to identify preterm and low birthweight infants: a systematic review and meta-analysis". BMJ Global Health 5, n.º 11 (novembro de 2020): e002976. http://dx.doi.org/10.1136/bmjgh-2020-002976.
Texto completo da fonteResumo:
IntroductionEighty percent of neonatal deaths occur among babies born preterm and/or small for gestational age (SGA). In sub-Saharan Africa and South Asia, approximately 40% of births occur outside of health facilities, and gestational age (GA) and birth weight are commonly unknown. Foot length (FL) has been proposed as a simple, surrogate measurement to identify and triage small babies born in the community. We conducted a systematic review and meta-analysis of the diagnostic accuracy of newborn FL to classify preterm and low birthweight infants.MethodsPubMed, EMBASE, Cochrane, Web of Science, POPLINE and WHO Global Health Library databases were searched. Studies of live-born infants that compared FL with GA and/or birth weight were included. Data on diagnostic accuracy were summarised, described, and pooled, as appropriate.ResultsSix hundred and two studies were identified and 41 included. Techniques for measuring FL included use of a firm plastic ruler, callipers, footprint or a measuring board. Twelve studies assessed the diagnostic accuracy of FL to identify preterm births; however, data were not pooled given heterogeneity and low quality of GA. 19 studies used FL to identify low birthweight infants (<2500 g, <2000 g). Among studies in Asia (n=3), FL <7.7 cm had pooled sensitivity and specificity of 87.6% (95% CI 61.1% to 99.0%) and 70.9% (95% CI 23.5% to 95.1%), respectively, to identify <2500 g infants. FL <7.3 cm had 82.1% (95% CI 63.7% to 92.2%) sensitivity and 82.1% (95% CI 59.2% to 90.8%) specificity for identifying <2000 g infants (n=3). In the African studies (n=3), FL <7.9 cm had pooled sensitivity and specificity of 92.0% (95% CI 85.6% to 95.7%) and 71.9% (95% CI 44.5% to 89.1%), respectively, to identify <2500 g neonates.ConclusionsFL is a simple proxy measure that can identify babies of low birthweight with high sensitivity, though somewhat lower specificity. Additional research is needed to determine the validity of FL to identify preterm infants, and understand the programmatic impact of screening on healthcare seeking and outcomes.PROSPERO registration numberCRD42015020499
13
Ham, Phillip B., Toby Anderton, Ryan Gallaher, Mike Hyrman, Erika Simmerman, Annamalai Ramanathan, David Fallaw, Steven Holsten e Charles Gordon Howell. "Development of Electronic Medical Record-Based “Rounds Report” Results in Improved Resident Efficiency, More Time for Direct Patient Care and Education, and Less Resident Duty Hour Violations". American Surgeon 82, n.º 9 (setembro de 2016): 853–59. http://dx.doi.org/10.1177/000313481608200950.
Texto completo da fonteResumo:
Surgeons frequently report frustration and loss of efficiency with electronic medical record (EMR) systems. Together, surgery residents and a programmer at Augusta University created a rounds report (RR) summarizing 24 hours of vitals, intake/output, labs, and other values for each inpatient that were previously transcribed by hand. The objective of this study was to evaluate the RR's effect on surgery residents. Surgery residents were queried to assess the RR's impact. Outcome measures were time spent preparing for rounds, direct patient care time, educational activity time, rates of incorrect/incomplete data on rounds, and rate of duty hour violations. Hospital wide, 17,200 RRs were generated in the 1-month study. Twenty-three surgery residents participated. Time spent preparing for rounds decreased per floor patient (15.6 ± 3.0 vs 6.0 ± 1.2, P < 0.0001) and per intensive care unit patient (19.9 ± 2.9 vs 7.5 ± 1.2 P < 0.0001). The work day spent in direct patient care increased from 45.1 ± 5.6 to 54.0 ± 5.7 per cent ( P = 0.0044). Educational activity time increased from 35.2 ± 5.4 to 54.7 ± 7.1 minutes per resident per day ( P = 0.0004). Reported duty hour violations decreased 58 per cent ( P < 0.0001). American Board of Surgery in Training exam scores trended up, and estimates of departmental annual financial savings range from $66,598 to $273,141 per year. Significant improvements occur with surgeon designed EMR tools like the RR. Hospitals and EMR companies should pair interested surgeons with health information technology developers to facilitate EMR enhancements. Improvements like RRs can have broad ranging, multidisciplinary impact and should be standard in all EMRs used for inpatient care at academic medical centers.
14
D'Angelo, Christopher R., Masha Kocherginsky, Michael R. Bishop, Lucy A. Godley, Justin Kline, Richard A. Larson, Hongtao Liu et al. "Incidence and Predictors of Respiratory Viral Infections By Multi-Plex PCR in Allogeneic Hematopoietic Cell Transplant (HCT) Recipients 50 Years and Older Including Geriatric Assessment (GA)". Blood 124, n.º 21 (6 de dezembro de 2014): 2464. http://dx.doi.org/10.1182/blood.v124.21.2464.2464.
Texto completo da fonteResumo:
Abstract Introduction Community respiratory viruses (CRV) are important agents of morbidity and mortality after HCT. Although several studies have included subsets of patients 50 years and older, no studies have specifically investigated the incidence of CRV infections in older patients nor the influence of health impairments as measured by Geriatric Assessment (GA). Methods We retrospectively reviewed patients undergoing allogeneic HCT, age 50 years or older at HCT, and who completed GA prior to HCT. The GA instruments and thresholds for prognostic marker analyses followed our prior published results (Muffly L et al, Haematologica 2014). We limited the cohort to transplant years 2009-2013 to coincide with the availability of a multiplex PCR for CRV covering respiratory syncytial virus (RSV), parainfluenza virus (PIV) 1-4, influenza A and B, Human metapneumovirus (HMPV), coronavirus (hCoV), entero/rhinovirus (human EV), and adenovirus (Adv). Testing was performed at the discretion of the treating physician as clinically indicated through either nasal swab and/or bronchoalveolar lavage. We analyzed cumulative incidence of CRV after HCT at day 100 and one year, outcomes, and univariate risk factors for infection. Results The baseline characteristics of the 121 evaluable patients included: median age 58 years (50 - 73); AML (39%); MDS (17%); not in remission/response (39%); haplo-cord (21%); myeloablative conditioning (16%); and T-cell depletion by ATG/alemtuzumab (95%). Thirty-three first-episode CRV infections occurred among 121 evaluable patients for a cumulative incidence of CRV by day 100 of 10.5% (95% CI: 5.5 – 17.2) and 1 year of 24.8% (CI: 16.9-33.4%). Multi-plex PCR identified the following CRV infections: influenza A or B (n=4, 12%), RSV (n=7, 21%), PIV (n=5, 15%), human EV (n=11, 33%), hCoV (n=1, 3%), Adv (n=3, 9%), and HMPV (n=2, 6%). Co-infections occurred in roughly half of the cases and commonly included cytomegalovirus, Pseudomonas aeruginosa, Aspergillus fumigatus and Clostridium difficile. Morbidity and mortality were restricted to those who developed lower respiratory tract infections (LRTI). The outcomes of LRTIs are presented in table 1. Viruses were grouped within the table according to characteristic disease course as previously described (Wolfromm et al, BBMT 2014). Twenty-two (67%) patients with CRV infection required hospitalization with a median length of stay of 11 days. Importantly, CRV directly contributed to death in 7 patients (32% of LRTIs). Of these, 5 patients had a bacterial co-infection and 6 of the 7 were receiving steroids at CRV onset. CRV infection showed no association with GA measures of high HCT-CI (p=.34), high CRP (p=.86), lower performance status (p=.66), impairments in instrumental activities of daily living (p=.96), frail (p=.83), low self-report physical function (p=1.0), and low self-report mental function (p=.51). The one-year incidence of CRV was non-significantly lower for albumin below 3.5 g/dL (11% vs. 28%, p=0.17), slow walk speed (11% vs 31%, p=.06) and age 60+ versus 50-59 (20% vs 28%, p=.36). The limited sample size precluded an analysis of CRV associated morbidity by GA. Conclusions The incidence of CRV infection of 25% among older allogeneic HCT recipients by multi-plex PCR appears similar or slightly lower than previously reported data for HCT in general. Health impairments by GA did not translate into heightened risk of CRV infection. Most LRTI related deaths occurred in patients receiving steroids at the onset of infection. Larger prospective studies will be needed to determine if patient health status influences CRV related morbidity in older adults. Table 1: Type and Outcomes of Lower Respiratory CRV Infections in Older HCT Patients Outcome N (%) LRTI 22 Etiology Flu/RSV/PIV/HMPV 13 (59) AdV 3 (14) hCoV/human EV 6 (27) ICU 9 (41) Ventilation 6 (27) Non CRV co-infection 16 (72) Death 7 (32) Disclosures Larson: Novartis: Consultancy, Research Funding. Stock:Sigma-Tau: Membership on an entity's Board of Directors or advisory committees, Research Funding. Artz:Miltenyi Biotec: Research Funding.
15
Giulietti, Nicola, Paolo Chiariotti, Gloria Cosoli, Giovanni Giacometti, Luca Violini, Alessandra Mobili, Giuseppe Pandarese, Francesca Tittarelli e Gian Marco Revel. "Continuous monitoring of the health status of cement-based structures: electrical impedance measurements and remote monitoring solutions". ACTA IMEKO 10, n.º 4 (30 de dezembro de 2021): 132. http://dx.doi.org/10.21014/acta_imeko.v10i4.1140.
Texto completo da fonteResumo:
<p class="Abstract">The continuous monitoring of cement-based structures and infrastructures is fundamental to optimize their service life and reduce maintenance costs. In the framework of the EnDurCrete project (GA no. 760639), a remote monitoring system based on electrical impedance measurements was developed. Electrical impedance is measured according to the Wenner’s method, using 4-electrode arrays embedded in concrete during casting, selecting alternating current as excitation, to avoid the polarization of both electrode/material interface and of material itself. With this measurement, it is possible to promptly identify events related to contaminants ingress or damages (e.g. cracks formation). Conductive additions are included in some elements to enhance signal-to-noise ratio, as well as the self-sensing properties of concrete. Specifically, a distributed sensor network was implemented<span style="text-decoration: line-through;">,</span> consisting of measurement nodes installed in the elements to be monitored, then connected to a central hub (RS-232 protocol). Nodes are realized with an embedded unit for electrical impedance measurements (EVAL-AD5940BIOZ board with AD5940 chip, by Analog Device) and a digital thermometer (DS18B20 by Maxim Integrated), enclosed in cabinets filled with an IP68 gel against moist-related problems. Data are available on a Cloud through Wi-Fi network or LTE modem, hence can be accessed remotely via a use-friendly multi-platform interface.</p>
16
Rosko, Ashley E., Sarah A. Wall, Robert A. Baiocchi, Don M. Benson, Jonathan E. Brammer, John C. Byrd, Yvonne A. Efebera et al. "Restoring Functional Deficits in Older Adults with Hematologic Malignancy". Blood 134, Supplement_1 (13 de novembro de 2019): 4776. http://dx.doi.org/10.1182/blood-2019-130531.
Texto completo da fonteResumo:
Background: Geriatric deficits in patients with malignancy are predictive of morbidity and mortality. Measuring geriatric deficits provides additional prognostic information not otherwise captured in routine oncology care. Currently, the gap in geriatric-care delivery is the paucity of data demonstrating effective interventions once geriatric deficits are identified. Older adults with hematologic malignancy are understudied and evaluating both the impact of geriatric factors and interventions to improve upon geriatric deficits are warranted. Here we demonstrate the impact of identifying functional impairment and an exercise program among older adults with hematologic malignancy. Methods: This was a single center prospective study of older patients (≥60 years) with hematologic malignancy. Patients actively receiving any therapeutic treatment (chemotherapy, immunotherapy, targeted agents) were enrolled in a six-month exercise program to attenuate functional decline. The Otago Exercise Program (OEP) has been found to be an effective exercise regimen to improve functional balance, muscle strength, and prevent fall-related injury and mortality.1 The OEP is a structured combination of physical therapist prescribed individualized exercise plans with home-based exercise targeted to improve balance and functional decline. Patients enrolled had mild or moderate impairments in physical function, as defined by a score ≤9 on the Short Physical Performance Battery (SPPB). Patients were evaluated at baseline for geriatric deficits (Visit 1), after four months of OEP training (Visit 2), and following two months of self-directed exercise (Visit 3 - end of study) using a standardized Geriatric Assessmpent (GA) tool (CARG GA). The relationship between geriatric deficits and mortality and hospital utilization were analyzed. The change in GA factors over 3 visits were evaluated through a linear mixed model. The proportional hazards model was built to assess the association between Visit 1 GA and overall survival (OS), where OS was defined as time from date of V1 to death, censoring patients who were still alive at time of last follow-up. The generalized linear models were used to link Visit 1 GA with other clinical outcomes such as hospital length of stay (LOS) and the probability of emergency room (ER) visit. Results: Older adults (median age: 75.5; range 62-83) actively receiving chemotherapy for hematologic malignancy were enrolled (n=30). Physical health scores as measured by the MOS-PFS increased significantly at the second visit. [Median MOS-PFS: V1=55 (0-100); V2=70 (30-100), p<.01; V3=57.5 (0-90), p=0.43], where patient reported KPS increased significantly and the improvement was sustainable [Median KPS: V1=80 (40-100); V2=90 (60-100), p=0.02; V3=90 (50-100), p=0.04]. Objective measures of physical function improved to normal scores by visit 2 and were sustained [Median SPPB: V1=7 (0-11); V2=11 (2-12), p<.01; V3=9 (2-12), p<0.01]. With a median follow-up of 21.4 months, 9 patients had died. Half of patients were hospitalized either once or multiple times with a median of 3 admissions (range 1-7).The total LOS ranged from 2 to 41 days with a median of 13 days. During the study period and 1-year follow up, 67% (20/30) patients had ER visits with a median count of 1.5 visits (range 1-6). The SPPB was the only tool that was associated with all three clinical outcomes; OS with a hazard ratio (HR) of 0.80 (95% confidence interval (CI) 0.65-0.97, p=0.03), LOS [Incidence Rate Ratio=0.86 (95% CI 0.75-0.98), p=0.02], and the odds of ER visit [odds ratio = 0.77 (95% CI 0.62-0.94), p=0.01]. Chronologic age had no relationship with OS, LOS, or ER utilization. Conclusions: Functional deficits of older patients with hematologic malignancy on active chemotherapy, both subjective and objective metrics, improved with the OEP exercise program. Objective markers of physical function (SPPB) correlated with mortality and hospital utilizations among this population. There was no significant relationship between age and clinical outcomes. Mitigating functional impairment among older adults with hematologic malignancy is important to improve clinical outcomes in this high-risk population. Disclosures Rosko: Vyxeos: Other: Travel support. Baiocchi:Prelude: Consultancy. Brammer:Celgene: Research Funding; Seatlle Genetics: Honoraria, Speakers Bureau. Byrd:Novartis: Other: Travel Expenses, Speakers Bureau; Pharmacyclics LLC, an AbbVie Company: Other: Travel Expenses, Research Funding, Speakers Bureau; Genentech: Research Funding; TG Therapeutics: Other: Travel Expenses, Research Funding, Speakers Bureau; Acerta: Research Funding; Ohio State University: Patents & Royalties: OSU-2S; Gilead: Other: Travel Expenses, Research Funding, Speakers Bureau; BeiGene: Research Funding; Janssen: Consultancy, Other: Travel Expenses, Research Funding, Speakers Bureau. Efebera:Takeda: Honoraria; Akcea: Other: Advisory board, Speakers Bureau; Janssen: Speakers Bureau. Maddocks:Pharmacyclics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Research Funding; Merck: Research Funding; Teva: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; BMS: Research Funding. Rogers:Acerta Pharma: Consultancy; AbbVie: Research Funding; Genentech: Research Funding; Janssen: Research Funding.
17
Sorror, Mohamed L., Barry E. Storer, Aaron T. Gerds, Bruno C. Medeiros, Paul J. Shami, John P. Galvin, Kehinde U. Adekola et al. "Limitations to Receiving Allogeneic Hematopoietic Cell Transplantation for Treatment of Acute Myeloid Leukemia: A Large Multi-Center Prospective Longitudinal Observational Study". Blood 132, Supplement 1 (29 de novembro de 2018): 1388. http://dx.doi.org/10.1182/blood-2018-99-112672.
Texto completo da fonteResumo:
Abstract Introduction: Acute myeloid leukemia (AML) is most frequently diagnosed in older patients (pts), whose median survival is less than 1 year. Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative treatment. However, older pts often have significant comorbidities and other geriatric health problems, and the effect of these on the probability of receiving HCT is unknown. To this end, we designed a prospective, multi-center, longitudinal, observational study dating from first presentation of adult pts with AML to be treated at one of 13 different referral centers that provide both AML treatment and HCT. We examined the effects of different variables (see methods) on the probability to 1) survive long enough to receive HCT and 2) to receive HCT if such survival occurred. Methods: We enrolled 695 pts (Table 1). Data on demographics, AML status, cytogenetic risks per European Leukemia Network (ELN), and response; age; comorbidities per the HCT-comorbidity index (CI); function including instrumental activities of daily living (IADL) and activities of daily living (ADL); frailty including walk test; geriatric assessment (GA) including cognition; Karnofsky performance status (KPS); QOL including the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT), Euro-QOL 5-Dimension scale (EQ-5D), ENRICHD Social Support Instrument, Social Activity Log, and Patient Health Questionnaire 9-item Depression Scale (PHQ-9) were collected at enrollment and at 1, 3, 6, 9, 12, 18, and 24 months thereafter. High-risk myelodysplastic syndromes (MDS) receiving AML-like therapy were included. We used competing risk Cox regression analyses, treating HCT as the event of interest and death without HCT as a competing risk, with staggered entry (left truncation) at time of consent. Associations between variables were assessed both at enrollment and over time. Results: The overall rate of HCT at 9 months after enrollment was 43% (Figure 1) and 92% of pts who received HCT did so by the 9 month mark. In multivariate analyses, death without HCT (Table 2) was associated with augmented HCT-CI scores ≥5 (HR:2.11, p<0.0001), age ≥50 years with those aged ≥70 years having the highest association (HR:2.71, p<0.0001), ELN intermediate (HR:2.43, p=0.0003) or unfavorable risks (HR:4.3, p<0.0001), receiving low-intensity induction regimens (HR:1.42, p=0.04), relapsed/refractory disease at enrollment (HR:2.04, p<0.0001), dependent status per ADL scores <14 (HR:1.59, p=0.005), and depression per PHQ-9 (HR:1.56, p=0.009). Among survivors (Table 3), low likelihood to receive HCT was associated with age ≥70 years (HR:0.40, p=0.0001), low ELN risk (HR:0.28, p<0.0001), low-intensity induction (HR:0.56, p=0.02), poor KPS (HR:0.49, p=0.0005), and relapse after initial complete remission (CR) (HR:0.41, p=0.001); while pts with high-risk MDS (HR:2.43, p<0.0001), relapsed/refractory disease at enrollment (HR:2.43, p<0.0001), and CR after induction (HR:4.59, p<0.0001) were more likely to receive HCT. Among pts aged ≥60 years, and after considering previous factors, impaired cognition (HR:0.45, p=0.007) and impaired hearing (HR:0.71, p=0.009) were associated with lower likelihood to receive HCT. Conclusions: In a prospective, observational, multi-center study, increasing age, comorbidity burden, ELN risk, low-intensity initial AML induction regimen, depression, and functional dependence increase risks of early mortality without HCT. In those who survived long enough to potentially receive HCT, age up to 69 years and/or multiple comorbidities were not found to be barriers to HCT, likely reflecting the widespread use of reduced-intensity conditioning regimens. However, the independent sharp decline in receipt of HCT in pts aged 70-80 years suggests continued bias, although pts in this age group have been shown to derive similar benefit from HCT as younger pts. Use of objective comorbidity and GA tools rather than age per se to decide on HCT is encouraged. The adverse impact of impairments in psychological health and function on survival and of impairments of cognition, geriatric health, and performance status on receipt of HCT emphasize the need for interventions that target these health limitations in conjunction with AML treatment to improve outcomes. Finally, the benefit of intensive vs. less-intensive induction therapies should be addressed with a randomized trial. Disclosures Gerds: Celgene: Consultancy; Apexx Oncology: Consultancy; Incyte: Consultancy; CTI Biopharma: Consultancy. Shami:Lone Star Biotherapies: Equity Ownership; Baston Biologics Company: Membership on an entity's Board of Directors or advisory committees; JSK Therapeutics: Employment, Equity Ownership, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy. Rizzieri:Arog: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Teva: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Jazz: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees. Wang:Novartis: Speakers Bureau; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy; Jazz: Speakers Bureau; Novartis: Speakers Bureau; Amgen: Consultancy; Jazz: Speakers Bureau; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees. Faderl:Jazz Pharmaceuticals: Employment, Equity Ownership. Koprivnikar:Amgen: Speakers Bureau; Otsuka: Consultancy; Alexion: Consultancy, Speakers Bureau. Sekeres:Celgene: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Opsona: Membership on an entity's Board of Directors or advisory committees; Opsona: Membership on an entity's Board of Directors or advisory committees. Becker:GlycoMimetics: Research Funding.
18
McCormick, Lisa C., Justine J. Reel, Melissa Alperin, Laura M. Lloyd e Kathleen R. Miner. "Strategic Approach to Assess Training Needs Across a Diverse Region". Pedagogy in Health Promotion 3, n.º 1_suppl (11 de maio de 2017): 28S—34S. http://dx.doi.org/10.1177/2373379917697064.
Texto completo da fonteResumo:
The mission of the Region IV (R-IV) Public Health Training Center (PHTC), headquartered at the Rollins School of Public Health at Emory University in Atlanta, GA, is to develop and implement programming to train and educate public health professionals in U.S. Department of Health and Human Services Region IV. To identify public health workforce development needs, the R-IV PHTC created a systematic process that included the implementation of a variety of strategies, to gain insights from each state within the diverse region. Conducting regular needs assessments is an integral step to ensure trainings are relevant and meet the needs of public health professionals. To this end, the PHTC employed a mixed methods approach to gather information on both competency-based and non–competency-based training needs, as well as training needs within R-IV’s content focus area of infectious disease. In R-IV there is great variability between the structures of the state and local health departments (e.g., some centralized, some decentralized), each of which faces different funding challenges and works with different service delivery models and regulatory authorities. Moreover, states have diverse populations (e.g., races, urban/rural, migrant/refugees, tribal, Appalachian) and face a wide range of public health priority concerns. Health departments were found to be at different stages of readiness to undertake a training needs assessment due to a number of issues, including their stage of pursuing Public Health Accreditation Board accreditation and recent participation in other needs assessment efforts. The R-IV PHTC approach to assessing training needs within this challenging environment is described.
19
Harrington, Pauline, Udodirim Onwubiko, Mingli Qi, David Holland, Pascale Wortley e Allison Chamberlain. "1964. Predictive Factors for HIV Seroconversion Among Women Attending an Urban Health Clinic in the South: A Matched Case–control Study in Atlanta, GA". Open Forum Infectious Diseases 6, Supplement_2 (outubro de 2019): S65. http://dx.doi.org/10.1093/ofid/ofz359.141.
Texto completo da fonteResumo:
Abstract Background In 2019, Fulton County, GA was named one of 48 priority “hotspots” to target in renewed efforts to end the HIV epidemic in the United States. To more accurately predict women at greatest risk for HIV, we conducted an individually matched case–control study among women who attended a Fulton County health clinic to identify risk factors associated with HIV seroconversion. Methods We obtained data about women who sought care at Fulton County Board of Health Sexual Health Clinic (SHC) between 2011 and 2016. Cases were women with at least one clinician-assisted visit (CAV) at the SHC prior to HIV diagnosis date. Controls were women who visited the clinic in this same period but remained HIV negative. Controls were individually matched to cases in a 2:1 matching ratio on race, age at first CAV, and date of first CAV. Conditional logistic regression was used to develop a model for predicting probability of and identifying risk factors for HIV seroconversion. Results Of 18,281 women who were HIV negative at their first visit to the SHC between 2011 and 2016, 110 (0.6%) seroconverted before 2018. Of these, 80 (73%) had a CAV prior to HIV diagnosis. Using these 80 cases and 160 matched controls, having a history of gonorrhea, multiple gonorrhea episodes, a history of syphilis, a greater number of sex partners in the past 2 months, anal sex, history of injection drug or crack cocaine use, a history of exchanging drugs/money for sex, and heterosexual sex with more than one sex partner in the last month were associated with HIV seroconversion in bivariate analyses. After conducting backward selection from a fully adjusted model, predictors remaining were: having a history of syphilis (OR = 4.9, 95% CI: 1.4, 16.9), anal sex (OR = 2.9, 95% CI: 1.0, 8.3), and injection drug or crack cocaine use (OR = 34.8, 95% CI: 3.7, 328.1). Women having all three risk factors were six times more likely to seroconvert compared with matched controls without these risk factors. Conclusion Our results offer clinical insights into which women are most at-risk for HIV and are therefore best candidates for initiating HIV prevention interventions like pre-exposure prophylaxis (PrEP) within a HIV “hotspot” in the South. Disclosures All Authors: No reported Disclosures.
20
Kastritis, Efstathios, Evangelos Terpos, Nikolaos Kanellias, Vasiliki Babali, Spyridon Orfanopoulos, Ursula Koloventzou, Maria Gavriatopoulou et al. "Real-World Prospective Evaluation of Different Geriatric Assessment Tools in Unselected Elderly Patients with Symptomatic Myeloma". Blood 126, n.º 23 (3 de dezembro de 2015): 4242. http://dx.doi.org/10.1182/blood.v126.23.4242.4242.
Texto completo da fonteResumo:
Abstract The diagnosis of MM that requires therapy in elderly individuals is increasing. The management of such patients is challenging due to several factors, besides disease characteristics and age that affect outcome. Geriatric assessment (GA) is a multidimensional diagnostic approach that collects data on the medical, psychosocial and functional capabilities and limitations of elderly patients to develop treatment and care decisions and improve the use of health care resources. The IMWG has proposed a simplified GA ("frailty score") based on 3 tools (Katz Activity of Daily Living (ADL), the Lawton Instrumental Activity of Daily Living (IADL) and the Charlson Comorbidity Index (CCI)) as a measure of frailty (Palumbo et al, Blood 2015). "Frailty score" was developed on patients who participated in clinical trials, thus, may have a selection bias. In our current "Real-World" study, we prospectively evaluated consecutive patients >65 years, irrespective of their participation in clinical trials and physical condition, in order to evaluate several different GA tools and comorbidity indices, along with standard disease related prognostic factors. The following tools were used: G8 geriatric assessment screening tool (G8-GAS), VES-13, GDS, Katz ADL, Lawton IADL, MMSE, KPS (%), ECOG PS, number of falls in the past 1 & 6 months, lower-extremity function and disability in elderly tool, nutritional assessment tools (DETERMINE and Mini Nutritional Assessment), social support score, cognition evaluation tools (MMSE), Geriatric Depression Scale and comorbidity indices (CCI, CIRS-G, ACE-27 tool). Since January 2012, 120 consecutive patients >65 years were diagnosed with symptomatic MM in our center (Department of Clinical Therapeutics, University of Athens) and had a GA. The median age of patients with a GA was 76 years (range 66-92); 55% were males; 26% had ISS-1, 24% ISS-2 and 50% ISS-3. In 100 patients cytogenetics were available: 19% had high risk cytogenetics (del17p or t(4;14)). Median eGFR was 60 ml/min/1.73 m2 and 22% had eGFR<30 ml/min/1.73 m2. Treatment was based on IMiDs in 47% of patients (thalidomide in 13% and lenalidomide in 34%) and proteasome inhibitors (mainly bortezomib) in 53%. At least PR was achieved by 78% of evaluable patients. Median follow up was 20 months and 2-year overall survival (OS) was 71%. Age was associated with OS and the risk of early death (<3 months): the respective HRs for death for ages ≤70 vs 71-80 vs >80 years was 1, 1.5 and 3 and early death rates were 3%, 8% and 20%, respectively. ISS was associated with OS (p=0.004) but the presence of high risk cytogenetics was not (2-year OS 75% vs 68%, p=0.714). There was no significant difference in the OS according to different types of primary therapy (p=0.593). Per IMWG "frailty score", 29% were fit, 17% intermediately fit and 54% frail; the respective 2-year OS was 77%, 81% and 62%. The differences in the allocation of patients in frailty categories compared to the original IMWG cohort (39%, 31% & 30%) is probably due to the fact that our patients were unselected. In univariate analysis several different GA tools showed prognostic significance: number of falls in the past 6 months (0 vs ≥1, p=0.002), lower extremity function (score <9 vs ≥9, p=0.014), mini nutritional assessment (score <11 vs ≥11, p=0.014), G8-GAS (score <12 vs ≥12, p<0.001), KPS <50% (p<0.001), ECOG PS >2 (p=0.04) and MMSE (score ≥6 vs <6, p=0.024). There was an association of early death with KPS ≤50% (p=0.003), ECOG PS >2 (p=0.05), Geriatric depression score (p=0.018) and G8-GAS score (p=0.015). IMWG "frailty score" was not associated with early death. In multivariate analysis, which included ISS and age, number of falls in the past 6 months (0 vs ≥1, HR: 4.7, p=0.007) and score <12 in the G8-GAS tool (HR: 4.7, p=0.004) were independent factors for survival. Addition of cytogenetics did not change the multivariate model. We also evaluated IMWG "frailty score" in a multivariate analysis, which included ISS stage, and we did not find statistical significance for OS. In conclusion, in elderly myeloma patients, G8-GAS provides prognostic information related to the risk of early death and overall survival, independently from disease characteristics and the treatment type. IMWG "frailty score" provides a simple tool which may be useful for patients fit to participate in clinical trials but in unselected, "Real-World", patients may have reduced prognostic performance. Disclosures Terpos: Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel expenses; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Other: travel expenses; Novartis: Honoraria. Dimopoulos:Celgene: Honoraria; Janssen: Honoraria; Genesis: Honoraria; Novartis: Honoraria; Onyx: Honoraria; Amgen: Honoraria; Janssen-Cilag: Honoraria.
21
Lopez De San Vicente, Borja, Paula Jaureguibeitia, Ane Zumarraga, Maria López Santillan, Fernando Pikabea, Elena Galve, Maitane Nuño et al. "BIG DATA in geriatric oncology: How could we assess effective working time?" Journal of Clinical Oncology 37, n.º 15_suppl (20 de maio de 2019): e18073-e18073. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18073.
Texto completo da fonteResumo:
e18073 Background: Electronic Medical Records (EMR) were born as a result of medicine digitalization. Healthcare information systems (HIS) hold great value to the workflow management and patient care. New technologies not only allow us work with a faster and more reliable medical history, but also understand how health professionals think and work. Time consumption is one of the biggest issues that geriatric assessment (GA) has to deal with. Hurria et al. developed a brief tool which requires minimal resources and time spent (≈30 mins) by healthcare providers. On the other hand, patients´ medical history review, writing reports or tumor board discussions are often underestimated on daily time schedule. The aim of this study is to analyse the effective working time (EWT) invested in geriatric assessment in our centre by Big Data analytics. Methods: From 1 March 2018 to 31 december 2018, > 70 years-old patients were prospectively recruited from the outpatient oncology practices at Basurto University Hospital. Nurse-guided geriatric assessment was scheduled 45 mins before oncologist’s first visit, and functional status, comorbidity, cognitive function, psychological state, social support, polypharmacy, nutritional status, and nurse interventions were measured. Patterns of nurse and medical behaviors from EMRs were tracked. The model to figure out active behaviour in HIS was defined as > 23 events/hour. EWT was established as time spent between first and last access to HIS. Isolated events and interventions by users other than oncologists and nurses were excluded. Results: 280 patients were enrolled, 54.3% men. Geriatric assessment detected: cognitive impairment 17 pts (6.9%), mental health alteration 78 pts (27.8%), Poor social support 10 pts (3,7%), polypharmacy 239 pts (89,28%), and severe malnutrition 34 pts (13.2%). Nurse specific intervention was made in 90 pts (32,6%). The median EWT by nurses for a GA was 39 minutes (SD 0:21), and 46 mins (SD 0:17) by oncologists´global evaluation. Nurses started in average 3 mins (SD 0:27) before scheduled visit, and oncologists 9 mins (SD 0:28) after. Conclusions: Big data analytics show an assumable effective working time for a geriatric assessment in our patients. HIS users behavior analysis could help in the management of our healthcare systems.
22
Akhtar, Othman Salim, Chong Wang, Kristopher Attwood, Desi Carozza, Elizabeth R. Gage-Bouchard, Tunazzina Kaijar, Paola Ghione, Francisco J. Hernandez-Ilizaliturri, Tanya M. Wildes e Pallawi Torka. "Evaluating the Role of Baseline Geriatric Assessment in Predicting Quality of Life in Older Adults with Non-Hodgkin Lymphoma on Oral Targeted Therapies". Blood 138, Supplement 1 (5 de novembro de 2021): 4094. http://dx.doi.org/10.1182/blood-2021-149934.
Texto completo da fonteResumo:
Abstract Background: Oral targeted therapies (OTT) have transformed the care of patients with non-Hodgkin lymphoma (NHL) with significantly improved survival outcomes compared to chemo-immunotherapy. While data from clinical trials suggest improvement in global health and some symptom scores, there is limited data on health-related outcomes in older adults who are more vulnerable to treatment-related adverse effects. Geriatric assessments can predict chemotherapy-related toxicity in older adults and the presence of geriatric impairments is associated with inferior quality of life. The role of geriatric assessment (GA) in predicting health-related quality of life (HRQoL) and treatment toxicity in patients with NHL on OTT is unknown. In this prospective study, we describe the association between OTT and HRQoL in older adults with NHL. We further describe the relationship between baseline geriatric assessment and longitudinal HRQoL parameters. Methods: We included patients (pts) ≥70 years (yrs) of age with NHL, initiating or already receiving OTT. A GA, including assessment of function, depression, cognition, physical performance and comorbidities, was performed at baseline. Pts were followed monthly for the first 3 months (mos), then every 3 mos for 1 year. Quality of life (QoL) was measured at each visit using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires Core 30 (EORTC QLQ-C30) and EORTC QLQ - chronic lymphocytic leukemia 16 (EORTC QLQ-CLL16). The log QoL scores were modeled as a function of visit and mean scores at 6 months were compared to baseline using a linear mixed model. A change in score of >10 was considered clinically significant based on previous work. Results: We enrolled 25 pts with a median age of 77 yrs (71-93 yrs). Median follow up was 6.3 mos (range, 2.7-8.8 mos). The most common diagnosis was chronic lymphocytic leukemia (n=21) followed by mantle cell lymphoma (n=3) and marginal zone lymphoma (n=1). Most pts (72%) were on OTT at study entry and the most frequently used OTTs were ibrutinib (n=17) and venetoclax (n=5). GA revealed the presence of a geriatric syndrome (GS) in more than 90% of pts, including cognitive impairment (28%), depression (24%), polypharmacy (92%) and recent falls (12%); 48% of pts had ≥2 GS. Nine pts (36%) had impaired 4-meter gait speed and/or timed-up-and-go (TUG); 20 pts (80%) had an adjusted CIRS-G score of ≥6. At baseline, dependence in independent activities of daily living (IADL) was associated with inferior global health status scores (69.1 vs 86.1, p=0.023) and physical functioning scores (66.7 vs 88.1, p=0.008). Similarly, an abnormal TUG (>10 seconds) was associated with a lower global health score (71.3 vs 86.1, p=0.037). Dependence in 2 or more activities of daily living (ADL) was also associated with lower baseline physical functioning scores (57.8 vs 88.0, p=0.003) and role functioning scores (61.1 vs 90.8, p=0.030). During the 6-month follow up, there was significant worsening of global health status (mean difference -5.4, p=0.024) and cognitive functioning scores (mean difference -9.6, p<0.001) in the entire cohort. There were no changes in other functional scales (physical, role, emotional and social functioning, fatigue scale, infection scale, social problems and future health) over time (Figure 1). Trends in symptom scores were mixed with improvement in some scores (pain, fatigue) and worsening of others (dyspnea, diarrhea, constipation), none of which met the predefined criteria for clinical relevance (absolute difference of >10). Presence of various geriatric impairments at baseline did not impact changes noted in global health, physical, emotional, social and role functioning over time. Interestingly, we found a greater improvement in symptom scores in patients with baseline impairments in IADL (fatigue, pain), ADL (pain) and a CIRS-G score of ≥6 (insomnia). Conclusion: The presence of geriatric syndromes is common in older adults with NHL with almost half of the patients in our cohort with ≥2 GS. Older adults with GS had lower baseline global health status and physical functioning scores but experienced greater improvement in symptoms scores and maintenance of longitudinal HRQoL than those without GS at baseline. Chronological age had no impact on baseline or longitudinal HRQoL, underscoring the need to incorporate GA into clinical practice rather than relying on age alone. Figure 1 Figure 1. Disclosures Wildes: Janssen: Consultancy; Carevive: Consultancy; Seattle Genetics: Consultancy; Sanofi: Consultancy. Torka: TG Therapeutics: Membership on an entity's Board of Directors or advisory committees.
23
Stege, Claudia A. M., Kazem Nasserinejad, Mark-David Levin, Saskia K. Klein, Esther de Waal, Corien Eeltink, Charlotte L. B. M. Korst et al. "Geriatric Impairments and Low Muscle Mass Are Associated with Treatment Discontinuation and Overall Survival in Newly Diagnosed Non-Transplant Eligible Multiple Myeloma Patients (nte-NDMM) Treated with Dose-Adjusted Melphalan-Prednisone-Bortezomib (MPV) — Results of the Dutch HOVON 123 Study". Blood 132, Supplement 1 (29 de novembro de 2018): 1889. http://dx.doi.org/10.1182/blood-2018-99-116920.
Texto completo da fonteResumo:
Abstract Introduction There is a high rate of treatment discontinuation (TD) in elderly patients with nte-NDMM, that negatively impacts overall survival (OS). In order to prevent TD identification of unfit and frail patients is a prerequisite, either to withhold or adapt treatment. Although the IMWG frailty score (IMWG-FS) identifies frail patients with higher TD and inferior OS there is a need for refinement. Therefore, we prospectively evaluated the feasibility of a dose-adjusted Melphalan-Prednisone-Bortezomib (MPV) regimen in nte-NDMM patients ≥75 years of age. In addition, we investigated the prognostic value of a geriatric assessment (GA) and muscle mass and function for TD and OS. This is a preliminary analysis of 220/240 included patients. A final update, including multivariable prediction models, of 240 patients will be available at the ASH meeting. Methods Patients were treated with 9 cycles of MPV: M 6 mg/m2, day 1-4; P 30 mg/m2, day 1-4; and V 1.3 mg/m2 day 1,8,15 and 22 of a 35-day cycle. Functional, cognitive, mental health, nutritional status and comorbidities were assessed at baseline (Table 1). Muscle mass and function were determined by CT scan and hand grip strength (HGS) and gait speed (GS), respectively. Presarcopenia was defined as low skeletal muscle mass (Skeletal Muscle Index (SMI) cm/m2) only, sarcopenia when additionally low muscle function (HGS or GS) was present, and severe sarcopenia when all 3 parameters were abnormal. Cut offs for muscle mass parameters were defined by sex-specific p5 and p10 values reported in the literature and a Bayesian statistical change point model. Associations between TD or OS and aforementioned factors were assessed via univariable regression models. Multivariable prediction models will be developed using variable selection procedures. Results 218/220 patients were eligible for frailty analysis; 61% frail, 28% unfit and 3% fit patients (7% unknown), according to IMWG-FS. Median follow-up was 22 months (inter quartile range (IQR) 15-32). TD within 9 cycles of MPV was 44%, being significantly higher in frail as compared to unfit patients (51% vs 29%, hazard ratio (HR) 2.52, 95% confidence interval (CI) 1.32-4.80, p=0.005, Fig. 1A). Overall response rate and median progression free survival were 74% and 17 months (IQR 12-22 months), both unaffected by frailty. Median OS was 45 months. Frail patients had a significant inferior OS as compared to unfit patients (median 31 versus 45 months, HR 2.13, 95% CI 1.21-3.76, p=0.009) (Fig. 1b). Frail patients were older, had significantly more comorbidities, lower physical function (both self-reported [EORTC QoL questionnaire and (i)ADL] and by physical examination [GS and HGS]), worse cognitive function, and more depression and malnutrition as compared to unfit patients (Table 1). Low muscle mass was detected in 13-22% of frail (depending on cut off) versus 5% of unfit patients. Sarcopenia was detected in 13-18% of frail (depending on cut off) and 5% of unfit patients. These data indicate that there are biological differences between unfit and frail patients. Subsequently, we investigated which GA and sarcopenia characteristics were associated with TD and OS. For TD, all IMWG-FS parameters but ADL, WHO ISS 3, muscle mass, depression and risk for malnutrition were associated (table 2). For OS all IMWG-FS parameters, WHO ISS 3, cytogenetic risk, muscle mass, depression, (risk of) malnutrition and cognitive function were associated (table 2). Interestingly, although there was a strong association between muscle mass as determined by CT-scan and both TD and OS, muscle function tests (HGS and GS) were not. Neither were sarcopenia definitions incorporating muscle function. Remarkably, self-reported physical functioning revealed from the QLQ-C30 was associated with TD and OS. Conclusion We here confirm the predictive value of the IMWG-FS for TD and OS. Importantly, we provided a biological background of frailty by showing more geriatric impairments and loss of muscle mass in frail versus unfit patients. In addition to known predictive factors for OS; IMWG-FS, ISS and cytogenetics, we found that GA and low muscle mass, but not muscle function, were associated with clinical outcome. We are currently developing a novel predictive scoring system for TD and OS incorporating these novel parameters, with the aim to refine currently available prediction models for identification of elderly patients who will benefit from therapy. Disclosures Levin: Celgene: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees. Minnema:Servier: Consultancy; Amgen: Consultancy; Takeda: Consultancy; Celgene: Consultancy, Research Funding; Janssen: Consultancy. van de Donk:Janssen Pharmceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Amgen: Research Funding; Novartis: Research Funding; Bristol-Myers Squibb: Research Funding; Celgene: Research Funding. Sonneveld:Karyopharm: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; BMS: Honoraria, Research Funding. Zweegman:Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene Corp.: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding.
24
Shah, Pearl, Yelissa Navarro, Kometh Thawanyarat, Robert Moody, Asim Ahmed, John Collar, Kathryne Holmes e Jack Yu. "Shifts in Reduction Mammaplasty Surgical Volumes With the Emergence of a Global Pandemic". Annals of Plastic Surgery 92, n.º 4 (abril de 2024): e14-e18. http://dx.doi.org/10.1097/sap.0000000000003807.
Texto completo da fonteResumo:
Introduction The onset of the COVID-19 pandemic resulted in significant changes to the surgical caseload for various surgery departments across the United States. As medical institutions prioritized resources for the expected increase in patient volumes due to the SARS-CoV-2 viral infection, surgical departments saw a decrease in nonemergent and elective surgical procedures. Reduction mammoplasties, which are largely covered by insurance, are among the elective procedures that provide significant revenue to the hospital. This expected decline in procedures suggests a potential decline in revenue provided by the plastic surgery department of a hospital. The purpose of this study was to analyze the loss of revenue experienced by a single academic medical institution due to changes in breast reduction mammoplasty volumes during the COVID-19 pandemic. Methods Upon institutional review board approval, using the Augusta University Medical Center's Financial Billing Data, 373 patients who underwent bilateral reduction mammoplasty were queried. A time horizon of March 2019 to February 2022 was used to determine the pre- and post-COVID case load and charges that were incurred. Statistical analysis to compare the prior 12 months and after 24 months of COVID was conducted using 2 samples of equal variance t test and F test confirming equal variance. Results There was a statistically significant increase in the number of reduction mammoplasties performed per month from the year before the onset of COVID-19 (March 2020) to the 2 years after (6.6–11.4 per month, P = 0.0024). There was a statistically significant increase in the per-month charges from the AU Health system for reduction mammoplasties for the same period ($31,780.92–$52,113.34 per month, P = 0.0054). Although there was an increase in per-month revenue from reduction mammoplasties, this increase failed to reach statistical significance ($7,059.95–$10,423.51 per month, P = 0.064). Conclusions The plastic surgery department saw a statistically significant increase in reduction mammoplasty cases and subsequent charges in the post-COVID cohort. These findings suggest that the emergence of a nationwide pandemic did not necessarily lead to a decrease in the volume of nonemergent surgical cases despite an expected decrease in caseload due to the need to reallocate hospital resources. On the contrary, there was an increase in caseload suggesting that there may be other factors contributing to patients' pursuance of reduction mammoplasty post-COVID including convenience, resulting from time off due to pandemic, meeting insurance-covered reduction criteria, and projected recovery time.
25
David, Kevin A., Suchitra Sundaram, Seo-Hyun Kim, Ryan Vaca, Yong Lin, Samuel Singer, Mary-Kate Malecek et al. "Real World (RW) Outcomes and Prognostication of Older Patients with Primary Central Nervous System Lymphoma (PCNSL) in the Contemporary Era". Blood 136, Supplement 1 (5 de novembro de 2020): 24–26. http://dx.doi.org/10.1182/blood-2020-136551.
Texto completo da fonteResumo:
Introduction: Treatment of older patients (pts) with PCNSL is challenging due to the prevalence of comorbidities, frailty, and complexities with delivery of chemotherapy (CT). The optimal induction CT and consolidation regimens for older PCNSL pts is unknown. Moreover, there are few large scale prognostication studies available, including analysis of geriatric assessments (GA). We analyzed detailed characteristics, treatment patterns and outcomes with prognostication across 17 academic centers. Methods: We conducted a large, RW retrospective study of newly diagnosed PCNSL pts (1/2008-1/2019) ages ≥ 60 years (yrs). Survival rates were estimated by Kaplan-Meier with differences assessed by log rank test. We detailed Cumulative Index Rating Scale-Geriatric (CIRS-G) scores & other GAs. Univariate associations were derived via Cox model with variables p<0.05 entered stepwise into a multivariate (MVA) model. Results: Among 491 initial cases, n=450 cases were verified for diagnosis & follow-up. Clinical features included: median age 71 yrs (60-88); male 47%; elevated LDH 30%; creatinine clearance <60 ml/min in 20% (median 81 ml/min); hemoglobin <10 g/dL in 8%; and albumin <3.5 g/dL in 35%. 21% of pts had prior or concurrent malignancy and 7% had history of solid organ transplant or autoimmune disease. Histology was DLBCL in 96% (COO non-GC in 76%) with CD20 expression seen in 98%. Immunohistochemistry showed MYC & BCL2 double expression in 40%; EBER was noted in 10% of pts (3/4 being PTLD pts). For disease location, brain parenchyma was involved in 94% of pts with 46% having a single site (54% >1 site). Cerebral involvement predominated in 75% with deep structure involvement in 20% & cerebellum in 5%. CSF involvement was documented in 13% of pts (unchecked in 26%). For GA at diagnosis, the median CIRS-G score was 6 (range 0-27) and impaired self-care activities of daily living (ADLs) were noted in 36%. Furthermore, geriatric syndrome (ie, dementia, delirium, depression, and/or falls) was present in 45% of pts. Induction therapy included CT in 91% of pts (of whom 82% had rituximab (Rtx)) and radiation therapy (RT) in 8%. The most common chemotherapy regimens were: high-dose methotrexate (HD MTX) or HD MTX with Rtx (MR) in 38%; HD MTX/procarbazine/vincristine (MPV) +/- Rtx 30%; HD MTX/temozolomide/Rtx (MTR) 22%; Rtx alone 2%; and HD MTX/cytarabine/thiotepa/Rtx (MATRIX) in 2%. Median MTX dosing for all pts was 3.5 g/m2 (range 1-8 g/m2), and by 3 most common regimens (all g/m2): MTR 5.1; MR 5.4; MPV 3.1 (P<.0001). For response to induction, 60% had complete response (CR), 18% partial response (PR), 6% stable disease & 16% had primary refractory disease. Induction CT was stopped due to toxicity in 21% of pts and the treatment-related mortality was 7%. Among 321 pts with CR or PR, 14% had autologous stem cell transplant (ASCT); 25% received consolidative CT; and 5% had RT. The most common CT maintenance regimens were temozolomide (n=22), lenalidomide (n=20) and HD MTX (n=15). Among pts experiencing relapse or progression, the most common 2nd line therapies were RT (n=40), MTX (n=39), temozolomide (n=14) and MTR (n=10); 2 pts ultimately went on to receive ASCT. With 42 month median follow-up (1-125), 3-yr PFS & OS for all pts were 38% & 52%, respectively (Fig 1A/1B). On MVA, factors associated with inferior PFS were: advancing age (continuous HR 1.05, P<.001); anemia (HR 1.14, P=.0035); high CIRS-G (HR 1.038, P=0.017) and geriatric syndrome (HR 1.537, P=.0098) (Fig 1C); and for inferior OS: advancing age (continuous HR 1.04, P=.01); low albumin (HR 2.203, P<.001); high CIRS-G (HR 1.053, P=.011); and geriatric syndrome (HR 1.851, P=.005) (Fig 1D). Among all pts, increasing HD MTX dosing in 500 mg/m2 increments was associated with improved PFS (HR 0.958, P=.0002) & OS (HR 0.954, P=.001); and pts treated with MTR had improved PFS & OS vs MPV or MR (Fig 1E /1F). The favorable effect of MTR vs MR persisted when controlling for age, CIRS-G & geriatric syndrome. Additionally, use of Rtx was associated with improved outcomes (PFS HR 0.592, P<.0001; OS HR 0.528, P<0.0001). Finally, pts achieving CR had significantly improved survival (Fig 1G/1H). Conclusions: Older pts with PCNSL have suboptimal outcomes, with 2/3 progressing in the first several years. GA is an important prognostic tool, and could be used to stratify pts in future investigations. In addition, use of Rtx, increasing MTX dose, and the MTR regimen were associated with improved outcomes. Disclosures Reddy: Genentech: Research Funding; Abbvie: Consultancy; KITE Pharma: Consultancy; Celgene: Consultancy; BMS: Consultancy, Research Funding. Bachanova:Gamida Cell: Membership on an entity's Board of Directors or advisory committees, Research Funding; Karyopharma: Membership on an entity's Board of Directors or advisory committees; Kite: Membership on an entity's Board of Directors or advisory committees; FATE: Research Funding; BMS: Research Funding; Incyte: Research Funding. Bond:Seattle Genetics: Honoraria. Goldlust:COTA: Other; BMS: Membership on an entity's Board of Directors or advisory committees, Other: travel; Tocagen: Membership on an entity's Board of Directors or advisory committees, Other: travel; Novocure: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: travel, Research Funding, Speakers Bureau; Boston Biomedical: Consultancy; Cortice Bio: Consultancy, Other: travel; WEX: Consultancy, Other: travel. Spurgeon:Beigene: Research Funding; Janssen: Consultancy, Research Funding; Pharmacyclics: Consultancy; Bristol-Myers Squibb: Research Funding; Genentech: Research Funding; Gilead: Research Funding; Acerta: Research Funding; AstraZeneca: Research Funding; Genmab: Research Funding; VelosBio: Consultancy, Research Funding; Cardinal Health: Honoraria; Verastem: Research Funding. Epperla:Verastem Oncology: Speakers Bureau; Pharmacyclics: Honoraria. Karmali:Takeda: Research Funding; Karyopharm: Honoraria; AstraZeneca: Speakers Bureau; BeiGene: Speakers Bureau; BMS/Celgene/Juno: Honoraria, Other, Research Funding, Speakers Bureau; Gilead/Kite: Honoraria, Other, Research Funding, Speakers Bureau. Naik:Celgene: Other: advisory board; Sanofi: Other: advisory board. Martin:Celgene: Consultancy; Bayer: Consultancy; Janssen: Consultancy; Sandoz: Consultancy; I-MAB: Consultancy; Teneobio: Consultancy; Beigene: Consultancy; Cellectar: Consultancy; Incyte: Consultancy; Kite: Consultancy; Morphosys: Consultancy; Karyopharm: Consultancy, Research Funding; Regeneron: Consultancy. Smith:Genentech/Roche: Consultancy, Other: Support of parent study and funding of editorial support, Research Funding; TG Therapeutics: Consultancy, Research Funding; FortySeven: Research Funding; Karyopharm: Consultancy, Research Funding; Pharmacyclics: Research Funding; BMS: Consultancy; Janssen: Consultancy; Celgene: Consultancy, Research Funding; Acerta: Research Funding. Rubenstein:Kymera: Research Funding. Kahl:ADC Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Consultancy; Celgene Corporation: Consultancy; AstraZeneca Pharmaceuticals LP: Consultancy, Membership on an entity's Board of Directors or advisory committees; Genentech: Consultancy; Pharmacyclics LLC: Consultancy; Roche Laboratories Inc: Consultancy; BeiGene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Acerta: Consultancy, Research Funding. Evens:Merck: Consultancy, Honoraria, Research Funding; Research To Practice: Honoraria, Speakers Bureau; Seattle Genetics: Consultancy, Honoraria, Research Funding; Pharmacyclics: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Epizyme: Consultancy, Honoraria, Research Funding; MorphoSys: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Mylteni: Consultancy, Honoraria.
26
Tahir, Muhammad, Ejaz A. Chaudhry, Faridullah K. Zimri, Nadeem Ahmed, Saeed A. Shaikh, Shoaib Khan, Usama K. Choudry, Amer Aziz e Allah R. Jamali. "Negative pressure wound therapy versus conventional dressing for open fractures in lower extremity trauma". Bone & Joint Journal 102-B, n.º 7 (julho de 2020): 912–17. http://dx.doi.org/10.1302/0301-620x.102b7.bjj-2019-1462.r1.
Texto completo da fonteResumo:
Aims It has been generally accepted that open fractures require early skeletal stabilization and soft-tissue reconstruction. Traditionally, a standard gauze dressing was applied to open wounds. There has been a recent shift in this paradigm towards negative pressure wound therapy (NPWT). The aim of this study was to compare the clinical outcomes in patients with open tibial fractures receiving standard dressing versus NPWT. Methods This multicentre randomized controlled trial was approved by the ethical review board of a public sector tertiary care institute. Wounds were graded using Gustilo-Anderson (GA) classification, and patients with GA-II to III-C were included in the study. To be eligible, the patient had to present within 72 hours of the injury. The primary outcome of the study was patient-reported Disability Rating Index (DRI) at 12 months. Secondary outcomes included quality of life assessment using 12-Item Short-Form Health Survey questionnaire (SF-12), wound infection rates at six weeks and nonunion rates at 12 months. Logistic regression analysis and independent-samples t-test were applied for secondary outcomes. Analyses of primary and secondary outcomes were performed using SPSS v. 22.0.1 and p-values of < 0.05 were considered significant. Results A total of 486 patients were randomized between January 2016 and December 2018. Overall 206 (49.04%) patients underwent NPWT, while 214 (50.95%) patients were allocated to the standard dressing group. There was no statistically significant difference in DRI at 12 months between NPWT and standard dressing groups (mean difference 0.5; 95% confidence interval (CI) -0.08 to 1.1; p = 0.581). Regarding SF-12 scores at 12 months follow-up, there was no significant difference at any point from injury until 12 months (mean difference 1.4; 95% CI 0.7 to 1.9; p = 0.781). The 30-day deep infection rate was slightly higher in the standard gauze dressing group. The non-union odds were also comparable (odds ratio (OR) 0.90, 95% CI 0.56 to 1.45; p = 0.685). Conclusion Our study concludes that NPWT therapy does not confer benefit over standard dressing technique for open fractures. The DRI, SF-12 scores, wound infection, and nonunion rates were analogous in both study groups. We suggest surgeons continue to use cheaper and more readily available standard dressings. Cite this article: Bone Joint J 2020;102-B(7):912–917.
27
Akter, Shahana, Mohammad Golam Sadik, Sadeka Choudhury Moni, Sanjoy Kumer Dey e M. A. Mannan. "Neurodevelopmental Outcome of Preterm Low Birth Weight Infants at 9 Months of Age". International Journal of Current Research and Review 14, n.º 22 (2022): 16–19. http://dx.doi.org/10.31782/ijcrr.2022.142204.
Texto completo da fonteResumo:
Introduction: The survival of preterm babies has increased worldwide, but the risk of neurodevelopmental disabilities remains high, which is of concern to both the public and professionals. The early identification of children at risk and the outcome of neurodevelopmental disabilities may increase access to intervention, potentially influencing. Objective/Aim: To determine the neurodevelopmental outcomes in preterm infants at 9 months of age. Methodology: Preterm babies <37weeks, weight < 2500 of gestational age (GA) who were admitted in NICU, BSMMU were prospectively included in the study. The prenatal, perinatal and postnatal features of the babies were recorded. Bayley Scales of Infants and Toddler Development, Third Edition (Bayley-III), was applied at 9 month of age. This prospective observational study was conducted in the Department of Neonatology, BSMMU, after approval by Institutional Review Board, over twelve month period. All Preterm low birth weight neonates satisfying the inclusion criteria were enrolled in the study. All patients are managed as per standard clinical guidelines of NICU, BSMMU. We included total 39 infants. The hospital outcomes were recorded as necrotizing enterocolitis (NEC), Bronchopulmonary dysplasia (BPD) and Retinopathy of prematurity (ROP). Data were analyzed using the statistical package for social sciences (SPSS) version 25. P value < 0.05 is considered as statistically significant. Results: All data of 39 babies were obtained during the study, mean birth weight was 1542.82 ± 444.93g, and mean gestational age was 33.00 ± 2.01 weeks. According to Bayley III scores, 23.1% cognitive delay, 7.7% language delay, and 43.6% motor delay were detected. A Positive correlation was found between BW and cognition composite scores (p= 0.001). A negative correlation was found between hospital stay and cognition composite scores (p = 0.002). Conclusion: The neurodevelopmental domain cognition, motor and language scores at 9 months of age are found lower. A Positive correlation was found between birth weight and cognition composite scores. A Positive correlation was found between gestational age and language composite scores.
28
Mukerji, Amit, Emily Rempel, Lehana Thabane, Heather Johnson, Georg Schmolzer, Brenda Hiu Yan Law, Pranav Jani et al. "High continuous positive airway pressures versus non-invasive positive pressure ventilation in preterm neonates: protocol for a multicentre pilot randomised controlled trial". BMJ Open 13, n.º 2 (fevereiro de 2023): e069024. http://dx.doi.org/10.1136/bmjopen-2022-069024.
Texto completo da fonteResumo:
IntroductionLow pressure nasal continuous positive airway pressure (nCPAP) has long been the mainstay of non-invasive respiratory support for preterm neonates, at a constant distending pressure of 5–8 cmH2O. When traditional nCPAP pressures are insufficient, other modes including nasal intermittent positive pressure ventilation (NIPPV) are used. In recent years, high nCPAP pressures (≥9 cmH2O) have also emerged as an alternative. However, the comparative benefits and risks of these modalities remain unknown.Methods and analysisIn this multicentre pilot randomised controlled trial, infants <29 weeks’ gestational age (GA) who either: (A) fail treatment with traditional nCPAP or (B) being extubated from invasive mechanical ventilation with mean airway pressure ≥10 cmH2O, will be randomised to receive either high nCPAP (positive end-expiratory pressure 9–15 cmH2O) or NIPPV (target mean Paw 9–15 cmH2O). Primary outcome is feasibility of the conduct of a larger, definitive trial as assessed by rates of recruitment and protocol violations. The main secondary outcome is failure of assigned treatment within 7 days postrandomisation. Multiple other clinical outcomes including bronchopulmonary dysplasia will be ascertained. All randomised participants will be analysed using intention to treat. Baseline and demographic variables as well as outcomes will be summarised and compared using univariate analyses, and a p<0.05 will be considered significant.Ethics and disseminationThe trial has been approved by the respective research ethics boards at each institution (McMaster Children’s Hospital: Hamilton integrated REB approval #2113; Royal Alexandra Hospital: Health Research Ethics Board approval ID Pro00090244; Westmead Hospital: Human Research Ethics Committee approval ID 2022/ETH01343). Written, informed consent will be obtained from all parents/guardians prior to study enrolment. The findings of this pilot study will be disseminated via presentations at national and international conferences and via publication in a peer-reviewed journal. Social media platforms including Twitter will also be used to generate awareness.Trial registration numberNCT03512158.
29
Venkata, Sujith Kumar Reddy Gurram, Ankur Srivastava, Prashanth Murthy, James Scott, Hussein Zein, Lara Leijser, Anirban Ghosh, Sarfaraz Momin, Sumesh Thomas e Khorshid Mohammad. "19 Quality Improvement bundled approach reduces the use of inotropes in extremely premature babies". Paediatrics & Child Health 27, Supplement_3 (1 de outubro de 2022): e8-e9. http://dx.doi.org/10.1093/pch/pxac100.018.
Texto completo da fonteResumo:
Abstract Background Consensus on definition and management of hypotension in preterm neonates is lacking. Owing to this, there are wide variations in the reported incidence of hypotension in premature infants, especially during first week of life. Inotropes can often cause vasoconstriction, which may alter brain perfusion especially in the absence of established cerebral autoregulation. Use of these drugs is associated with multiple short- and long-term morbidities. Objectives To evaluate the effect of quality improvement (QI) bundle on rate of inotrope use and associated morbidities. Design/Methods Inborn preterm neonates born at <29weeks gestational age (GA) and admitted to level III NICU were included. Neonates with major congenital malformations, congenital heart diseases, antenatal diagnosed genetic defects, and neonates admitted after 72 hours of age were excluded from the study. We implemented a QI bundle (Figure 1) focussing on first 72hours from birth which included delayed cord clamping, avoidance of routine echocardiography, addition of clinical criteria to define hypotension, factoring iatrogenic causes of hypotension (ruling out lung hyperinflation), and standardization of respiratory management. Rate of use of inotropes in the first 72hours of life along with acute brain injury and mortality before and after implementation of the QI bundle were compared. The balancing measure was the rate of ischemic lesions in the form of cPVL. Cranial ultrasound was performed to screen for brain injury. Study was approved by the local research ethics board (REB14-1466). Results We included 671 neonates (301 before and 364 after the implementation of the bundle) among which 6 neonates were excluded based on the criteria. QI bundle implementation was associated with significant reduction in overall use of inotropes (24% vs 7%, p<0.001), dopamine (18% vs 5%, p<0.001), and dobutamine (17% vs 4%, p<0.001). Rate of acute brain injury decreased significantly: Acute brain injury of any grade (34% vs 20%, p<0.001) and severe brain injury (15% vs 6%, p<0.001). There was no difference in incidence of cPVL (1% vs 1.4%, p=0.66). Associations remained significant after adjusting for confounding factors. The QI bundle implementation was associated with a significant reduction in the use of inotropes when analyzed based on the 6 monthly time intervals (p = 0.006) (Figure 2) Conclusion Our QI bundled approach resulted in reduction in inotrope use and associated brain morbidities in premature babies. Follow-up studies evaluating the impact of this initiative on long-term outcomes in survivors are required to complement findings of improved short-term outcomes seen in this study.
30
Lew, Meagan V., Yi Ren, Yen P. Lowder, Kristi M. Romero, Jillian C. Thompson, Lauren M. Bohannon, Harvey Cohen et al. "Geriatric Assessment Identifies Impairments in Younger Candidates for Allogeneic Hematopoietic Stem Cell Transplantation". Blood 134, Supplement_1 (13 de novembro de 2019): 1984. http://dx.doi.org/10.1182/blood-2019-127264.
Texto completo da fonteResumo:
Introduction: Geriatric assessment (GA) is a multidimensional evaluation of patient health and function that may detect impairments not identified as part of routine care, predict treatment-related morbidity and mortality, and inform treatment plans. Given evidence of these benefits, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) recommend GA for older candidates of hematopoietic stem cell transplantation (HCT). However, both older and younger HCT candidates will often receive multiple rounds of chemotherapy before HCT, leading to functional impairments in all age groups. Furthermore, HCT patients often experience a significant gap between when they are first evaluated and actually proceed to transplant (e.g., while a donor search is conducted), creating an opportunity to identify impairments and optimize function prior to transplant. Methods: To address this opportunity, we created a clinical pre-HCT optimization program (C-POP) to evaluate physical function, cognitive function, nutritional status, and mental health in all adults who were deemed potential candidates for allogeneic HCT by a HCT physician. We applied this standard of care program to all adult candidates for HCT, regardless of age, with the goal of identifying functional impairments and then referring patients to services to optimize those impairments prior to HCT. We defined impairments using validated measures and compared results to established norms or scoring, controlling for age and gender where appropriate (e.g., the cut-off for six-minute walk distance was adjusted for age, gender, height, and weight, while the cut-off for falls was any fall regardless of characteristics). Patients with impairments were referred to the appropriate supportive care (e.g., physical function impairment -> referral to physical therapy). Results were prospectively analyzed at new patient evaluation (NPE), which was the first time the patient met a HCT physician and sign-off, which occurred within a week before starting transplant. While the program is ongoing, we present here the results of patients evaluated between October 16th, 2017 and July 1st, 2019. Patients are divided into three pre-specified age groups: <40 years old, 40-59 years old, and >=60 years old, with results compared using a chi-squared test. Results: We evaluated 115 patients: 21 (18%) <40 years, 40 (35%) 40-59 years, and 54 (47%) >=60 years). There were no differences between the age groups in other demographics (gender, race, and ethnicity). At NPE, 93 (81%) met criteria for at least 1 impairment in physical function, cognitive function, nutritional status, or mental health; 62 (54%) met criteria for impairments in 2 or more areas. Surprisingly, patients <40 years were more likely to screen positive for physical function (20/21, 95%) than patients 40-59 years (26/40, 65%) and patients >=60 years (36/54, 67%) (p=0.03). Of those 115 patients, 52 (45%) proceeded to HCT, including 12 (57%) <40 years, 18 (45%) 40-59 years, and 22 (41%) >=60 years (p=0.75); of those patients who have not proceeded to HCT, 40 (35%) will never proceed to HCT (e.g., deemed not a candidate after functional evaluation or died of disease prior to HCT) while 23 (20%) are still awaiting HCT (e.g., donor search ongoing). Patients who proceeded to HCT were less likely to have mental health impairments (2/52, 4% vs. 9/40, 23%, p=0.006). Of the 52 who were seen at new patient evaluation and proceeded to transplant, 40 (77%) were seen at sign off. Of those who had impairments at NPE, 12/23 (52%) improved their physical function to normal limits, 4/9 (44%) improved their cognitive function, and 9/13 (69%) improved their nutritional status by the time of sign-off (of those who were seen at sign-off, none had mental health impairments at NPE). Discussion: These results demonstrate that younger as well as older candidates for HCT exhibit a high degree of functional impairment. However, this impairment could be amenable to improvement prior to HCT. These findings support application of GA to all HCT candidates regardless of age. We will investigate the effect of referred interventions (e.g., physical therapy, seeing a dietician) in improving functional impairments in future studies, as well as look at the effect of these findings on HCT outcomes. Disclosures Wiggins: Incyte, Inc.: Speakers Bureau. Gasparetto:Janssen: Consultancy, Honoraria, Other: Travel, accommodations, or other expenses paid or reimbursed ; Celgene: Consultancy, Honoraria, Other: Travel, accommodations, or other expenses paid or reimbursed ; BMS: Consultancy, Honoraria, Other: Travel, accommodations, or other expenses paid or reimbursed . Rizzieri:Millennium: Speakers Bureau; Novartis: Consultancy; AbbVie: Consultancy; Pfizer: Consultancy; Amgen: Consultancy; Incyte: Consultancy, Speakers Bureau; TEVA: Consultancy; Spectrum: Consultancy; Kite Pharma: Consultancy; Gilead Sciences: Consultancy, Speakers Bureau; Seattle Genetics: Consultancy, Speakers Bureau; Jazz Pharmaceuticals: Speakers Bureau. Horwitz:Abbvie Inc: Membership on an entity's Board of Directors or advisory committees. Sung:Novartis: Research Funding; Merck: Research Funding; Seres: Research Funding.
31
Eli S, Onwuegbule CA, Kua P, Okagua KE, Iwo-Amah RS, Owhonda G, Nonye-Enyidah EI et al. "Mean gestational age at booking amongst antenatal clinic attendees at a Tertiary Hospital in Rivers State, Nigeria". International Journal of Science and Research Archive 7, n.º 1 (30 de outubro de 2022): 438–42. http://dx.doi.org/10.30574/ijsra.2022.7.1.0201.
Texto completo da fonteResumo:
Background: Many literature have reported that the first 14 weeks as recommendation for pregnant women to book for antenatal care. The World Health Organization (WHO) has recommended that pregnant women register for antenatal care (ANC) in the first 12 weeks of pregnancy or after two missed periods. However, there are challenges of late booking in the developing countries of the world due to illiteracy, socio-cultural beliefs, economy and religious ideologies. Aim: To determine the mean gestational age at booking amongst ANC attendees at Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Rivers State, Nigeria. Method: The present cross-sectional and observational study was conducted after informed consent was given by antenatal clinic attendees. Antenatal women who attended antenatal clinic were recruited for the study during January to June 2019. Data was collected from the consented women using a pretested questionnaire. Data were expressed in absolute numbers and percentage scale. Permission for the study was obtained from the ethical committee of the Rivers State Hospital Management Board. The information was entered into a spread sheet and analyzed using SPSS Version 25. Result: A total of 500 questionnaires were distributed and 488 questionnaires retrieved. The mean age was 31.44 years and the modal parity was 0. For the educational status 357 (73.2%) had tertiary level, 126 (25.8%) had secondary level, 5 (1%) had primary level of education, while 5 (1%) of the respondents did not provide their educational status. The mean gestational age (GA) at booking was 19 weeks. Eighty one (16.6%) of the ANC attendees registered for ANC in the third trimester. Total number of ANC attendees that registered late for ANC were 414 (84.8%). Conclusion: The study revealed that majority of antenatal clinic attendees at the RSUTH registered late for ANC representing 84.8% of the pregnant women at booking. There is need to educate women of reproductive age to register early for ANC to prevent adverse maternal and perinatal outcome.
32
Sil, Soumitri, Kristina Lai, Jennifer L. Lee, Jordan Gilleland-Marchak, Beth Thompson, Lindsey L. Cohen, Peter A. Lane e Carlton Dampier. "Engagement in Cognitive-Behavioral Therapy for Chronic Pain Management Is Associated with Reductions in Healthcare Utilization in Pediatric Sickle Cell Disease". Blood 134, Supplement_1 (13 de novembro de 2019): 418. http://dx.doi.org/10.1182/blood-2019-130580.
Texto completo da fonteResumo:
Introduction: Chronic pain in sickle cell disease (SCD) is a multifactorial complication that can contribute to high healthcare utilization. Multidisciplinary treatments going beyond medication alone are needed for the most effective chronic pain management. Cognitive-behavioral therapy (CBT) is effective for youth with chronic pain and focuses on improving daily functioning and coping, but the clinical effectiveness for chronic SCD pain has not been evaluated. This study examined changes in healthcare use over time for youth with chronic SCD pain who participated in CBT compared to controls with chronic SCD pain who never initiated CBT. Methods: Youth receiving care at comprehensive SCD clinics at three tertiary care locations at Children's Healthcare of Atlanta were included if they were aged 6-18 years, any SCD genotype, and referred to a pediatric psychology outpatient clinic for chronic pain management from November 2014-March 2018. Youth were excluded if they received bone marrow transplantation during the study period, had ongoing CBT past the study period, or were not actively followed for ≥1 year of medical care pre- or post-CBT. Patients were grouped based on therapy attendance: Established Care (i.e., attended ≥3 CBT sessions within 3 consecutive months); Early Termination (i.e., attended <3 CBT sessions within 3 consecutive months); or Control (i.e., did not attend any CBT visits). Patient-reported outcomes included typical pain intensity, functional disability, and coping efficacy at pre- and post-treatment. Healthcare utilization outcomes were abstracted from electronic medical records including: number of inpatient admissions for pain, total inpatient days for pain, and emergency department dependency ratio (EDR; ratio of ED visits to sum of ED and outpatient visits). For the treatment groups, utilization outcomes were calculated from 12-months prior to the first CBT visit, and from 12-months following the last CBT visit. For the control group, outcomes were calculated for 12-months prior to the referral date, and from 12-months following the average duration of CBT for treatment groups (i.e., 3.5 months) to account for passage of time. Changes over time in inpatient admissions, hospital days, and EDR were evaluated separately using linear mixed effect models with a random effect for person-specific intercepts and slopes, which were retained based on model contribution determined by Bayesian Information Criterion. Time, patient characteristics, SCD-modifying treatments, therapy attendance, number of CBT sessions, and interaction effects were initially included in the models; the most parsimonious models were chosen based on backward selection. Results: At time of referral, youth (n=101) were on average (M) 13.4 years old (SD=2.92), 56.4% female, 68.1% HbSS or HbSβ0, 63.9% prescribed hydroxyurea, and 12.6% received chronic transfusions. The Control (n=44) and Treatment Groups (n=57) did not significantly differ by age, sex, genotype, or treatment with hydroxyurea or chronic transfusion. Based on therapy attendance, 36.1% Established Care, 21.8% were Early Termination, and 42% Controls. Adjusting for age, genotype, and hydroxyurea, patients who terminated CBT early had increased admissions and total hospital days over time compared to controls; those who established care had a reduction in admissions and hospital days over time compared to controls (F's=3.27-3.61, p's<.05). EDR decreased by 0.1 over time for Established Care; for every 1 completed CBT session, EDR was further reduced by 0.01 (p<.05). Patients who completed CBT (n=18) reported decreases in typical pain intensity (Mpre= 5.47, SD=2.24; Mpost=3.76, SD=2.84; p<.01), functional disability (Mpre=26.24, SD=8.45; Mpost=15.18, SD=10.85; p<.001), and improved coping efficacy (Mpre=8.0, SD=2.21; Mpost=9.65, SD=2.94; p<.05) from pre- to post-treatment. Conclusions: Establishing care in CBT may support reductions in admissions for pain, length of stay, and ED dependency for youth with chronic SCD pain beyond the potential effects of age, genotype, and SCD-modifying treatments. Reductions in utilization may be partially supported by patient-reported improvements in functioning, coping, and lower pain intensity following CBT. Reducing barriers to access and enhancing clinical implementation of multidisciplinary treatments may optimize the health of youth with chronic SCD pain. Disclosures Lane: NHLBI: Research Funding; CDC: Research Funding; GA Dept: Other: Contract for newborn screeninjg follow-up services services; Bio Products Laboratory: Other: Sickle Cell Advisory Board; FORMA Therapeutics: Other: Clinical Advisory Board. Dampier:Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Micelle BioPharma: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Global Blood Therapeutics: Consultancy; Epizyme: Consultancy; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Katz Foundation: Research Funding; Modus Therapeutics: Consultancy; NIH: Research Funding; Merck: Research Funding.
33
Kutlar, Ferdane, Lee Hilliard, Lina Zhuang, Niren Patel e Abdullah Kutlar. "Hb Dothan [β25/26 (B7/B8)/(-GTG/-GLY)/Gly+Glu→Glu]; A Novel Mechanism Leading to a M-Hemoglobin." Blood 112, n.º 11 (16 de novembro de 2008): 1440. http://dx.doi.org/10.1182/blood.v112.11.1440.1440.
Texto completo da fonteResumo:
Abstract Hereditary methemoglobinemia is a relatively rare disorder usually manifesting with cyanosis at birth. The more common form results from the deficiency of the enzyme, NADH-Cytochrome b5 reductase (methemoglobin reductase, diaphorase) and displays an autosomal recessive inheritance pattern. Less common are the so-called M-hemoglobins with an autosomal dominant pattern, which result from amino acid substitutions in the heme binding pocket of α, β, or less commonly γ-globin chains. The majority of the M-hemoglobin (Hb) variants occur from substitutions in the E or F-helices, which constitute the heme binding pocket, most commonly from amino acid substitutions involving the conserved proximal (F8) or distal (E11) histidine residues. Here we report a new Hb variant due to a three nucleotide deletion (-GTG between codons 25 and 26 of the β globin gene causing a single amino acid (-Gly) deletion in the B helix (B7/B8) of the β-globin chain that leads to methemoglobinemia with a novel mechanism. The propositus is a 9 month old Caucasian boy from Dothan AL who was found to have a low O2 saturation prior to an ENT procedure. He was referred to cardiology at Children’s Health System, Birmingham, AL to rule out a congenital heart disease. A low O2 saturation (85–86%) was confirmed. Cardiac catheterization excluded the structural abnormality of the heart. Cooximetry showed a normal PaO2 but confirmed a low O2 saturation. Methemoglobin level was 20%, while methemoglobin reductase activity was in the low–normal range but when repeated was found to be normal. His growth and development have been normal. On alkaline electrophoresis an abnormal hemoglobin band was observed. The patient’s blood was sent to the Hemoglobinopathy Laboratory of the Sickle Cell Center at MCG, Augusta, GA for definite identification of the variant. CBC revealed a RBC of 4.3 M/mm3, HGB 13.6 g/dL, HCT 40.8 %, MCV 95.2 fl, MCH 31.8 pg MCHC 33.4 g/dL, Retics 4.4 %. Isoelectrofocusing (IEF) on agarose showed the presence of an abnormal Hb with approximately the same isoelectric point (pI) as Hb F. Quantitation of Hb components by Cation Exchange HPLC revealed 62.7% Hb A, 27.9% Hb X, 3.0% Hb A2, and 6.4% Hb F. By globin chain analyses with reversed phase HPLC, βχ was detected as 37.6% of the total beta chains. Isopropanol stability test gave strongly positive results. P50 was found to be 24.8 mm Hg in the patient and 26.4 in the control (slightly increased oxygen affinity). Peptide analysis was done using mass spectrometry (Alphalyse, Palo Alto, CA) where tryptic digests of purified Hb X (95.0% enriched) and normal control (97.0% Hb A) were analyzed and compared. Peptide 19–30 of helix-B fragment revealed 1314 Da mass in control, whereas peptide 19–29 (with –Gly) of helix-B fragment of Hb X gave 1257 Da mass, confirming the deletion of a Gly residue. The corresponding deletion of three nucleotides (-GTG) in the genomic DNA (codons 25–26: GTGGAG→GAG ) was demonstrated by polymerase chain reaction (PCR) amplification and direct sequencing of β-globin gene and confirmed by cDNA sequencing of β-globin mRNA. No abnormality was detected in the sequences of δ, Gγ, Aγ, α1 and α2 globin genes. The three nucleotide deletion between codons 25 and 26 (-GTG) of the β-globin gene causes a one amino acid (-Gly) deletion in the B helix (B7/B8) of the β-globin chain, however does not alter the amino acid composition of β-globin chain after the deletion point but results in a shorter (145 AA, instead of the normal 146) mutant β-globin chain. As a result close spatial contact of amino acids in tertiary structure of hemoglobin is altered completely. Most importantly, distal histidine at residue 63 of E7 helix now becomes Gly leading to methemoglobin formation. A similar variant was previously reported in a Japanese baby, Hb Higashitochigi (Fujisawa et al, Hemoglobin, 17:467, 1993) where a three nucleotide deletion in codons 24/25 also resulted in the loss of a single Gly residue with a similar outcome. These two cases differ from the known M-hemoglobins all of which result from single amino acid substitution in the E or F-helices thus altering the heme pocket. Hb Dothan and Hb Higashitochigi represent a novel mechanism for M-hemoglobin generation where an in frame deletion alters the tertiary structure of the globin chain with alterations in the structure of E-helix and loss of the distal histidine residue.
34
Belada, David, Grzegorz S. Nowakowski, Juan Miguel Bergua Burgues, Marc André, Katerina Kopeckova, Don A. Stevens, Marek Trněný et al. "A Phase Ib, Open-Label, Randomized Study to Assess Safety and Preliminary Efficacy of Tafasitamab (MOR208) or Tafasitamab + Lenalidomide in Addition to R-CHOP in Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma: Analysis of the Safety Run-in Phase". Blood 136, Supplement 1 (5 de novembro de 2020): 27–28. http://dx.doi.org/10.1182/blood-2020-139788.
Texto completo da fonteResumo:
Introduction Approximately 15-20% of treatment-naïve patients with diffuse large B-cell lymphoma (DLBCL) have CD20-low tumors, while CD19 is homogeneously expressed in >90% of cases of DLBCL. CD20-low DLBCL is associated with poor response to rituximab-based regimens (Johnson NA, et al. 2009). CD19 functions as a positive regulator of B-cell receptor signaling and is important for B-cell activation and proliferation and is therefore an attractive therapeutic target in addition to CD20. Tafasitamab (MOR208) is a humanized, Fc-enhanced, anti-CD19 monoclonal antibody with improved antibody-dependent cellular cytotoxicity and phagocytosis. Monotherapy with tafasitamab has shown clinical activity in relapsed/refractory (R/R) non-Hodgkin's lymphoma (Jurczak W, et al. 2018). In the Phase II, single-arm L-MIND study (NCT02399085) in patients with R/R DLBCL, combined treatment of tafasitamab with lenalidomide resulted in a high proportion of patients having a complete response (Salles GA, et al. 2020). First-MIND (NCT04134936) is a Phase Ib, randomized study of tafasitamab + R-CHOP (Arm A) or tafasitamab + lenalidomide + R-CHOP (Arm B) in patients with newly diagnosed DLBCL. Here, we report data from the safety run-in phase. Study design and methods Patients must be aged ≥18 years, treatment naïve, with histologically confirmed DLBCL not otherwise specified and have intermediate- to high-risk disease (International Prognostic Index [IPI] 2-5) and an ECOG performance status of 0-2. Known double- or triple-hit lymphoma and transformed lymphoma are excluded. Treatment consists of six 21-day cycles of tafasitamab (12 mg/kg intravenously [IV], on Day [D] 1, 8 and 15) in addition to R-CHOP (Arm A) or tafasitamab (12 mg/kg IV, on D1, 8 and 15) + lenalidomide (25 mg orally, on D1-10) in addition to R-CHOP (Arm B). Granulocyte-colony stimulating factor prophylaxis was mandatory in all patients. The study includes a safety run-in phase and a main phase. In the safety run-in phase, 24 patients were enrolled. The primary objective is to assess safety; secondary objectives include ORR, PET-CR rate at end of treatment, PFS, event-free survival, long-term safety, pharmacokinetics and immunogenicity of tafasitamab. Exploratory objectives include the assessment of circulating cell-free tumor DNA. Approximately 60 patients will be recruited in 9 countries across Europe and the US. Results Recruitment is ongoing. Thirty-six patients were randomized; 18 in each arm. The data presented for the safety run-in phase consist of 24 patients: 13 patients in Arm A and 11 patients in Arm B. All completed the first treatment cycle; 88% of patients entered into Cycle 2 and 50% of patients entered into Cycle 3 of treatment. At baseline, their median age was 67 years (range: 47-76; Arm A) and 65 years (range: 40-74; Arm B). Overall, 33% of patients were male and 67% female; IPI scores were: IPI 2, 33%; IPI 3, 42%; IPI 4, 25%. Most patients had advanced stages III/IV (92%) and approximately 50% had bulky disease. Cell of origin was determined to be germinal center B-cell (GCB) DLBCL in 13%, non-GCB DLBCL in 42% and not yet classified in 46% of cases. A total of 248 treatment-emergent adverse events (AEs) by system organ class were documented: 111 in Arm A and 137 in Arm B. Grade ≥3 neutropenia was observed in 54% (Arm A) and 46% (Arm B) of patients. Thrombocytopenia Grade ≥3 was observed in 8% (Arm A) and 18% (Arm B) of patients. Diarrhea, fatigue and vomiting were comparable between the two arms. Febrile neutropenia was uncommon in both arms, with one event each (Figure 1). To date, 23 serious AEs were observed: 11 in Arm A (Grade 2, 1; Grade 3, 6; Grade 4, 4) and 12 in Arm B (Grade 2, 3; Grade 3, 7; Grade 4, 2). One suspected unexpected serious adverse reaction was reported in Arm B - pneumocystis jirovecii pneumonia. No treatment-associated deaths occurred. Conclusions R-CHOP can be safely combined with tafasitamab or tafasitamab + lenalidomide in patients with treatment-naïve DLBCL. Toxicities appear to be similar to what is expected with R-CHOP alone or in combination with lenalidomide. Enrollment is ongoing and updated safety and early efficacy data will be presented at the meeting. Disclosures Belada: Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel expenses, Research Funding; Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel expenses, Research Funding; Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel expenses, Research Funding; Celgene: Research Funding; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Nowakowski:NanoString: Research Funding; Seattle Genetics: Consultancy; Curis: Consultancy; MorphoSys: Consultancy, Research Funding; Celgene/BMS: Consultancy, Research Funding; Kite: Consultancy; Kymera: Consultancy; Ryvu: Consultancy, Membership on an entity's Board of Directors or advisory committees. André:Takeda: Consultancy; Karyopharm: Consultancy; Gilead: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Novartis: Consultancy, Research Funding; Seattle Genetics: Consultancy; Abbvie: Consultancy; Roche: Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; Amgen: Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; Johnson & Johnson: Research Funding; Celgene: Other, Research Funding; CHU UCL Namur, site Godinne, Yvoir, Belgium: Current Employment; Bristol-Myers-Squibb: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company). Stevens:Amgen, MorphoSys: Consultancy. Trněný:Takeda: Consultancy, Honoraria, Other: Travel Expenses; Bristol-Myers Squibb Company: Consultancy, Honoraria, Other: Travel Expenses; Amgen: Honoraria; Abbvie: Consultancy, Honoraria, Other: Travel Expenses; Roche: Consultancy, Honoraria, Other: Travel Expenses; MorphoSys: Consultancy, Honoraria; Incyte: Consultancy, Honoraria; Celgene: Consultancy; Janssen: Consultancy, Honoraria, Other: Travel Expenses; Gilead: Consultancy, Honoraria, Other: Travel Expenses. Pérez Persona:Celgene: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau; Jannsen: Consultancy, Speakers Bureau; Amgen: Consultancy; Abbvie: Consultancy, Speakers Bureau; Takeda: Consultancy. Klöpfer:MorphoSys AG: Current Employment. Brackertz:MorphoSys AG: Current Employment. Lohrmann:MorphoSys AG: Current Employment. Lahiry:MorphoSys AG: Current Employment. Shah:MorphoSys AG: Current Employment. Fingerle-Rowson:MorphoSys AG: Current Employment. Brugger:MorphoSys AG: Current Employment. Burke:Epizyme: Consultancy; Roche: Consultancy; Bristol Myers Squibb: Consultancy; Kura: Consultancy; Celgene: Consultancy; Adaptive Biotechnologies: Consultancy; Gilead: Consultancy; Seattle Genetics: Speakers Bureau; AbbVie: Consultancy; Verastem: Consultancy; Bayer: Consultancy; Astra Zeneca: Consultancy; Adaptive: Consultancy; Morphosys: Consultancy.
35
Bessette, L., M. Movahedi, D. Choquette, L. Coupal, C. Bombardier e E. Keystone. "AB0196 IMPACT OF ANTIRHEUMATIC TREATMENTS ON THE INDIVIDUAL COMPONENTS OF THE ACR COMPOSITE SCORE IN PATIENTS WITH RA: REAL-WORLD DATA FROM TWO REGISTRIES". Annals of the Rheumatic Diseases 82, Suppl 1 (30 de maio de 2023): 1280.1–1280. http://dx.doi.org/10.1136/annrheumdis-2023-eular.2287.
Texto completo da fonteResumo:
BackgroundStandard criteria for measuring treatment efficacy in patients with RA include ACR response rates, which require meeting a threshold of ≥ 20/50/70% improvement in several physician- and patient-reported measures, including tender and swollen joint counts (TJC and SJC, respectively; primary criteria) and at least 3 of 5 secondary criteria (Physician (Ph) global assessment (GA), Patient (Pt) GA, Pain, HAQ-DI, and CRP).ObjectivesThe purpose of the analysis was to evaluate the impact of csDMARDs, TNF inhibitors (TNFi), and tofacitinib (TOFA) on each ACR score component in real-life practice.MethodsClinical data of RA patients with a CDAI >10 at the time they started a csDMARDs (all biologic naïve), TNFi or TOFA were pooled from two registries: Ontario Best Practices Research Initiative (OBRI) and RHUMADATA. Endpoints summarized descriptively included proportions of pts achieving: ACR20/50/70 responses, ≥ 20/50/70% improvements and mean percent improvement in individual ACR components (TJC, SJC, PhGA, PtGA, Pain, HAQ-DI, and CRP) at Month (M6).ResultsA total of 669 pts were included (csDMARD, n=157, TNFi, n=252; TOFA, n=260). At baseline, patients starting TOFA had longer disease duration, failed more bDMARDs and used more corticosteroids than csDMARDs and TNFi. The CDAI was similar between the 3 groups. ACR50 response rates were numerically lower for the TOFA group (Table 1). The ACR70 response was similar in the 3 groups. An overall higher proportion of patients in all three-medication groups achieved ≥20/50/70% improvement in primary ACR components vs secondary components. Among secondary components, ≥20/50/70% improvement rates were numerically highest for PhGA and lowest for HAQ-DI and pain. The improvement in the SJC and TJC were numerically similar between all groups (Table 1). Among ACR20/50/70 responders for all medications, mean percent improvement was more than 80% for primary components, and ranged from 30% to 80% for secondary components (Figure 1).ConclusionIn this real-world practice analysis, physician-reported measures (TJC, SJC, and PhGA) contribute slightly more to overall ACR20/50/70 responses, compared with Pt-reported outcomes (PROs; PtGA, Pain and HAQ-DI). In the ACR20 response group, a lower-level outcome, the improvement of the SJC and TJC, exceeded 80%. Pain was the most important factor in achieving an ACR50 for pts treated with TOFA, possibly reflecting the different effects of JAKi on pain.Table 1.Percentage of patients treated with csDMARD, TNFi, and TOFA who reported an ACR50 response and ≥ 50% improvement at month 6csDMARD (N=157)TNFi (N=252)TOFA (N=260)ACR50 response and ≥ 50% improvement in each component of the ACR50 score, n (%)ACR50 response27.4%25.3%19.4%TJC62.1%63.8%68.5%SJC64.9%67.8%67.2%PhGA58.3%51.7%50.3%PtGA44.9%38.8%32.7%Pain27.6%23.7%26.7%HAQ-DI23.6%17.3%17.7%CRP40.9%41.4%35.6%The analysis is based on observed case data (without imputation) of patients with all 7 components assessed ACR50/70: American College of Rheumatology ≥ 50/70% response rates; CRP: C-reactive protein; csDMARD: conventional synthetic disease-modifying antirheumatic drug; HAQ-DI: Health Assessment Questionnaire–Disability Index; Pain: patient-reported pain (visual analog scale); PhGA: physician global assessment; PtGA: patient global assessment of disease activity; SJC: swollen joint count; TJC: tender joint count; TNFi: tumour necrosis factor inhibitors; TOFA: tofacitinib.Figure 1.Mean percent improvement in ACR components in those patients who achieved an ACR20/50/70 at month 6Analysis is based on observed case data (without imputation) of patients with all 7 components assessedACR20/50/70: American College of Rheumatology ≥ 20/50/70% response rates.AcknowledgementsWe acknowledge the OBRI and RHUMADATA investigators.Disclosure of InterestsLouis Bessette Grant/research support from: has served as a consultant or member of a speakers bureau for, and has received grant/research support from, AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva, and UCB., Mohammad Movahedi: None declared, Denis Choquette Grant/research support from: Rhumadata is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli Lilly Canada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada., Louis Coupal: None declared, Claire Bombardier Grant/research support from: OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Aurora, Bristol-Meyers Squibb, Celgene, Hospira, Janssen, Lilly, Medexus, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB., Edward Keystone Grant/research support from: Amgen, Merck, Pfizer Pharmaceuticals, PuraPharm. Speaker Honoraria Agreements: AbbVie, Amgen, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis. Consulting Agreements/Advisory Board Membership: AbbVie, Amgen, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis.
36
Adamkiewicz, Tom, Mohamed Mubasher, Folashade Omole, Melvin R. Echols, Jason Payne, Tennille Leak-Johnson, Jan Morgan-Billingslea et al. "Sickle Cell Disease (SCD) As a Risk for COVI19 Compared to Those without SCD Among Patients Admitted in a Large Urban Center, As Estimated By PCR Sars-v-2 Positive Vs Negative Testing". Blood 138, Supplement 1 (5 de novembro de 2021): 4170. http://dx.doi.org/10.1182/blood-2021-148846.
Texto completo da fonteResumo:
Abstract A diagnosis of SCD is considered to be at risk for COVD19. To further define the association between SCD and infection with COVID-19, we estimated risk, by comparing presence or absence of COVID19 infections in individuals with and without SCD admitted concurrently to a large urban health care facility (Grady Memorial Hospital, Atlanta, GA; 960 beds, 5th largest public hospital in the US). Primary outcome was a positive or negative COVID-19 diagnosis as defined bySARS-CoV-2 PCR testing. A patient was considered to be COVID-19 positive if tested positive withSARS-CoV-2 PCR for the first time, anytime during the study period, irrespective of number of tests. A patient was considered to be COVID-19 negative if patient had no positive tests during the study period, and had one or moreSARS-CoV-2 PCR negative tests. For COVID19 positive patients, the admission of theSARS-CoV-2 PCR positive test was included in the analysis. For COVID19 negative patients, the first admission with aSARS-CoV-2 PCR negative test was considered for analysis. For this interim analysis, SCD was defined by ICD10 and registry data. Clinical diagnosis such as obesity and respiratory failure were defined by ICD10 coding. Data was obtained from quarterly centralized Epic EMR data extractions. Analysis of outcome of COVID19 positive vs negatives was stratified in four separate analysis: all admissions, ICU admissions, those with respiratory failure and those who died. Multivariate dichotomous logistic regression analyses modeled binary outcome effect of SCD, adjusted for age (<40 vs. > 40 years), sex at birth (females vs. males) and obesity (SAS version 9.4 was used for statistical analyses and overall significance level was set at 0.05). To ensure population homogeneity analysis was conducted on patient ages 20 to 60 years that were Black/African American and admitted from the Emergency Department for a short stay and/or the medicine service (variable interactions at a p<0.01). The study was approved by the institutional review board and by the hospital research oversight committee. Overall, between 3/23/2020 and 6/30/2020, 23697 patients were admitted once or more to Grady Memorial Hospital with one or more PCR sars-cov-2 test, of these 405 were patients with SCD (1.7%). Of the total, 2566 patients (10.8%) tested positive for COVID-19, and 48 patients with SCD (11.8%) were positive. Of 7041 (29.7%) were part of the study population, 332 (4.7%) where patients with SCD (hemoglobin [hb] SS/Sbeta0 =252, hbSC n=55, hbS beta thalassemia+ or hbS beta thalassemia undetermined n=21). Among patients without SCD, 36.3% were female, (n=2557) and among patients with SCD, 53.6% (n=178). The mean age of patients without SCD was: 51.1 years (standard deviation [std]) +/- 19.5 years), and for those with SCD: 35.0 years (std +/- 12.0 years). Results of univariate and multivariate analysis are presented in the table. In conclusion, in a Black/African American patients admitted from the Emergency Room for observation and/or the internal medicine service, when adjusted for age, gender and obesity, with SCD are at a significant increased risk for admissions with COVID-19 infection in general as well as ICU admission or admission with respiratory failures. Further studies can help articulate the risk associated with SCD as well as its potential interaction with other factors, with attention to confounders. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
37
Shafrir, A. L., L. A. Wise, J. R. Palmer, Z. O. Shuaib, L. M. Katuska, P. Vinayak, M. Kvaskoff, K. L. Terry e S. A. Missmer. "Validity of self-reported endometriosis: a comparison across four cohorts". Human Reproduction 36, n.º 5 (17 de fevereiro de 2021): 1268–78. http://dx.doi.org/10.1093/humrep/deab012.
Texto completo da fonteResumo:
Abstract STUDY QUESTION How accurately do women report a diagnosis of endometriosis on self-administered questionnaires? SUMMARY ANSWER Based on the analysis of four international cohorts, women self-report endometriosis fairly accurately with a > 70% confirmation for clinical and surgical records. WHAT IS KNOWN ALREADY The study of complex diseases requires large, diverse population-based samples, and endometriosis is no exception. Due to the difficulty of obtaining medical records for a condition that may have been diagnosed years earlier and for which there is no standardized documentation, reliance on self-report is necessary. Only a few studies have assessed the validity of self-reported endometriosis compared with medical records, with the observed confirmation ranging from 32% to 89%. STUDY DESIGN, SIZE, DURATION We compared questionnaire-reported endometriosis with medical record notation among participants from the Black Women’s Health Study (BWHS; 1995-2013), Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (E3N; 1990-2006), Growing Up Today Study (GUTS; 2005–2016), and Nurses’ Health Study II (NHSII; 1989–1993 first wave, 1995–2007 second wave). PARTICIPANTS/MATERIALS, SETTING, METHODS Participants who had reported endometriosis on self-administered questionnaires gave permission to procure and review their clinical, surgical, and pathology medical records, yielding records for 827 women: 225 (BWHS), 168 (E3N), 85 (GUTS), 132 (NHSII first wave), and 217 (NHSII second wave). We abstracted diagnosis confirmation as well as American Fertility Society (AFS) or revised American Society of Reproductive Medicine (rASRM) stage and visualized macro-presentation (e.g. superficial peritoneal, deep endometriosis, endometrioma). For each cohort, we calculated clinical reference to endometriosis, and surgical- and pathologic-confirmation proportions. MAIN RESULTS AND THE ROLE OF CHANCE Confirmation was high—84% overall when combining clinical, surgical, and pathology records (ranging from 72% for BWHS to 95% for GUTS), suggesting that women accurately report if they are told by a physician that they have endometriosis. Among women with self-reported laparoscopic confirmation of their endometriosis diagnosis, confirmation of medical records was extremely high (97% overall, ranging from 95% for NHSII second wave to 100% for NHSII first wave). Importantly, only 42% of medical records included pathology reports, among which histologic confirmation ranged from 76% (GUTS) to 100% (NHSII first wave). Documentation of visualized endometriosis presentation was often absent, and details recorded were inconsistent. AFS or rASRM stage was documented in 44% of NHSII first wave, 13% of NHSII second wave, and 24% of GUTS surgical records. The presence/absence of deep endometriosis was rarely noted in the medical records. LIMITATIONS, REASONS FOR CAUTION Medical record abstraction was conducted separately by cohort-specific investigators, potentially introducing misclassification due to variation in abstraction protocols and interpretation. Additionally, information on the presence/absence of AFS/rASRM stage, deep endometriosis, and histologic findings were not available for all four cohort studies. WIDER IMPLICATIONS OF THE FINDINGS Variation in access to care and differences in disease phenotypes and risk factor distributions among patients with endometriosis necessitates the use of large, diverse population samples to subdivide patients for risk factor, treatment response and discovery of long-term outcomes. Women self-report endometriosis with reasonable accuracy (>70%) and with exceptional accuracy when women are restricted to those who report that their endometriosis had been confirmed by laparoscopic surgery (>94%). Thus, relying on self-reported endometriosis in order to use larger sample sizes of patients with endometriosis appears to be valid, particularly when self-report of laparoscopic confirmation is used as the case definition. However, the paucity of data on histologic findings, AFS/rASRM stage, and endometriosis phenotypic characteristics suggests that a universal requirement for harmonized clinical and surgical data documentation is needed if we hope to obtain the relevant details for subgrouping patients with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by Eunice Kennedy Shriver National Institute of Child Health and Development grants HD48544, HD52473, HD57210, and HD94842, National Cancer Institute grants CA50385, R01CA058420, UM1CA164974, and U01CA176726, and National Heart, Lung, and Blood Institute grant U01HL154386. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. AS, SM, and KT were additionally supported by the J. Willard and Alice S. Marriott Foundation. MK was supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme (#PIOF-GA-2011-302078) and is grateful to the Philippe Foundation and the Bettencourt-Schueller Foundation for their financial support. Funders had no role in the study design, conduct of the study or data analysis, writing of the report, or decision to submit the article for publication. LA Wise has served as a fibroid consultant for AbbVie, Inc for the last three years and has received in-kind donations (e.g. home pregnancy tests) from Swiss Precision Diagnostics, Sandstone Diagnostics, Kindara.com, and FertilityFriend.com for the PRESTO cohort. SA Missmer serves as an advisory board member for AbbVie and a single working group service for Roche; neither are related to this study. No other authors have a conflict of interest to report. Funders had no role in the study design, conduct of the study or data analysis, writing of the report, or decision to submit the article for publication. TRIAL REGISTRATION NUMBER N/A.
38
"Infection control handbook: A user-friendly tool M. Nowacki, RN,* R. Lovell, MD, G. Lowery, MSN, RN. Medical College of Georgia, Augusta, GA". American Journal of Infection Control 23, n.º 2 (abril de 1995): 130. http://dx.doi.org/10.1016/0196-6553(95)90227-9.
Texto completo da fonte
39
"Infection control environmental surveys: A measure for quality improvement G. Lowery, MSN, RN,* J. Corbett, RN, CIC. Medical College of Georgia, Augusta, GA". American Journal of Infection Control 23, n.º 2 (abril de 1995): 130–31. http://dx.doi.org/10.1016/0196-6553(95)90228-7.
Texto completo da fonte
40
"FRANKLIN R. TAY, BDSC (HONS), PHD, Associate Professor, Department of Endodontics, College of Dental Medicine, Georgia Health Sciences University, Augusta, GA, USA". Endodontic Topics 20, n.º 1 (março de 2009): 95. http://dx.doi.org/10.1111/j.1601-1546.2012.00275_11.x.
Texto completo da fonte
41
"FRANKLIN R. TAY, BDSC (HONS), PHD, Associate Professor, Department of Endodontics, College of Dental Medicine, Georgia Health Sciences University, Augusta, GA, USA". Endodontic Topics 21, n.º 1 (setembro de 2009): 105. http://dx.doi.org/10.1111/j.1601-1546.2012.00276_17.x.
Texto completo da fonte
42
"Polymerase chain reaction testing for Mycobacterium tuberculosis: The benefits for evaluating exposures G. Lowery, MSN, RN,* R. Lovell, MD. Medical College of Georgia, Augusta, GA". American Journal of Infection Control 23, n.º 2 (abril de 1995): 111. http://dx.doi.org/10.1016/0196-6553(95)90156-6.
Texto completo da fonte
43
Casanova, Tracy, Jiby Yohannan, Elizabeth Wood, James Griffin, Catherine Wallace, Susan Brands, Amanda Draheim e Lara Stepleman. "Filling a Gap in Healthcare for the Transgender Community in the Central Savannah River Area". Journal of Student-Run Clinics 9, n.º 1 (23 de janeiro de 2023). http://dx.doi.org/10.59586/jsrc.v9i1.353.
Texto completo da fonteResumo:
Background: Lack of insurance coverage and provider training are significant barriers that contribute to health disparities among members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. Locality can exacerbate health disparities due to lack of competent providers and higher levels of community stigma. The Equality Clinic in Augusta, GA, was created by medical students at the Medical College of Georgia to provide care to uninsured or underinsured members of the LGBTQ community in the Central Savannah River Area. The purpose of the following report is to examine demographic characteristics and presenting concerns of patients served by the Equality Clinic during its first two years of existence.
Methods: The current report utilized retrospective medical record review from the first two years of operation to identify trends in patient demographics, presenting concerns, and service utilization.
Results: Although the Equality Clinic was created to provide multiple facets of healthcare to the broader LGBTQ community, the services that were utilized in the first two years were strongly composed of gender affirmative care for those who identified as transgender. Overall, the patients served at the Equality Clinic were healthy with few chronic health conditions reported, however, a high rate of substance use was endorsed.
Conclusions: This study may point to unique needs of transgender patients and highlights the lack of access to gender-related care in the rural southeast United States.
44
"Mycobacterium Gordonae: Tap in on the problem G. Lowery, MSN, RN,* J. Corbett, RN, CIC, R. Lovell, MD, J. Steele, MD, PhD. Medical College of Georgia, Augusta, GA". American Journal of Infection Control 23, n.º 2 (abril de 1995): 110. http://dx.doi.org/10.1016/0196-6553(95)90155-8.
Texto completo da fonte
45
"Birth weight versus infection weight of neonates: Relevance to nosocomial infections D. Goins, MSN, RNC,* G. Lowery, MSN, RN, R. Lovell, MD. Medical College of Georgia, Augusta, GA". American Journal of Infection Control 23, n.º 2 (abril de 1995): 119. http://dx.doi.org/10.1016/0196-6553(95)90187-6.
Texto completo da fonte
46
"The investigation and reduction of surgical site infections for cesarean sections G. Lowery, MSN, RN,* J. Carmany, BSN, RN, R. Lovell, MD. Medical College of Georgia, Augusta, GA". American Journal of Infection Control 23, n.º 2 (abril de 1995): 120. http://dx.doi.org/10.1016/0196-6553(95)90189-2.
Texto completo da fonte
47
Ahluwalia, Pankaj, Ashutosh Vashisht, Harmanpreet Singh, Nikhil Shri Sahajpal, Ashis K. Mondal, Kimya Jones, Jaspreet Farmaha et al. "Ethno‐demographic disparities in humoral responses to the COVID‐19 vaccine among healthcare workers". Journal of Medical Virology 95, n.º 9 (setembro de 2023). http://dx.doi.org/10.1002/jmv.29067.
Texto completo da fonteResumo:
AbstractThe COVID‐19 pandemic had a profound impact on global health, but rapid vaccine administration resulted in a significant decline in morbidity and mortality rates worldwide. In this study, we sought to explore the temporal changes in the humoral immune response against SARS‐CoV‐2 healthcare workers (HCWs) in Augusta, GA, USA, and investigate any potential associations with ethno‐demographic features. Specifically, we aimed to compare the naturally infected individuals with naïve individuals to understand the immune response dynamics after SARS‐CoV‐2 vaccination. A total of 290 HCWs were included and assessed prospectively in this study. COVID status was determined using a saliva‐based COVID assay. Neutralizing antibody (NAb) levels were quantified using a chemiluminescent immunoassay system, and IgG levels were measured using an enzyme‐linked immunosorbent assay method. We examined the changes in antibody levels among participants using different statistical tests including logistic regression and multiple correspondence analysis. Our findings revealed a significant decline in NAb and IgG levels at 8−12 months postvaccination. Furthermore, a multivariable analysis indicated that this decline was more pronounced in White HCWs (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.07−4.08, p = 0.02) and IgG (OR = 2.07, 95% CI = 1.04−4.11, p = 0.03) among the whole cohort. Booster doses significantly increased IgG and NAb levels, while a decline in antibody levels was observed in participants without booster doses at 12 months postvaccination. Our results highlight the importance of understanding the dynamics of immune response and the potential influence of demographic factors on waning immunity to SARS‐CoV‐2. In addition, our findings emphasize the value of booster doses to ensure durable immunity.
48
Alsadon, Omar, Abdulaziz Abdullah Alkhureif e Aftab Ahmed Khan. "Effect of Gum Arabic powder on the mechanical properties of denture base acrylic". Pakistan Journal of Medical Sciences 39, n.º 1 (16 de novembro de 2022). http://dx.doi.org/10.12669/pjms.39.1.6937.
Texto completo da fonteResumo:
Objective: This study aimed to improve the mechanical properties of denture base material using various concentrations of natural biopolymer, i.e., Gum Arabic (GA).
Methods: This experimental study was conducted at the Dental Health Department of the College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia from May 2022 to July 2022. After obtaining exemption from the institutional review board, the powdered GA was added in ratios of weight 5, 10, and 20% to PMMA heat-cured acrylic powder to produce bar-shaped samples (65 × 10 × 30 mm3 in dimensions). While the control group was prepared as such. Micro hardness (n=10/group) and fracture toughness (n=10/group) were evaluated. One-way analysis of variance method was used to statistically analyze the results (p<0.05) using SPSS version 23.
Results: Significant differences were observed for micro hardness (p<0.001) and fracture toughness (p=0.007) between the means of the different study groups. The control group exhibited the highest micro hardness (22.5±0.6 VHN) and fracture toughness (1.25±0.11 MPa.m1/2) value among the study groups. While 20 wt. % GA and 10 wt. % GA groups showed the lowest micro hardness and fracture toughness values, respectively.
Conclusions: GA powder might not be an appropriate reinforcing material for denture base or the higher filler loading of GA in denture base acrylic might be detrimental to the mechanical properties.
doi: https://doi.org/10.12669/pjms.39.1.6937
How to cite this: Alsadon O, Alkhureif AA, Khan AA. Effect of Gum Arabic powder on the mechanical properties of denture base acrylic. Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.6937
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
49
Lee, Victor H. K., Cameron G. Grant, Betty-Anne Mittermuller, Sarbjeet Singh, Brenda Weiss, Jeanette M. Edwards e Robert J. Schroth. "Association between early childhood oral health impact scale (ECOHIS) scores and pediatric dental surgery wait times". BMC Oral Health 20, n.º 1 (17 de outubro de 2020). http://dx.doi.org/10.1186/s12903-020-01263-8.
Texto completo da fonteResumo:
Abstract Background Severe Early Childhood Caries (S-ECC) is an aggressive form of tooth decay that often requires pediatric dental rehabilitative surgery. The Early Childhood Oral Health Impact Scale (ECOHIS) measures oral health-related quality of life (OHRQL). The purpose of this study was to determine whether there is an association between ECOHIS scores and surgery wait times for children undergoing dental treatment for S-ECC under general anesthesia (GA). Methods The hypothesis was that there is no present association between wait times and ECOHIS score. Children under 72 months of age with S-ECC were recruited on the day of their slated dental surgery under GA. Parents/caregivers completed a questionnaire that included the ECOHIS. Data were merged with other ECOHIS scores from a previous study. Wait times were acquired from the Patient Access Registry Tool (PART) database. Data analysis included descriptive statistics and bivariate analyses. A p-value of ≤0.05 was considered statistically significant; 95% confidence intervals (CIs) were reported for each correlation coefficient. This study was approved by the University of Manitoba’s Health Research Ethics Board. Results Overall, 200 children participated, the majority of whom were Indigenous (63%) and resided in Winnipeg (52.5%). The mean age was 47.6 ± 13.8 months and 50.5% were female. Analyses showed ECOHIS scores were not significantly correlated with children’s wait times. Observed correlations between ECOHIS and children’s wait times were low and not statistically significant, ranging from ρ = 0.11 for wait times and child impact section (CIS) scores (95% CI: − 0.04, 0.26; p = 0.14), ρ = − 0.08 for family impact section (FIS) scores (95% CI: − 0.23, 0.07; p = 0.28), and ρ = 0.04 for total ECOHIS scores (95% CI: − 0.11, 0.19; p = 0.56). Conclusion No significant associations were observed between ECOHIS scores and wait times. In fact, those with worse OHRQL appeared to wait longer for surgery. ECOHIS scores could, however, still be used to help prioritize children for dental surgery to ensure that they receive timely access to dental care under GA. This is essential given the challenges posed by COVID-19 on timely access to surgical care.
50
Yoon, Jane C., Juliana Prieto, Sarita Shah, Javarrio Clark, Allison Chamberlain e David P. Holland. "Implementation of close contact elicitation at the time of COVID-19 testing—Atlanta, GA, October–November 2020". Journal of Public Health, 21 de maio de 2021. http://dx.doi.org/10.1093/pubmed/fdab174.
Texto completo da fonteResumo:
Abstract Background Contact tracing during the Coronavirus Disease 2019 (COVID-19) pandemic in the USA has been met with various challenges. In an attempt to improve the yield of close contact collection, the Fulton County Board of Health implemented a pilot approach to contact elicitation at the time of testing. Methods Between October and November 2020, close contacts were elicited from persons under investigation (PUIs) at one COVID-19 testing site in Fulton County, GA. Secure online data collection forms were used to record PUI demographic data, close contact information and reasons for not providing contacts. Results Of 1238 PUIs, 48% reported at least one contact. Among the 66 people who tested positive, 16 (24%) reported contacts compared to 578/1165 (50%) who tested negative. PUIs of increasing age were less likely to provide contacts; Black and Hispanic PUIs were also less likely to report any contacts compared to White and Asian PUIs. Conclusions Our study revealed that PUIs testing positive were less likely to provide contacts compared to PUIs testing negative. Age and racial differences were also noted in the provision of contacts. Further investigation is needed to understand these discrepancies in order to devise more effective strategies for contact elicitation.