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Rhodes, Scott D., Kristie Long Foley, Carlos S. Zometa, and Fred R. Bloom. "Lay Health Advisor Interventions Among Hispanics/Latinos." American Journal of Preventive Medicine 33, no. 5 (2007): 418–27. http://dx.doi.org/10.1016/j.amepre.2007.07.023.
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Santos, Rebecca. "An action researcher in an advisor’s hat: A short reflection on lessons the OECD has learned from undertaking action research in the realm of policy and politics." IJAR – International Journal of Action Research 17, no. 1-2021 (2021): 102–7. http://dx.doi.org/10.3224/ijar.v17i1.06.
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Action research has enormous potential for policymakers, and those who advise them, to work in more iterative, reflective, and collaborative ways. For complex systems facing wicked problems, any approach that gets it closer to framing a problem well and drawing upon diverse forms of knowledge to bring about change, is good. Advisors who do action research in policymaking or political settings should be sensitive to the fact that this methodology may confound expectations regarding the ‘traditional’ advisor role. As such, some careful navigation of this approach (and what it means for the relationship and perception policymakers may have with those they engage to advise them) is required. This opinion piece shares lessons from an advisor working in the OECD’s innovation team, which embraced the action research methodology to reflect on and design innovative policy interventions with public sector policymakers. Action researchers who are using this methodology to produce policy advice may be more successful in auguring, and better navigating, new kinds of relationships with government if they heed the following lessons: frame the value of action research with decision makers, diversify your data and follow the story, and prime practitioners to participate.
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Hish, Alexander J., Gabriela A. Nagy, Caitlin M. Fang, et al. "Applying the Stress Process Model to Stress–Burnout and Stress–Depression Relationships in Biomedical Doctoral Students: A Cross-Sectional Pilot Study." CBE—Life Sciences Education 18, no. 4 (2019): ar51. http://dx.doi.org/10.1187/cbe.19-03-0060.
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Although doctoral students in the biomedical sciences have been recognized as a population at particular risk for mental health problems such as burnout and depression, little research has been conducted to identify candidate targets for intervention. To this end, we used the stress process model to evaluate potential mediators of stress–burnout and stress–depression relationships in biomedical doctoral students. A cross-sectional sample ( n = 69) completed validated self-report measures of stress; symptoms of burnout and depression; and perceptions of mastery, social support, and advisor support. In linear regression models, we found that academic stressors were most predictive of burnout, whereas family/monetary stressors were most predictive of depression. In mediation models, we found that the relationship between stress and burnout was partially mediated by mastery and advisor support, while the stress–depression relationship was partially mediated by mastery. These findings represent a first step in identifying interventional targets to improve mental health in this at-risk population. Whereas certain stressors are inherent to the doctoral training environment, psychosocial interventions to enhance one’s sense of mastery and/or to improve advisor relationships may mitigate the influence of such stressors on burnout and depression.
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Holdsworth, Elizabeth, Nicki Thorogood, Annik Sorhaindo, and Kiran Nanchahal. "A Qualitative Study of Participant Engagement With a Weight Loss Intervention." Health Promotion Practice 18, no. 2 (2016): 245–52. http://dx.doi.org/10.1177/1524839916659847.
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Background. Overweight and obesity are major public health problems and an increasing global challenge. In lieu of wider policy changes to tackle the obesogenic environment in which we presently reside, improving the design of individual-level weight loss interventions is important. Aim. To identify which aspects of the Camden Weight Loss randomized controlled trial weight loss intervention participants engaged with, with the aim of improving the design of future studies and maximizing retention. Method. A qualitative study comprising semistructured interviews ( n = 18) and a focus group ( n = 5) with intervention participants. Results. Two important aspects of participant engagement with the intervention consistently emerged from interviews and focus group: the advisor–participant relationship and the program structure. Some materials used during the program sessions were important in supporting the intervention; however, others were not well received by participants. Conclusion. An individual-level weight loss intervention should be acceptable from the patient perspective in order to ensure participants are engaged with the program for as long as possible to maximize favorable results. Providing ongoing support in a long-term program with a trained empathetic advisor may be effective at engaging with people trying to lose weight in a weight loss intervention.
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Jackson, Edward, Piyali Chatterjee, Susan Smith, Karen Badal, and David E. Griffith. "1330. Diagnosis and Management of NTM Lung Disease: Effect of Online Educational Interventions on Infectious Disease Specialist Knowledge." Open Forum Infectious Diseases 5, suppl_1 (2018): S406. http://dx.doi.org/10.1093/ofid/ofy210.1163.
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Abstract Background Diagnosis and management of nontuberculous mycobacterial (NTM) lung disease is challenging for clinicians due to its rarity and the need for complicated, multidrug antibiotic regimens. The objective of this study was to determine whether online educational interventions can effectively address knowledge gaps among ID specialists regarding diagnosis and treatment of patients with NTM lung disease. Methods Two educational interventions, consisting of a text-based activity with interactive questions, and a video-based discussion between two experts, were developed and made available online. Educational impact of each intervention was assessed using a 3-question repeated pairs pre-/post-assessment study design. Data from a sampling of learners were collected from September 11, 2017 through January 17, 2018. Statistical analyses included a paired (within-physician) two-tailed t-test and McNemar’s χ2 statistic, with Cramer’s V to determine the overall effect of each intervention. Results Overall, a total of 1,273 ID specialist learners participated in the two activities from launch through April 30, 2018. Analysis demonstrated a significant improvement (P < 0.05) in overall knowledge with considerable educational impact (V = 0.195 and 0.259). Improvements in specific areas included (figure). Despite gains in knowledge, additional gaps were also identified: (1) Regarding treatment of M. abscessus lung disease, 18% were unable to discern between guideline recommended therapies for M. abscessus and MAC complex NTM, and an additional 14% would treat with a less aggressive, noncurative regimen (n = 211), and (2) regarding treatment of fibrocavitary MAC complex NTM; nearly one-third (31%) would treat a using a thrice-weekly regimen, despite an indication for a daily regimen (n = 114). Conclusion Participation in interactive text-based as well as video-based activities improved the ability of ID specialists to make evidence-based decisions in the care of NTM lung disease. The findings also uncovered educational needs that warrant further education in selecting appropriate therapeutic regimens particularly in cases where aggressive therapy is indicated. Disclosures E. Jackson, Medscape: Employee, Salary. P. Chatterjee, Medscape: Employee, Salary. S. Smith, BioFire Diagnostics: Independent Medical Education, Educational grant. K. Badal, Medscape: Employee, Salary. D. E. Griffith, Aradigm Corporation: Advisor/consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. Bayer Healthcare Pharmaceuticals: Advisor/consultant, Consulting fee. Grifols: Advisor/consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. Insmed Incorporated: Advisor/consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Grant recipient and Speaker honorarium.
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Patil, Sonal J., Melissa Lewis, Erin M. Tallon, et al. "Lay Advisor Interventions in Rural Populations: A Systematic Review and Meta-analysis." American Journal of Preventive Medicine 57, no. 1 (2019): 117–26. http://dx.doi.org/10.1016/j.amepre.2019.02.007.
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Hubler, Thomas M. "Family Business Consultants as Leaders." Family Business Review 11, no. 3 (1998): 187–92. http://dx.doi.org/10.1111/j.1741-6248.1998.00187.x.
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Consulting and working as an advisor to family businesses are awesome responsibilities. The interventions and advice we give will in some instances have an impact on a family for generations. As a result, it is critical to understand what factors create success as well as failure. In most instances, understanding our failures provides the richest opportunity to create future benefits for our clients. Accepting this challenge of learning from our mistakes requires courage and leadership to explore and understand our own depths and the five common shadows facing family business consultants and advisors. For those of us who take the risk and accept the challenge, the benefits are enormous—not only for ourselves and our profession but more importantly for our clients who are the recipients of our work.
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Law, Rebecca-Jane, Joseph Langley, Beth Hall, et al. "‘Function First’: how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods." BMJ Open 11, no. 7 (2021): e046751. http://dx.doi.org/10.1136/bmjopen-2020-046751.
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ObjectivesTo develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory.DesignRealist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation.ResultsA taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions.Abridged realist programme theoryRoutinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy.Co-designThe programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff; describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active; and provide materials to support behaviour change.ConclusionsPrevious physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including implications relevant to COVID-19), and testing in a future study. The integration of realist and co-design methods strengthened this study.
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Csipke, Emese, Lauren Yates, Esme Moniz Cook, et al. "Promoting independence in dementia: protocol for a feasibility trial of the PRIDE intervention for living well with dementia." International Journal of Clinical Trials 5, no. 4 (2018): 177. http://dx.doi.org/10.18203/2349-3259.ijct20184399.
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<p class="abstract"><strong>Background:</strong> Dementia can lead to social exclusion, loss of identity and independence, due to deterioration in cognition and activities of daily living. The aim of the study is to investigate the feasibility of the Promoting Independence in Dementia (PRIDE) intervention, designed to facilitate independence in people with mild dementia.</p><p class="abstract"><strong>Methods:</strong> This is a mixed-methods feasibility trial of the PRIDE, in preparation for a future randomised controlled trial. Up to 50 people with dementia will be recruited. Demetia advisors will deliver the three session intervention. Quantitative outcomes will be taken at baseline and up to three months post baseline. Fidelity checklists will assess fidelity to the intervention. Qualitative implementation data will be gathered in a series of post-intervention semi-structured interviews with staff and participants. This will include data to examine participant experiences of and engagement with the intervention, and other aspects of delivery such as recruitment of DAWs, fidelity and experiences of receiving and delivering the intervention. This study aims to establish and field test the PRIDE intervention; determine the recruitment rate of sites, providers and participants; assess fidelity in delivery of the intervention and engagement with people with dementia; assess the feasibility and acceptability of outcome measure data and assess the acceptability of the intervention by stakeholders.</p><p class="abstract"><strong>Conclusions: </strong>There has been increased need for non-pharmacological interventions for mild dementia. The results of this feasibility study will allow us to plan for a definitive RCT of a three session dementia advisor led intervention for mild dementia.</p>
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Aponte-González, Johanna, Paul Brown, and Javier Eslava-Schmalbach. "Preferences based interventions to address the use of antibiotics without prescription: a discrete choice experiment." Pharmacy Practice 19, no. 3 (2021): 2401. http://dx.doi.org/10.18549/pharmpract.2021.3.2401.
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Background: In many countries, concerns have arisen over the population using antibiotics without consulting a physician. This practice can place patients at risk and increase antibiotic resistance in the community.
 Objective: To evaluate individuals' preferences regarding the use of antibiotics. The study also assessed the likely effectiveness of interventions aimed at reducing inappropriate use of antibiotics.
 Methods: A discrete choice experiment (DCE) was conducted in Bogotá, Colombia. The attributes were determined by a systematic literature review and four focus group sessions. The DCE included nine factors – cost, time to get attention, level of symptoms, efficacy, safety, among others- and one label -using or not antibiotics. Data analysis was carried out using a generalized multinomial logit (GMNL) model. Marginal probabilities of different sets of attributes' levels were compared to estimate the likely effectiveness of interventions.
 Results: The survey was administered to 222 participants from diverse socioeconomic backgrounds. The results suggest that participants preferred not taking antibiotics and having a physician as an advisor, but the probability of inappropriate antibiotic use increased as the waiting time or the cost of receiving advice rose. The pharmacy was the preferred source of antibiotics, and participants chose the pharmacy worker (nonprofessional) as an advisor over the nurse on the phone. In the absence of any interventions aimed at reducing the use of antibiotics, approximately 47.3% of people would misuse antibiotics. This reduces to 26.5% when people perceive the efficacy of the antibiotics as low and the potential risks of self-medicating as high. An alternative model using a nursing service would likely lower inappropriate use of antibiotics.
 Conclusions: Even though people prefer not using antibiotics or visiting a physician in case of disease rather than self-medicating, current access conditions might discourage them from appropriately use antibiotics. The results suggest that interventions that informing people about the risks of self-medication and the low efficacy might significantly reduce inappropriate use of antibiotics. Our results also suggest that programs that empower other health professionals to provide access to antibiotics would likely further lower inappropriate use.
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Luther, Megan, Tristan Timbrook, Vrishali Lopes, Aisling Caffrey, and Kerry LaPlante. "Impact of Vancomycin-Associated Acute Kidney Injury on Patient Outcomes in MRSA Bacteremia." Open Forum Infectious Diseases 4, suppl_1 (2017): S344. http://dx.doi.org/10.1093/ofid/ofx163.822.
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Abstract Background Acute kidney injury (AKI) is a well-known adverse effect of vancomycin. Varying degrees and causes of AKI have demonstrated different effects on patient outcomes. Since AKI with vancomycin is typically reversible, we investigated how AKI associated with vancomycin therapy impacts patient mortality and time to discharge. Methods Unique patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and who received at least one dose of vancomycin were identified in a national Veterans Affairs cohort from January 1, 2002 to October 14, 2015. Patients with a history of dialysis in the previous year and those with AKI on admission were excluded. AKI was defined according to RIFLE criteria, as an increase in serum creatinine (SCr) of 0.5 mg/dL or 1.5× from the admission SCr, on a day they received vancomycin. Patient characteristics including demographics and comorbidities defined by ICD9 codes were compared between groups. Effect estimates for inpatient mortality were determined with a backward stepwise logistic regression model in SAS 9.2. For patients without inpatient mortality, time to discharge was analyzed using Wilcoxon rank-sum test. Results There were 7691 included patients with MRSA bacteremia, and 23.8%&#x2028;(n = 1830) developed AKI during therapy. Mean age was 66.7 (±12) years and 97.8% (n = 7525) were male. Patients with AKI were more likely to have congestive heart failure, diabetes, chronic kidney disease, and to be admitted to the intensive care unit (all P &lt; 0.001). Overall inpatient mortality was 17.7% (n = 1361). The crude odds of inpatient mortality were 67% higher in patients with AKI. In the adjusted model, AKI was an independent predictor of mortality (OR 1.19, 95% CI 1.02–1.40, P &lt; 0.03). Median (IQR) time to discharge was 11 (6–19) days without AKI and 18 (11–31) days with AKI (P &lt; 0.0001). Conclusion Vancomycin-associated AKI is associated with increased inpatient mortality and longer time to discharge. Further research is needed to compare clinical outcomes for other groups of patients, and to determine the impact of monitoring interventions to improve safety and decrease AKI. Disclosures A. Caffrey, Merck: Grant Investigator, Grant recipient The Medicines Company: Grant Investigator, Grant recipient Pfizer: Grant Investigator, Grant recipient K. LaPlante, Merck: Grant Investigator, Grant recipient Pfizer: Grant Investigator, Grant recipient Cempra: Scientific Advisor, Consulting fee The Medicines Company: Grant Investigator, Grant recipient Allergan: Scientific Advisor, Consulting fee Bard/ Davol: Scientific Advisor, Consulting fee Ocean Spray: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient Zavante: Scientific Advisor, Consulting fee Achaogen: Scientific Advisor, Consulting fee
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Marleau, Justin N., and Kimberly D. Girling. "Keeping science’s seat at the decision-making table: Mechanisms to motivate policy-makers to keep using scientific information in the age of disinformation." FACETS 2, no. 2 (2017): 1045–64. http://dx.doi.org/10.1139/facets-2017-0087.
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Policy-makers are confronted with complex problems that require evaluating multiple streams of evidence and weighing competing interests to develop and implement solutions. However, the policy interventions available to resolve these problems have different levels of supporting scientific evidence. Decision-makers, who are not necessarily scientifically trained, may favour policies with limited scientific backing to obtain public support. We illustrate these tensions with two case studies where the scientific consensus went up against the governing parties’ chosen policy. What mechanisms exist to keep the weight of scientific evidence at the forefront of decision-making at the highest levels of government? In this paper, we propose that Canada create “Departmental Chief Science Advisors” (DCSAs), based on a program in the UK, to help complement and extend the reach of the newly created Chief Science Advisor position. DCSAs would provide advice to ministers and senior civil servants, critically evaluate scientific work in their host department, and provide public outreach for the department’s science. We show how the DCSAs could be integrated into their departments and illustrate their potential benefits to the policy making process and the scientific community.
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Mayfield-Johnson, Susan, Danielle Fastring, Daniel Le, and Jane Nguyen. "Addressing the Social Vulnerability of Mississippi Gulf Coast Vietnamese Community through the Development of Community Health Advisors." Sustainability 12, no. 9 (2020): 3892. http://dx.doi.org/10.3390/su12093892.
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Background: Resiliency is the ability to prepare for, recover from, and adapt to stressors from adverse events. Social vulnerabilities (limited access to resources, political power, and representation; lack of social capital; aspects of the built environment; health inequities; and being in certain demographic categories) can impact resiliency. The Vietnamese population living along the Mississippi Gulf Coast is a community that has unique social vulnerabilities that impact their ability to be resilient to adverse events. Objectives: The purpose of this project was to address social vulnerability by implementing and evaluating a volunteer Community Health Advisor (CHA) project to enhance community resiliency in this community. Methods: A program implemented over eight three-hour sessions was adapted from the Community Health Advisor Network curriculum that focused on healthy eating, preventing chronic conditions (hyperlipidemia, diabetes, hypertension, cancer, and poor mental health). Topics also included leadership and capacity development skills. Results: Participants (n = 22) ranged from 35 to 84 years of age. Most were female (63.6%), married (45.5%), unemployed (63.6%), had annual incomes of <$10,000, and had high school diplomas (68.2%). Community concerns were crime (50.0%), volunteerism (40.0%), language barriers (35.0%), and food insecurity (30.0%). Approximately 75% had experienced war trauma and/or refugee camps, and 10% had experienced domestic violence. Scores on the Community Health Advisor Core Competency Assessment increased from pre-test to post-test (t = −5.962, df = 11, p < 0.0001), as did SF-8 scores (t = 5.759, df = 17, p < 0.0001). Conclusions: Strategies to reduce vulnerabilities in the Vietnamese community should include developing interventions that address health risks and strengths and focus on root causes of vulnerability.
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Brenes-Chacon, Helena, Cristina Garcia-Maurino, Melissa Moore-Clingenpeel, et al. "1465. Age-Dependent Interactions Among Clinical Characteristics, Viral Loads and Disease Severity in Young Children with Respiratory Syncytial Virus Infection (RSV) Infection." Open Forum Infectious Diseases 7, Supplement_1 (2020): S734—S735. http://dx.doi.org/10.1093/ofid/ofaa439.1646.
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Abstract Background Differences in clinical presentation and viral loads according to age in young children with RSV, and their correlation with disease severity are poorly defined. The aim of this study was to define age-dependent the differences in demographic, clinical factors and viral loads between children &lt; 2 years of age with mild RSV infection evaluated as outpatients versus those hospitalized with severe RSV infection. Figure 1. Sign and Symptoms according to disease severity and age in infants with RSV infection. Most relevant signs and symptoms were stratified in outpatients (orange) vs inpatients (blue) by age in (A) &lt; 3 months, (B) between 3 and 6 months, and (C) &gt; 6 to 24 months of age. The Y axis represents the signs and symptoms in the two disease severity groups and the X axis the frequency of that specific symptom (%). Numbers next to bars represent the exact number of patients with that specific sign/symptom. Comparisons by Fisher exact test. Symbol (*) indicate significant 2-sided p values Figure 2. Viral load differences according to age in infants with RSV infection. The Y axis represents RSV loads in log10 copies/mL and the X axis differences in viral loads in outpatients (orange) and inpatients (blue) in the three age groups. Comparisons by Mann Whitney test. Methods Previously healthy children &lt; 2 years old with mild (outpatients) and severe (inpatients) RSV infection were enrolled and nasopharyngeal swabs were obtained for RSV typing and quantitation by real-time PCR. Patients were stratified by age (0-&lt; 3, 3-6, and &gt;6-24 months) and multivariable analyses were performed to identify clinical and viral factors associated with severe disease. Results From 2014-2018 we enrolled 534 children with RSV infection: 130 outpatients and 404 inpatients. Median duration of illness was 4 days for both groups, yet viral loads were higher in outpatients than inpatient in the three age groups (Fig 1). Wheezing was more frequent in outpatients of older age (&gt;3 months) than in inpatients (p&lt; 0.01), while fever was more common in inpatients that outpatients (p&lt; 0.01) and increased with age (Fig 2). Adjusted analyses confirmed that increased work of breathing and fever were consistently associated with hospitalization irrespective of age, while wheezing in infants &gt;3 months, and higher RSV loads in children &gt;6-24 months were independently associated with reduced disease severity. Conclusion Age had a significant impact defining the interactions among viral loads, specific clinical manifestations and disease severity in children with RSV infection. These observations highlight the importance of patient stratification when evaluating interventions against RSV. Disclosures Octavio Ramilo, MD, Bill & Melinda Gates Foundation (Grant/Research Support)Janssen (Grant/Research Support, Advisor or Review Panel member)Medimmune (Grant/Research Support)Merck (Advisor or Review Panel member)NIH/NIAID (Grant/Research Support)Pfizer (Consultant, Advisor or Review Panel member)Sanofi/Medimmune (Consultant, Advisor or Review Panel member) Asuncion Mejias, MD, PhD, MsCS, Janssen (Grant/Research Support, Advisor or Review Panel member)Merck (Advisor or Review Panel member)Roche (Advisor or Review Panel member)
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Farrow, M., J. Biglands, S. Tanner, et al. "THU0522 DIFFERENCES IN MUSCLE PROPERTIES IN GCA PATIENTS COMPARED TO HEALTHY CONTROLS AS ASSESSED BY QUANTITATIVE MRI." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 500.2–500. http://dx.doi.org/10.1136/annrheumdis-2020-eular.6025.
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Background:Giant cell arteritis (GCA) is a systemic inflammatory vasculitis that often presents with headaches and visual symptoms. It is a medical emergency as it can lead to permanent sight loss. Prompt treatment with high doses of glucocorticoid therapy are often required. However, it has been shown that GCA patients on glucocorticoid therapy develop muscle weakness, known as glucocorticoid induced myopathy (1).Quantitative MRI may be sensitive to detect the differences in muscle parameters between newly diagnosed GCA patients compared to healthy controls. MRI T2 is sensitive to fluid related to physiological changes at the molecular level, and is regarded as an indirect measure of muscle inflammation (2). MRI muscle fat fraction (FF) is useful for identifying myosteatosis (3). Diffusion tensor imaging (DTI) is sensitive to changes in muscle microstructure and may be useful in identifying changes to muscle fibres (4).Objectives:To obtain preliminary estimates of the extent to which quantitative MRI-based measurements of muscle T2, FF, DTI and volume differ between newly diagnosed GCA patients and healthy controls (HC) and how the muscle changes over 3- and 6-month intervals following glucocorticoid therapy.Methods:MRI of the mid-thigh were acquired using Dixon imaging to assess FF, Stimulated Echo Acquisition Mode echo planar imaging (STEAM-EPI) to measure diffusion, and a fat-suppressed multi-echo spin-echo to measure T2. Regions of interest were drawn around the quadriceps and hamstrings. All participants had knee extension and flexion torque measured on an isokinetic dynamometer, and isometric dynamometer to measure grip strength.Results:20 GCA patients (68.2±8.3 years, 14/20 female, mean ESR 26.9mm/h, mean CRP 39.6mg/L) were enrolled within 14 days of starting glucocorticoids: 15 returned at 3 months (mean ESR 17mm/h, mean CRP 5.7mg/L); 8 returned at 6 months (mean ESR 18 mm/h, mean CRP 6mg/L). 20 directly age- and gender-matched HC also were recruited. T2 and FF were higher and muscle volume lower in the GCA patients at baseline compared to HC (fig. 1 and 2). Within the hamstrings, the mean differences between GCA patients and HC for T2, FF and muscle volume were 2.2ms (95% CI 1, 4; p=0.09), 3.8% (95% 2, 5; p<0.001), and -166cm3 (95% CI 110, 210; p<0.001) respectively. There was no substantive difference in mean diffusivity or fractional anisotropy. Results in the quadriceps followed a similar trend. Following glucocorticoid treatment, there were no substantive changes in MRI measurements. Knee flexion/extension and handgrip strength were lower in the GCA patients at baseline compared to HC, with differences of -5.3Nm (95% CI -32.6, -7.4; p=0.003) and -4.4Nm (95% CI -56.7, -1.3; p=0.04) for flexion and extension respectively. Muscle strength did not change following glucocorticoid treatment.Figure 1.Quantitative MRI measurements of GCA patients and healthy controls in the hamstrings.Conclusion:This pilot study suggests for the first time that muscle health may be affected in newly diagnosed GCA patients compared to age and gender matched HC, as demonstrated by higher T2 and FF, and lower muscle volume and muscle strength. These preliminary results show that muscle changes may occur in the early stages of GCA and persist throughout the disease duration. If these findings are confirmed, it will be important to consider interventions to improve muscle health in the treatment pathway for GCA.References:[1]Proven A, et al. Arthritis and rheumatism. 2003;49(5):703-8.[2]Maillard SM, et al. 2004;43(5):603-8.[3]Grimm A, et al. The Journal of Frailty & Aging. 2018.[4]Ran J, et al. 2016;263(7):1296-302.Figure 2.Quantitative muscle volume and muscle strength measurements of GCA patients and healthy controls.Disclosure of Interests:Matt Farrow: None declared, John Biglands: None declared, Steven Tanner: None declared, Elizabeth Hensor: None declared, Sarah Mackie Grant/research support from: Roche (attendance of EULAR 2019; co-applicant on research grant), Consultant of: Sanofi, Roche/Chugai (monies paid to my institution not to me), Paul Emery Grant/research support from: AbbVie, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Roche (all paid to employer), Consultant of: AbbVie (consultant, clinical trials, advisor), Bristol-Myers Squibb (consultant, clinical trials, advisor), Lilly (clinical trials, advisor), Merck Sharp & Dohme (consultant, clinical trials, advisor), Novartis (consultant, clinical trials, advisor), Pfizer (consultant, clinical trials, advisor), Roche (consultant, clinical trials, advisor), Samsung (clinical trials, advisor), Sandoz (clinical trials, advisor), UCB (consultant, clinical trials, advisor), Ai Lyn Tan: None declared
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Shalbak, Ihab. "Hegemony thinking." Thesis Eleven 147, no. 1 (2018): 45–61. http://dx.doi.org/10.1177/0725513618787660.
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This paper is concerned with the deployment and the transformation of Gramsci’s notion of hegemony and the purpose it serves. I argue that, in its travel from Rome to London, this notion acquired something like a truth-value. In London the notion yielded what I call ‘hegemony thinking’: a distinctive style of thinking that focused on strategy to carry out effective political interventions. To demonstrate my claim I trace the Marxism Today discussion on the crisis of the Left and strategy in the UK. In particular, I look at the engagements of the late historian Eric Hobsbawm and the cultural theorist Stuart Hall with Gramsci’s work, and examine the appropriation of the coordinates of hegemony by the entrepreneur and Blair policy advisor Geoff Mulgan.
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Erdem, Guliz, Joshua Watson, Don Buckingham, Octavio Ramilo, and William J. Barson. "1331. Reducing Inpatient Antimicrobial Treatment Duration for Febrile Infants through Implementation of Rapid Diagnostic Testing and Clinical Risk Definition." Open Forum Infectious Diseases 7, Supplement_1 (2020): S676—S677. http://dx.doi.org/10.1093/ofid/ofaa439.1513.
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Abstract Background The management approach to febrile infants remain challenging. Despite new advances in rapid diagnostic testing, febrile infants with a viral infection could receive prolonged antimicrobial treatment due to concerns for co-existing serious bacterial infection (SBI). We sought to decrease the duration of antibiotic treatment in febrile infants less than 8 weeks of age hospitalized on inpatient infectious disease service following sepsis evaluation, who have enterovirus, parechovirus, or respiratory viruses detected, from average 30 hours to 24 hours and sustain for six months. Figure 1. Antibiotic Treatment Duration of Infants Underfoing Evaluation for Sepsis Figure 2. Length of Stay in Infants Underfoing Sepsis Evaluation Methods A new management guideline that defined “low-risk” infants, as well as inclusion and exclusion criteria, was created to monitor the accurate duration of parenteral treatment and length of hospitalization. Respiratory viruses were detected by a multiplex PCR assay. We created a QlikSense App for further clinical characterization of patients and follow-up. This management guideline was adapted as a quality improvement division initiative. Control charts were used to assess the impact of the interventions. Figure 3. Readmissions in Infants Underfoing Sepsis Evaluation Results The management guideline was developed and implemented by pediatric infectious disease faculty. Febrile infants &lt; 8 weeks of age were included if they had both documented viral infections and sepsis evaluation. 178 infants were admitted with fevers in 2018 and 148 infants were admitted in 2019. The mean inpatient antibiotic treatment duration decreased from 27.7 hours in 2018 to 24.9 hours in 2019 (P &gt; 0.05) (Figure 1). There was no significant difference in length of hospitalization or 30-day readmission rates (Figure 2 and 3). There was no reported readmission for SBI. Conclusion Antibiotic treatment could be discontinued in clinically stable infants with a documented viral infection after 24 hours of negative blood, CSF, and urine bacterial culture incubation so as not to receive unnecessary prolonged inpatient treatment that may increase side effects. In addition to possible decreased treatment side effects our protocol led to decreased patient care costs with no documented changes in readmission rates. Disclosures Octavio Ramilo, MD, Bill & Melinda Gates Foundation (Grant/Research Support)Janssen (Grant/Research Support, Advisor or Review Panel member)Medimmune (Grant/Research Support)Merck (Advisor or Review Panel member)NIH/NIAID (Grant/Research Support)Pfizer (Consultant, Advisor or Review Panel member)Sanofi/Medimmune (Consultant, Advisor or Review Panel member)
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Norton, Brianna L., Brianna L. Norton, Nataly Rios Gutierrez, Chinazo O. Cunningham, and Alain H. Litwin. "1062. HCV GET-UP: A Group Evaluation and Treatment Uptake Intervention Improves HCV Linkage to Care for PWID." Open Forum Infectious Diseases 7, Supplement_1 (2020): S559—S560. http://dx.doi.org/10.1093/ofid/ofaa439.1248.
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Abstract Background Though PWID represent the overwhelming majority of those living with HCV in the United States, most have not been treated. PWID often have reduced access to specialty care, as well as limited HCV knowledge, low perceived vulnerability to poor HCV-related health outcomes, poor self-efficacy, high levels of perceived stigma, and mistrust of healthcare providers. We therefore evaluated an primary care based HCV Group Evaluation and Treatment UPtake (HCV GET-UP) intervention to improve HCV medical evaluation and treatment uptake for HCV+ PWIDs. Figure 1 Methods We enrolled 84 HCV+ PWID and randomize them 1:1 to a 4-week group evaluation intervention followed by individual treatment (intervention) versus onsite treatment alone (control). The group consisted of 4 weekly 1-hour sessions focused on HCV education, peer motivation, and health behavior change skills, along with an HCV medical evaluation. Both arms received HCV treatment according to national guidelines. Baseline questionnaires were performed via Audio Computer-Assisted Self-Interview (ACASI) technology. Clinical Data was extracted from the medical chart. Our primary outcomes were HCV linkage to care (HCV evaluation) and treatment uptake. Bivariate analyses were performed to evaluate HCV treatment outcomes between arms using chi square tests. Results Of the 76 participants that have currently completed the study (84 enrolled) 35% identified their race as black, 61% identified their ethnicity as Hispanic, 79% were male, and 25% of the participants were homeless. 87% had genotype 1, 28% were HIV+, and 20% had cirrhosis. Baseline urine tocixicologies were positive for cocaine in 38% of participants and 40% for heroin. Of those randomized to the group treatment arm vs individual arm 87% vs 62% were linked to care (p=0.012), 51% vs. 41% initiated treatment (p=.35), 41% vs. 35% completed treatment (p=0.6), and 33% vs. 27% (p=0.6) Conclusion HCV GET-UP, a primary-care based group evaluation and treatment uptake intervention significantly improved linkage to care for HCV+ PWID. Though this is encouraging, we must integrate other interventions to aid PWID as they move through the more proximal steps of the HCV cascade, for HCV cure still remains elusive for the majority of PWID enrolled. Disclosures Chinazo O. Cunningham, MD, MPH, General Electric Health (Other Financial or Material Support, My husband is currently employed by General Electric Health and receives stock and stock options.)Quest Diagnostics (Other Financial or Material Support, My husband was previously employed by Quest Diagnostics and received stocks and stock options.) Alain H. Litwin, MD, MPH, MS, Gilead (Advisor or Review Panel member)Merck (Advisor or Review Panel member)
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Cooper, Claudia, Ryan Li, Constantine Lyketsos, and Gill Livingston. "Treatment for mild cognitive impairment: systematic review." British Journal of Psychiatry 203, no. 4 (2013): 255–64. http://dx.doi.org/10.1192/bjp.bp.113.127811.
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BackgroundMore people are presenting with mild cognitive impairment (MCI), frequently a precursor to dementia, but we do not know how to reduce deterioration.AimsTo systematically review randomised controlled trials (RCTs) evaluating the effects of any intervention for MCI on cognitive, neuropsychiatric, functional, global outcomes, life quality or incident dementia.MethodWe reviewed 41 studies fitting predetermined criteria, assessed validity using a checklist, calculated standardised outcomes and prioritised primary outcome findings in placebo-controlled studies.ResultsThe strongest evidence was that cholinesterase inhibitors did not reduce incident dementia. Cognition improved in single trials of: a heterogeneous psychological group intervention over 6 months; piribedil, a dopamine agonist over 3 months; and donepezil over 48 weeks. Nicotine improved attention over 6 months. There was equivocal evidence that Huannao Yicong improved cognition and social functioning.ConclusionsThere was no replicated evidence that any intervention was effective. Cholinesterase inhibitors and rofecoxib are ineffective in preventing dementia. Further good-quality RCTs are needed and preliminary evidence suggests these should include trials of psychological group interventions and piribedil.Declarations of interestC.L. has received grant support (research or continuing medical education) from NIMH, NIA, Associated Jewish Federation of Baltimore, Weinberg Foundation, Forest, GlaxoSmithKline, Eisai, Pfizer, AstraZeneca, Lilly, Ortho-McNeil, Bristol-Myers Squibb, Novartis, National Football League (NFL), Elan, Functional Neuromodulation; and has been a consultant/advisor to AstraZeneca, GlaxoSmithKline, Eisai, Novartis, Forest, Supernus, Adlyfe, Takeda, Wyeth, Lundbeck, Merz, Lilly, Pfizer, Genentech, Elan, NFL Players Association, NFL Benefits Office, Avanir, Zinfandel, Bristol-Myers Squibb; and received honorarium or travel support from Pfizer, Forest, GlaxoSmithKline, Health Monitor.
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Yu, Mei-yu, Lixin Song, Amy Seetoo, Cuijuan Cai, Gary Smith, and Deborah Oakley. "Culturally Competent Training Program: A Key to Training Lay Health Advisors for Promoting Breast Cancer Screening." Health Education & Behavior 34, no. 6 (2006): 928–41. http://dx.doi.org/10.1177/1090198107304577.
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The lay health advisor (LHA) training program for breast cancer screening was conducted among Chinese– English bilingual trainees residing in Southeast Michigan. Guided by Bandura's Social Learning Theory, the development of the training curriculum followed the health communication process recommended by the National Cancer Institute. Data analysis based on questionnaires completed by 79 LHAs indicated that the breast cancer screening training program significantly increased LHAs' knowledge and self-efficacy ( p < .01, t test, two-tailed) and LHAs had a positive perception with regard to the training manual. Regression analysis found that LHAs who were younger, employed, and demonstrated a positive perception of the training manual tended to have higher self-efficacy in promoting breast cancer screening ( R2 = .30). This study suggests that a culturally competent training program effectively increases LHAs' self-efficacy. The findings have implications for developing effective LHA training programs in Asian American communities where LHA interventions are rarely implemented.
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Zhou, Yuan, Larissa Lewis, Michelle McIntosh, et al. "Risk factors for Clostridium difficile infection in C. difficile colonized ICU patients." Open Forum Infectious Diseases 4, suppl_1 (2017): S403. http://dx.doi.org/10.1093/ofid/ofx163.1007.
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Abstract Background Clostridium difficile is a major cause of healthcare-associated infections leading to significant morbidity and mortality; however, data-driven interventions to decrease C. difficile infections (CDI) are lacking due to an incomplete understanding of disease transmission and risk factors. Asymptomatic C. difficile carriers may be an important source of nosocomial transmission and disease but few studies have examined colonized patients who later develop CDI. We describe risk factors for the development of CDI in a critical care population screened for C. difficile colonization. Methods All patients admitted to our medical or trauma ICUs were screened for toxigenic C. difficile by PCR via rectal swab. Colonized patients were placed in contact enteric precautions for their entire hospitalization and monitored for signs and symptoms of CDI. Retrospective chart review assessed risk factors associated with development of CDI. Results 868 rectal swabs were collected from 4/01/16 to 10/31/16. 40 patients were colonized with C. difficile on ICU admission and 20 developed symptomatic CDI (Table 1). Risk factors for CDI in colonized patients include enteral feeding and exposure to antibiotics (Table 2). Conclusion 50% of C. difficile colonized ICU patients progressed to symptomatic CDI during their hospitalization. Antibiotic use was a significant risk factor for CDI. C. difficile carriers may be a particularly vulnerable population for CDI, warranting further investigation for early identification of colonized patients and strategies for infection prevention. Disclosures F. C. Fang, BioFire: Collaborator, Consultant and Scientific Advisor, Consulting fee, Research support and Speaker honorarium; Cepheid: Collaborator, Consultant and Scientific Advisor, Consulting fee, Educational grant, Research support and Speaker honorarium
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Byars-Winston, Angela, Belinda Gutierrez, Sharon Topp, and Molly Carnes. "Integrating Theory and Practice to Increase Scientific Workforce Diversity: A Framework for Career Development in Graduate Research Training." CBE—Life Sciences Education 10, no. 4 (2011): 357–67. http://dx.doi.org/10.1187/cbe.10-12-0145.
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Few, if any, educational interventions intended to increase underrepresented minority (URM) graduate students in biological and behavioral sciences are informed by theory and research on career persistence. Training and Education to Advance Minority Scholars in Science (TEAM-Science) is a program funded by the National Institute of General Medical Sciences at the University of Wisconsin–Madison with the twin goals of increasing the number of URM students entering and completing a PhD in BBS and increasing the number of these students who pursue academic careers. A framework for career development in graduate research training is proposed using social cognitive career theory. Based on this framework, TEAM-Science has five core components: 1) mentor training for the research advisor, 2) eight consensus-derived fundamental competencies required for a successful academic career, 3) career coaching by a senior faculty member, 4) an individualized career development plan that aligns students’ activities with the eight fundamental competencies, and 5) a strengths, weaknesses, opportunities, and threats personal career analysis. This paper describes the theoretical framework used to guide development of these components, the research and evaluation plan, and early experience implementing the program. We discuss the potential of this framework to increase desired career outcomes for URM graduate trainees in mentored research programs and, thereby, strengthen the effectiveness of such interventions on participants’ career behaviors.
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Aitken, Samuel L., Micah Bhatti, Pranoti Sahasrabhojane та ін. "1055. Epidemiology and Mechanisms of Carbapenem Resistance in Recurrent Extended-Spectrum β-Lactamase- Producing Enterobacteriaceae Bacteremia". Open Forum Infectious Diseases 5, suppl_1 (2018): S315. http://dx.doi.org/10.1093/ofid/ofy210.892.
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Abstract Background Carbapenems are the treatment of choice for bacteremia caused by extended spectrum β-lactamase producing Enterobacteriaceae (ESBL-E). The emergence carbapenem resistance (CR) in ESBL-E isolates has been described; however, the rate of such resistance in clinical settings is unknown. We describe the frequency and mechanisms of CR in recurrent ESBL-E bacteremia at an NCI-designated cancer center. Methods We performed a prospective whole genome sequencing (WGS) study and retrospective cohort review of adult (age ≥18 years) patients with ESBL-E bacteremia between January 2015 and July 2016. Recurrent bacteremia was defined as identification of the same organism in blood culture at any time following initial successful treatment. CR was defined as resistance to meropenem. Carbapenemase production was assessed in the microbiology laboratory using Carba-NP. Available paired isolates underwent WGS via Illumina HiSeq for assessment of clonality and identification of CR mechanisms. Results One hundred and sixteen patients with ESBL-E bacteremia were identified. E. coli was the most common organism (86%), followed by K. pneumoniae (12%), and K. oxytoca (2%). Recurrent bacteremia was identified in 17 (15%) patients (E. coli [n = 15], K. pneumoniae [n = 2]). Of these, 6 (35%) were CR and 5/6 (83%) were Carba-NP negative. All six recurrent CR isolates occurred in patients with leukemia. Five isolate pairs were available for WGS. In four of five pairs (three E. coli, one K. pneumoniae), CR emerged from the same strain causing the original infection; one recurrence was caused by a distinct E. coli with a OXA-48-like gene. Compared with parental strains, CR E. coli contained deletions in porin-encoding genes and had increased mapping depth for genes encoding CTX-M ESBLs. The K. pneumoniae was Carba-NP negative with no identifiable CR mechanism. Conclusion Emergence of CR following treatment for ESBL-E bacteremia was seen only in leukemia patients and was primarily due to porin loss and amplification of ESBL genes, rather than acquisition of exogenous carbapenemases. These are the first clinical data describing the molecular mechanism of ESBL-E transformation to CR. These data serve as the basis for future studies of antimicrobial stewardship interventions to limit the emergence of CR in ESBL-E. Disclosures S. L. Aitken, Shionogi: Scientific Advisor, Consulting fee. Medicines Company: Scientific Advisor, Consulting fee. Merck & Co.: Scientific Advisor, Consulting fee.
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Holt, Richard I. G., Rebecca Gossage-Worrall, Daniel Hind, et al. "Structured lifestyle education for people with schizophrenia, schizoaffective disorder and first-episode psychosis (STEPWISE): randomised controlled trial." British Journal of Psychiatry 214, no. 2 (2018): 63–73. http://dx.doi.org/10.1192/bjp.2018.167.
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BackgroundObesity is a major challenge for people with schizophrenia.AimsWe assessed whether STEPWISE, a theory-based, group structured lifestyle education programme could support weight reduction in people with schizophrenia.MethodIn this randomised controlled trial (study registration: ISRCTN19447796), we recruited adults with schizophrenia, schizoaffective disorder or first-episode psychosis from ten mental health organisations in England. Participants were randomly allocated to the STEPWISE intervention or treatment as usual. The 12-month intervention comprised four 2.5 h weekly group sessions, followed by 2-weekly maintenance contact and group sessions at 4, 7 and 10 months. The primary outcome was weight change after 12 months. Key secondary outcomes included diet, physical activity, biomedical measures and patient-related outcome measures. Cost-effectiveness was assessed and a mixed-methods process evaluation was included.ResultsBetween 10 March 2015 and 31 March 2016, we recruited 414 people (intervention 208, usual care 206) with 341 (84.4%) participants completing the trial. At 12 months, weight reduction did not differ between groups (mean difference 0.0 kg, 95% CI −1.6 to 1.7, P = 0.963); physical activity, dietary intake and biochemical measures were unchanged. STEPWISE was well-received by participants and facilitators. The healthcare perspective incremental cost-effectiveness ratio was £246 921 per quality-adjusted life-year gained.ConclusionsParticipants were successfully recruited and retained, indicating a strong interest in weight interventions; however, the STEPWISE intervention was neither clinically nor cost-effective. Further research is needed to determine how to manage overweight and obesity in people with schizophrenia.Declaration of interestR.I.G.H. received fees for lecturing, consultancy work and attendance at conferences from the following: Boehringer Ingelheim, Eli Lilly, Janssen, Lundbeck, Novo Nordisk, Novartis, Otsuka, Sanofi, Sunovion, Takeda, MSD. M.J.D. reports personal fees from Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, Servier, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceuticals International Inc.; and, grants from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, Janssen. K.K. has received fees for consultancy and speaker for Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Servier and Merck Sharp & Dohme. He has received grants in support of investigator and investigator-initiated trials from Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme. K.K. has received funds for research, honoraria for speaking at meetings and has served on advisory boards for Lilly, Sanofi-Aventis, Merck Sharp & Dohme and Novo Nordisk. D.Sh. is expert advisor to the NICE Centre for guidelines; board member of the National Collaborating Centre for Mental Health (NCCMH); clinical advisor (paid consultancy basis) to National Clinical Audit of Psychosis (NCAP); views are personal and not those of NICE, NCCMH or NCAP. J.P. received personal fees for involvement in the study from a National Institute for Health Research (NIHR) grant. M.E.C. and Y.D. report grants from NIHR Health Technology Assessment, during the conduct of the study; and The Leicester Diabetes Centre, an organisation (employer) jointly hosted by an NHS Hospital Trust and the University of Leicester and who is holder (through the University of Leicester) of the copyright of the STEPWISE programme and of the DESMOND suite of programmes, training and intervention fidelity framework that were used in this study. S.R. has received honorarium from Lundbeck for lecturing. F.G. reports personal fees from Otsuka and Lundbeck, personal fees and non-financial support from Sunovion, outside the submitted work; and has a family member with professional links to Lilly and GSK, including shares. F.G. is in part funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care Funding scheme, by the Maudsley Charity and by the Stanley Medical Research Institute and is supported by the by the Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.
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Wade, Ros, Alexis Llewellyn, Julie Jones-Diette, et al. "VP16 Interventional Management Of Hyperhidrosis: A Systematic Review." International Journal of Technology Assessment in Health Care 33, S1 (2017): 153–54. http://dx.doi.org/10.1017/s0266462317003105.
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INTRODUCTION:Hyperhidrosis is characterized by uncontrollable excessive sweating, which occurs at rest, regardless of temperature, and can significantly affect quality of life. There is substantial variation in the availability of treatments in secondary care and uncertainty regarding optimal patient management. A systematic review was undertaken to assess the clinical effectiveness of treatments prescribed by dermatologists (iontophoresis, anticholinergic medications, botulinum toxin injections) and minor surgical treatments (curettage and newer energy based technologies) for primary hyperhidrosis and identify areas for further research.METHODS:Fifteen databases and trial registers were searched to July 2016. Pairwise meta-analyses were conducted for comparisons between botulinum toxin injections and placebo for axillary hyperhidrosis. For other treatments data were synthesised narratively due to limited and heterogeneous data.RESULTS:Fifty studies were included in the review; thirty-two randomized controlled trials (RCTs), seventeen non-RCTs and one case series. There was substantial variation between the studies in terms of country of origin (indicating climate and population differences), interventions and methods of outcome assessment. Most studies were small, at high risk of bias and poorly reported. There was moderate quality evidence of a large statistically significant effect of botulinum toxin injections on axillary hyperhidrosis symptoms in the short to medium term (up to 16 weeks), compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was low or very low quality. Combining the evidence and patient advisor input, we established that further research on the clinical and cost-effectiveness of botulinum toxin injections (with anesthesia) versus iontophoresis for palmar hyperhidrosis would be useful.CONCLUSIONS:The evidence for the effectiveness and safety of treatments for primary hyperhidrosis is limited overall and few firm conclusions can be drawn. However, there is moderate quality evidence to support the use of botulinum toxin injections for axillary hyperhidrosis. A trial comparing botulinum toxin injections with iontophoresis for palmar hyperhidrosis is warranted.
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Choe, Hannah, Nirav N. Shah, Patrice Chevallier, et al. "A Single-Arm, Open-Label Phase 1 Study of Itacitinib (ITA) with Calcineurin Inhibitor (CNI)-Based Interventions for Prophylaxis of Graft-Versus-Host Disease (GVHD; GRAVITAS-119)." Blood 136, Supplement 1 (2020): 50–51. http://dx.doi.org/10.1182/blood-2020-140747.
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Background Despite prophylaxis, GVHD remains a significant cause of morbidity and nonrelapse mortality after allogeneic hematopoietic cell transplantation (HCT). ITA is a potent, selective Janus kinase (JAK) 1 inhibitor that has been combined safely with steroids in patients (pts) with acute GVHD. We describe results from a proof-of-concept study evaluating ITA + CNI-based regimens for GVHD prophylaxis. Study Design and Methods GRAVITAS-119 (NCT03320642) was a single-arm, open-label study enrolling pts aged ≥18 y undergoing allogeneic HCT using peripheral blood stem cells from 8/8 or 7/8 matched related or unrelated donors for a hematologic malignancy. Eligible pts were candidates for reduced-intensity conditioning with Karnofsky Performance Status ≥70%. Pts were excluded for prior HCT, JAK inhibitor therapy, or active uncontrolled infection. Pts received oral ITA 200 mg once daily (QD) beginning 3 d before HCT + tacrolimus (Tac)/methotrexate (MTX) or cyclosporine A (CSA)/mycophenolate mofetil (MMF) ± antithymocyte globulin (ATG) per institutional practice. ITA dose reduction/interruption was permitted for toxicity. ITA was reduced to 100 mg QD by Day 90 and discontinued by Day 180 unless pts required systemic GVHD treatment (tx), had malignancy relapse or unacceptable toxicity, or withdrew consent. The primary endpoint was Day 28 hematologic recovery (absolute neutrophil count [ANC] ≥500/mm3 for 3 consecutive measurements and platelets [plt] ≥20,000/mm3 with no transfusions in the preceding 3 d). Secondary endpoints included incidence of acute and chronic GVHD, GVHD- and relapse-free survival (GRFS), overall survival, and safety. Results Sixty-five pts were enrolled and treated with ITA + Tac/MTX (n=41; +ATG, n=8; no ATG, n=33) or ITA + CSA/MMF (n=24; +ATG, n=16; no ATG, n=8). Median (range) age was 65 (25-76) y, and 57% were male. The most common underlying malignancies were acute myeloid leukemia (40%) and myelodysplastic syndrome (26%). Disease risk index was classified as low, intermediate, and high in 11%, 66%, and 23% of pts, respectively. Pts received grafts from matched related (51%), matched unrelated (40%), or single-antigen mismatched unrelated (9%) donors. Busulfan/fludarabine (51%) and a fludarabine/melphalan reduced-intensity regimen (18%) were the most common conditioning regimens; 11% of regimens contained total body irradiation. Median (range) exposure to ITA was 140 (10-187) d; 74% received ITA for &gt;90 d. All pts achieved hematologic recovery. Median (range) time to ANC and plt recovery among patients who had count nadir (ANC &lt;500/mm3 and/or plt &lt;20,000/mm3) was 17 (4-31) and 14 (9-26) d, respectively. ANC recovery was on Day 31 for 1 pt with secondary myelofibrosis (MF). Two pts had secondary graft failure, 1 on tx (Tac/MTX/ATG; Day 65), with no evidence of viral infection, and 1 during post-tx follow-up (Tac/MTX; Day 182); both underwent retransplantation. Malignancy relapse (median follow-up, 363 d) occurred in 12 pts (18%), including 3 pts with molecular/cytogenetic relapse requiring intervention. In 63 evaluable pts, cumulative incidence of grade III/IV acute GVHD at Day 180 was 4.8% and 1-y GRFS was 38.5%. Secondary efficacy endpoints by tx group are in Table 1. The most common grade 3/4 hematologic adverse events (AEs) were thrombocytopenia (49%) and anemia (31%). 17 pts (26%) had cytomegalovirus reactivations (n=10 +ATG), 8 (12%) had Epstein-Barr virus (EBV) infection (no post-transplant lymphoproliferative disorder cases; all +ATG), and 1 pt (2%) had invasive bronchopulmonary aspergillosis (Tac/MTX +ATG). AEs (22%) and relapse (17%) were the most common reasons for ITA discontinuation; the most common AEs leading to discontinuation were mixed chimerism (6%), thrombocytopenia (3%), and hypertriglyceridemia (3%). 8 pts in the +ATG group received post-transplant rituximab for EBV infection (n=7) and/or azaciditine maintenance therapy (n=3). 15 pts (24%) in the per-protocol population died. 3 deaths occurred on tx due to infections (n=2) and intracranial hemorrhage (n=1; Table 2). Conclusions Results from this small open-label trial in a heterogeneous pt population demonstrated that GVHD prophylaxis with ITA + CNI-based regimens was well tolerated and rates of severe acute GVHD were low. 1 pt with MF did not achieve ANC recovery on Day 28. An ITA + Tac + post-transplant cyclophosphamide cohort is currently being investigated in GRAVITAS-119. Disclosures Shah: Cell Vault: Research Funding; Celgene: Consultancy, Honoraria; Miltenyi Biotec: Honoraria, Research Funding; Kite Pharma: Consultancy, Honoraria; Incyte: Consultancy; TG Therapeutics: Consultancy; Verastim: Consultancy; Lily: Consultancy, Honoraria. Chevallier:Incyte Corporation: Honoraria. Rubio:Medac: Consultancy; MSD: Honoraria; Gilead: Honoraria; Neovii: Research Funding; Novartis: Honoraria. Schroeder:Astellas: Other; Dova Pharmaceuticals: Other; FlatIron Inc: Other; GSK: Other; Gilead Sciences Inc: Other; Novo Nordisk: Other; Genentech Inc: Research Funding; Merck: Consultancy, Honoraria, Speakers Bureau; Takeda: Consultancy, Honoraria, Speakers Bureau; Incyte Corporation: Other: served on advisory boards and received honoraria or consultant fees, Research Funding; Cellect Inc: Research Funding; Janssen: Research Funding; Partners Therapeutics: Other; Pfizer: Other; AbbVie: Consultancy, Honoraria, Speakers Bureau; Fortis: Research Funding; Seattle Genetics: Research Funding; Amgen: Other: served on advisory boards and received honoraria or consultant fees, Research Funding; Celgene: Research Funding; PBD Incorporated: Research Funding; Genzyme Sanofi: Other: served on advisory boards and received honoraria or consultant fees, Research Funding. Hardy:Incyte Corporation: Other: Advisory Board Member; Kite/Gilead: Other: Advisory Board Member; American Gene Technologies: Other: DSMB Member. Stiff:Kite, a Gilead Company: Research Funding; Amgen: Research Funding; Gamida Cell: Research Funding; Atara: Research Funding; Unum: Research Funding; Delta-Fly: Research Funding; Macrogenics: Research Funding. Solano:Incyte Corporation: Other: Received fees for an advisory role. Yakoub-Agha:Celgene: Honoraria; Novartis: Honoraria; Gilead/Kite: Honoraria, Other: travel support; Janssen: Honoraria; Jazz Pharmaceuticals: Honoraria. Rowley:AbbVie: Current equity holder in publicly-traded company; FATE Therapeutics: Consultancy. Duarte:Incyte Corporation: Other: Has received speaker and advisor fees. Morariu-Zamfir:Incyte Corporation: Current Employment, Current equity holder in publicly-traded company. Arbushites:Incyte Corporation: Current Employment, Current equity holder in publicly-traded company. Ding:Incyte Corporation: Current Employment, Current equity holder in publicly-traded company. Perales:Miltenyi Biotec: Research Funding; Kite/Gilead: Honoraria, Research Funding; Incyte Corporation: Honoraria, Research Funding; Nektar Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Cidara Therapeutics: Other; Servier: Membership on an entity's Board of Directors or advisory committees, Other; NexImmune: Membership on an entity's Board of Directors or advisory committees; Medigene: Membership on an entity's Board of Directors or advisory committees, Other; Omeros: Honoraria, Membership on an entity's Board of Directors or advisory committees; MolMed: Membership on an entity's Board of Directors or advisory committees; Bellicum: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Consultancy, Honoraria; Bristol Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria. OffLabel Disclosure: Itacitinib is a novel JAK1 inhibitor that has not been approved for use in acute GVHD or for any other indication.
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Gibbs, Kenneth D., John McGready, and Kimberly Griffin. "Career Development among American Biomedical Postdocs." CBE—Life Sciences Education 14, no. 4 (2015): ar44. http://dx.doi.org/10.1187/cbe.15-03-0075.
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Recent biomedical workforce policy efforts have centered on enhancing career preparation for trainees, and increasing diversity in the research workforce. Postdoctoral scientists, or postdocs, are among those most directly impacted by such initiatives, yet their career development remains understudied. This study reports results from a 2012 national survey of 1002 American biomedical postdocs. On average, postdocs reported increased knowledge about career options but lower clarity about their career goals relative to PhD entry. The majority of postdocs were offered structured career development at their postdoctoral institutions, but less than one-third received this from their graduate departments. Postdocs from all social backgrounds reported significant declines in interest in faculty careers at research-intensive universities and increased interest in nonresearch careers; however, there were differences in the magnitude and period of training during which these changes occurred across gender and race/ethnicity. Group differences in interest in faculty careers were explained by career interest differences formed during graduate school but not by differences in research productivity, research self-efficacy, or advisor relationships. These findings point to the need for enhanced career development earlier in the training process, and interventions sensitive to distinctive patterns of interest development across social identity groups.
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Bixby, Morgan L., Brian R. Raux, Aakansha Bhalla, Christopher McCoy, and Elizabeth B. Hirsch. "219. Characteristics Associated with Inappropriate Antibiotic Prescribing in Patients with Asymptomatic Bacteriuria (ASB)." Open Forum Infectious Diseases 7, Supplement_1 (2020): S111. http://dx.doi.org/10.1093/ofid/ofaa439.263.
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Abstract Background Antibiotic treatment of asymptomatic bacteriuria (ASB) is considered inappropriate, does not improve patient outcomes, and may lead to adverse events such as antibiotic resistance and Clostridioides difficile infection. Previous stewardship interventions have focused on reducing unnecessary urine culture collection in individuals without urinary symptoms; however, further interventions to reduce inappropriate prescribing in ASB are warranted. This study sought to identify characteristics associated with treatment of ASB in order to implement future stewardship interventions. Methods This two-center, retrospective cohort study included unique emergency department or inpatient adults with consecutive non-duplicate monomicrobial urine isolates of Enterobacterales or Pseudomonas aeruginosa collected between 8/2013 and 1/2014 from two academic hospitals in Boston, Massachusetts. Patients with ASB (without chart-documented urinary-specific symptoms) were identified through chart review and stratified into two groups: those treated with empiric urinary tract infection (UTI) antibiotics and those untreated. Logistic regression analyses were performed to identify variables independently associated with antibiotic treatment of ASB. Results During the study, 255 patients were determined to have ASB and a majority (80.8%) were treated with empiric UTI antibiotics. Most patients were female (71.4%) and elderly (mean age 70 years). The most common organisms isolated were Escherichia coli (59.2%), Klebsiella spp. (23.1%), and P. aeruginosa (9.8%). The presence of isolated fever (OR, 7.83 [95% confidence interval, 1.51, 144.20]); p = 0.05), urinalysis positive for pyuria (&gt;10 white blood cells) (OR, 2.52 [95% CI, 1.15, 5.54]; p = 0.02), and Klebsiella spp. urine isolate (OR, 2.99 [95% CI, 1.19, 8.60]; p = 0.02) were independently associated with treatment. Conclusion A large proportion of ASB patients were treated with antibiotics despite clinical practice guidelines recommending against this practice. Isolated fever, pyuria, and Klebsiella spp. culture were all significantly associated with the treatment of ASB; targeted review of these patients by stewardship programs may help to reduce inappropriate ASB treatment within these institutions. Disclosures Elizabeth B. Hirsch, PharmD, Merck (Grant/Research Support) Nabriva Therapeutics (Advisor or Review Panel member)
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Ramazani, Suzanne, Nathaniel D. Bayer, Julie Albright Gottfried, et al. "The Value of Family Advisors as Coleaders in Pediatric Quality Improvement Efforts: A Qualitative Theme Analysis." Journal of Patient Experience 7, no. 6 (2020): 1708–14. http://dx.doi.org/10.1177/2374373520939827.
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Engaging family advisors in pediatric quality improvement (QI) efforts is well-studied in intensive care but less understood in other settings. The purpose of this study was to assess the perceived impact of including a family advisor as a colead on a QI initiative that successfully improved the family-centered timing of routine morning blood tests performed on pediatric inpatients. Five structured written reflections from core QI team members were analyzed using inductive thematic analysis and 3 major themes were identified. The first found that a family advisor’s presence from the beginning of a QI initiative helps inform project design. The second determined that family partners working with residents fostered a better shared understanding of the role of trainees and caregivers in improving the quality of care. The third found that a family partner is an effective change agent to enact practice improvement, support professional development, and enhance resident education. Our qualitative analysis showed that engaging a family advisor as a colead influenced the design, implementation, and post-intervention impact of the initiative and improved family-centered outcomes.
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Bradt, D. A., and P. Aitken. "(A59) Advent of the Confide Guidelines for Disaster Medicine Reporting." Prehospital and Disaster Medicine 26, S1 (2011): s16. http://dx.doi.org/10.1017/s1049023x11000665.
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Disaster reports are common in the literature. Accurate and complete reporting assists readers and researchers in developing best practices. There have been notable efforts, such as the Utstein Template, to standardize the language of disasters and promote consistent use of definitions. However, case reports are complicated by the presence of four dominant types recognized in the literature. Moreover, the disciplines of medicine, public health, and disaster management differ in origins, definitions, research paradigms, and tools of evidence-based decision-making. Finally, biomedical journal guidelines for authors writing disaster case reports have lacked the rigor of standards associated with observational studies (2007 STROBE statement, 2010 MOOSE statement), or with randomized controlled trials (1996 CONSORT statement, 1999 QUORUM statement). This paper examines current efforts to intensify the rigor of future disaster case reports through uniform reporting requirements for authors. The initial workgroup comprised editorial board members of two biomedical journals indexed in the US National Library of Medicine—Prehospital and Disaster Medicine, and Emergency Medicine Australasia. The workgroup members self-selected based on extensive disaster field experience as technical advisor with governmental, non-governmental, Red Cross and UN agencies. The workgroup identified key information needed to understand the context, structure, process, and outcome/impact of disaster field interventions. Then, the workgroup organized this information in thematic domains. Consensus guidelines emerged for Reports of Field Interventions in Disasters and Emergencies (CONFIDE). The CONFIDE Statement addresses 16 keys areas within seven domains, including: field authorization for access, field logistics, initial assessment, clinical epidemiology, and funding. The Statement was first published in December 2010, at which time, the authors began integrating the guidelines with biomedical journal instructions for authors. The paper details current efforts to broaden editorial acceptance of the guidelines, implications for future authors, and potential benefits to the disaster medicine community.
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Malone, Kevin M., Seamus G. McGuinness, Eimear Cleary, Janis Jefferies, Christabel Owens, and Cecily C. Kelleher. "Lived Lives: A Pavee Perspective. An arts-science community intervention around suicide in an indigenous ethnic minority." Wellcome Open Research 2 (April 13, 2017): 27. http://dx.doi.org/10.12688/wellcomeopenres.11330.1.
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Background: Suicide is a significant public health concern, which impacts on health outcomes. Few suicide research studies have been interdisciplinary. We combined a psychobiographical autopsy with a visual arts autopsy, in which families donated stories, images and objects associated with the lived life of a loved one lost to suicide. From this interdisciplinary research platform, a mediated exhibition was created (Lived Lives) with artist, scientist and families, co-curated by communities, facilitating dialogue, response and public action around suicide prevention. Indigenous ethnic minorities (IEMs) bear a significant increased risk for suicide. Irish Travellers are an IEM with social and cultural parallels with IEMs internationally, experiencing racism, discrimination, and poor health outcomes including elevated suicide rates (SMR 6.6). Methods: An adjusted Lived Lives exhibition, Lived Lives: A Pavee Perspective manifested in Pavee Point, the national Traveller and Roma Centre. The project was evaluated by the Travelling Community as to how it related to suicide in their community, how it has shaped their understanding of suicide and its impacts, and its relevance to other socio-cultural contexts, nationally and internationally. The project also obtained feedback from all relevant stakeholders. Evaluation was carried out by an international visual arts research advisor and an independent observer from the field of suicide research. Results: Outputs included an arts-science mediated exhibition with reference to elevated Irish Traveller suicide rates. Digital online learning materials about suicide and its aftermath among Irish Travellers were also produced. The project reached its target audience, with a high level of engagement from members of the Travelling Community. Discussion: The Lived Lives methodology navigated the societal barriers of stigma and silence to foster communication and engagement, working with cultural values, consistent with an adapted intervention. Feedback from this project can inform awareness, health promotion, education and interventions around suicide and its aftermath in IEMs.
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Wolf,, Zane Robinson, Denise Nagle Bailey,, and Patricia A. Keeley,. "Creation of a Caring Protocol: Activities and Dissemination Strategies in Caring Research and Instruments." International Journal of Human Caring 18, no. 1 (2014): 66–82. http://dx.doi.org/10.20467/1091-5710.18.1.66.
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Few acute care healthcare agencies have tested the effect of a caring-focused program on the satisfaction of hospitalized, adult patients. Caring interventions need to be tested to document the effectiveness of nurse caring on a healthcare outcome, patient satisfaction. This study identified critical elements in interventional studies on nurse caring by determining patterns and caring activities in interventions (programs, protocols, or standards) to develop a caring protocol for a National Cancer Institute Comprehensive Cancer Center (NCICCC). Research, other published articles on caring programs, and instruments were analyzed for patterns and elements indicative of caring behaviors or activities representing nurse caring that could contribute to a caring intervention. Intervention dissemination strategies were also analyzed for incorporation into the program’s implementation in a nursing department of the NCICCC. Content analysis techniques identified patterns and activities in caring interventions and intervention dissemination strategies. Comments and written suggestions on the draft caring protocol were solicited from agency stakeholders (N = 22), including administrators, key nursing staff, and members of the Patient Family Advisory Council. The caring protocol/standard of practice and dissemination strategies were identified.
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Neelapu, Sattva S., Armin Ghobadi, Caron A. Jacobson, et al. "2-Year Follow-up and High-Risk Subset Analysis of Zuma-1, the Pivotal Study of Axicabtagene Ciloleucel (Axi-Cel) in Patients with Refractory Large B Cell Lymphoma." Blood 132, Supplement 1 (2018): 2967. http://dx.doi.org/10.1182/blood-2018-99-111368.
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Abstract Background: Axi-cel is a US FDA-approved, autologous anti-CD19 chimeric antigen receptor (CAR) T cell therapy for the treatment of patients with relapsed or refractory large B cell lymphoma with ≥ 2 prior systemic therapies. This report focuses on high-risk patient populations as well as long-term durability of response, and B cell recovery. Methods: In ZUMA-1, eligible patients with refractory large B cell lymphoma (diffuse large B cell lymphoma, primary mediastinal B cell lymphoma, transformed follicular lymphoma) underwent leukapheresis and received low-dose conditioning followed by a target dose of 2 × 106 anti-CD19 CAR T cells/kg (Neelapu and Locke et al. NEJM. 2017; NCT02348216). Outcomes in patients with double-expressor B cell lymphoma (MYC [≥ 40%] and BCL-2 [≥ 50%] protein expression by immunohistochemistry [IHC]) or high-grade B cell lymphoma (HGBCL), defined as double- or triple-hit (MYC+ and BCL2+ and/or BCL6+ by fluorescence in situ hybridization) or not otherwise specified (MYC- and > 70% Ki67 by IHC) were examined by independent pathology review. Exploratory analyses, including normal B cell levels in peripheral blood over time and frequency of use of safety interventions of interest, were also performed. A long-term follow-up analysis will be conducted with a data cutoff of August 11, 2018 for all 108 patients, including the HGBCL subgroup. Results: As of August 11, 2017, all 108 patients had at least 1 year of follow-up, with a median follow-up of 15.4 months. The objective response rate (ORR) was 82% with a complete response (CR) rate or 58%. The CR rate was 53% (29/55) in patients with disease refractory to ≥ 2 consecutive prior lines of therapy and 72% (18/25) in patients who had relapsed within 12 months after autologous stem cell transplantation. High-risk genetics were assessed in the 47 evaluable pre-treatment tumor samples: 37 patients (79%) had HGBCL or double-expressor B cell lymphoma and had an ORR of 89% (33/37) including a CR rate of 68% (25/37). Forty-two percent of patients overall had ongoing responses with a median follow-up of 15.4 months including 49% (18/37) of patients with high-risk genetics. To investigate the relationship between B cell recovery and ongoing response, B cell levels were assessed over time. Overall, of the 87 evaluable patients, 47% had no detectable B cells at baseline, and the remainder had levels close to or below the lower level of quantification of the assay. In patients with ongoing responses at 12 months post axi-cel infusion, 19 of the 35 (54%) patients with evaluable samples had detectable B cells at 12 months. This suggests B cell recovery in some patients with ongoing response as only 6 of 40 (15%) patients with evaluable samples had detectable B cells at 3 months after axi-cel infusion. Grade ≥ 3 cytokine release syndrome (CRS) and neurologic events (NE) were generally reversible and reported for 12% and 31% of patients, respectively. Tocilizumab (45%) and/or steroids (28%) were used for the management of CRS and NE. The use of vasopressors, dialysis, and intubation were minimal, used in only 17%, 3%, and 3% of patients, respectively. Thirty-four percent of patients (37/108) had either no CRS/NE (6%) or only Grade 1 CRS with (12%) or without (16%) Grade 1 NE. For these 37 patients, the median onset of CRS and NE was 2 and 7 days after infusion, respectively. Patients with Grade 0 - 1 CRS/NE had similar efficacy (ORR, 86%; CR, 65%) but lower peak/AUC CAR T cell levels vs the overall population. Updated safety and efficacy results will be presented with a minimum follow-up of 2 years and a median follow-up of 27.1 months. Conclusion: High rates of durable response were observed in patients with HGBCL and double-expressor B cell lymphoma, with approximately half of these patients (18/37) maintaining CR at ≥ 1 year. Efficacy in these high-risk populations was comparable to the overall patient population in ZUMA-1. At 12 months, B-cell recovery was observed in over half the patients with ongoing remission. About one-third of patients had only Grades 0 - 1 CRS/NE yet showed comparable efficacy with the overall patient population. High-grade CRS/NE were largely managed with tocilizumab and steroids with very low use of intensive or invasive interventions. Updated outcomes with a minimum of 2 years of follow-up will be presented. Disclosures Neelapu: Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Cellectis: Research Funding; Poseida: Research Funding; Merck: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Acerta: Research Funding; Karus: Research Funding; Bristol-Myers Squibb: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees; Unum Therapeutics: Membership on an entity's Board of Directors or advisory committees; Kite/Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Miklos:Adaptive Biotechnologies: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Pharmacyclics - Abbot: Consultancy, Research Funding; Kite - Gilead: Consultancy, Research Funding; Genentech: Research Funding; Janssen: Consultancy, Research Funding. Hill:Pharmacyclics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Research Funding; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pharmacyclics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Genentech: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees. Deol:Novartis: Consultancy; Kite Pharmaceuticals: Consultancy. Reagan:Seattle Genetics: Research Funding. Flinn:Agios: Research Funding; Forty Seven: Research Funding; Celgene: Research Funding; Calithera: Research Funding; Portola: Research Funding; Kite: Research Funding; Forma: Research Funding; Genentech: Research Funding; Verastem: Research Funding; BeiGene: Research Funding; Incyte: Research Funding; Seattle Genetics: Research Funding; Trillium: Research Funding; Janssen: Research Funding; Merck: Research Funding; TG Therapeutics: Research Funding; ArQule: Research Funding; Constellation: Research Funding; Infinity: Research Funding; Novartis: Research Funding; Gilead: Research Funding; Curis: Research Funding; Pharmacyclics: Research Funding; Verastem: Consultancy, Research Funding; Takeda: Research Funding; Pfizer: Research Funding. McSweeney:Kite, a Gilead Company: Honoraria, Membership on an entity's Board of Directors or advisory committees. Munoz:Alexion: Consultancy; Genentech: Consultancy, Honoraria; Juno: Consultancy, Honoraria; Pharmacyclics: Consultancy, Honoraria; Janssen: Consultancy; Kite: Consultancy, Honoraria, Speakers Bureau; Bayer: Consultancy, Speakers Bureau; Gilead: Speakers Bureau; Pfizer: Consultancy; Bristol-Myers Squibb: Consultancy. Siddiqi:Juno Therapeutics: Other: Steering committee. Herrera:Bristol-Myers Squibb: Consultancy, Research Funding; Genentech: Consultancy, Research Funding; Seattle Genetics: Research Funding; Pharmacyclics: Consultancy, Research Funding; AstraZeneca: Research Funding; Gilead Sciences: Research Funding; Merck, Inc.: Consultancy, Research Funding; KiTE Pharma: Consultancy, Research Funding; Immune Design: Research Funding. Xue:Kite, a Gilead Company: Employment. Jiang:Kite, a Gilead Company: Employment. Bot:KITE: Employment. Rossi:KITE: Employment. Kim:Kite, a Gilead Company: Employment. Go:KITE: Employment. Locke:Cellular BioMedicine Group Inc.: Consultancy; Novartis Pharmaceuticals: Other: Scientific Advisor; Kite Pharma: Other: Scientific Advisor.
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Strauß, Nadine. "Communicating Sustainable Responsible Investments as Financial Advisors: Engaging Private Investors with Strategic Communication." Sustainability 13, no. 6 (2021): 3161. http://dx.doi.org/10.3390/su13063161.
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Although sustainable responsible investing (SRI) has increasingly become popular on the financial markets, the potential of raising capital from private investors for sustainable development has not been efficiently seized thus far. The lack of knowledge and training about SRI by financial advisors has often been identified as one of the main reasons for this investment gap. In order to accelerate the role of financial advisors as change agents for SRI, this study proposes several strategic communication interventions that advisors could employ in their advisory talks to raise more attention and engagement among private investors for SRI. The interventions proposed are oriented on the 5A model of SRI decision making by Herwig Pilaj and drawn from an interdisciplinary literature review on sustainability, communication, and attitudinal and behavioral change. The results provide a perspective and practical guide for financial advisors on how to effectively communicate SRI to private investors. Limitations and areas future research are discussed.
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Kirk-Kuwaye, Michael, and Dawn Nishida. "Effect of Low and High Advisor Involvement on the Academic Performances of Probation Students." NACADA Journal 21, no. 1-2 (2001): 40–45. http://dx.doi.org/10.12930/0271-9517-21.1-2.40.
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While advisors can find support in theory and practice for assisting students who are performing poorly in academics, the optimal involvement level for improving academic performance is undetermined. We conducted three experimental trials to compare low- and high-involvement of advisors assisting probation students. The involvement levels for the low-involvement groups were identical, while involvement varied among those groups receiving the high-involvement treatment. We found a significant difference in academic performance only between the group that experienced the greatest advisor involvement and the simultaneously assessed low-involvement group. The results suggest that full institutional intervention is needed to effectively help probation students.
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Raval, Amit D., Kristin Kistler, Yuexin Tang, Yoshihiko Murata, and David R. Snydman. "1706. Association between Cytomegalovirus Infection/Disease and Morbidity and Mortality in Kidney Transplantation: A Systematic Literature Review of Observational Studies." Open Forum Infectious Diseases 7, Supplement_1 (2020): S835—S836. http://dx.doi.org/10.1093/ofid/ofaa439.1884.
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Abstract Background Cytomegalovirus (CMV) is a common pathogen in kidney transplant recipients (KTRs). KTRs may develop CMV viremia that is asymptomatic (‘CMV infection’) or associated with clinical and laboratory findings (‘CMV disease’) such as fever, leukopenia/neutropenia, and malaise (‘CMV syndrome’), and/or evidence of specific organ(s) involvement (‘CMV end-organ disease’). The extent to which CMV affects morbidity such as acute rejection (AR), graft loss (GL), other opportunistic infections (OI), or mortality in KTRs has not been systematically evaluated recently. Therefore, we examined the association between CMV infection/disease and morbidity and mortality in KTRs using a systematic review of observational studies from the last decade. Methods MEDLINE and Embase were searched to identify observational studies published between January 2008 and November 2018 reporting outcomes of interest by CMV status. Meta-analysis was used to derive pooled odds ratio (pOR) with 95% confidence intervals(CIs) using the random-effects models and I2 statistics to estimate heterogeneity between studies using R version 3.5.1. Results Of 1,860 retrieved citations, 23 studies with a total of 6,994 KTRs met inclusion criteria. The majority of studies were conducted in Europe (N=14) and included participants regardless of donor/recipient CMV serostatus (N=14). Included studies reported outcomes by different clinical manifestations of CMV. Overall, CMV infection/disease was associated with an increased odd of AR, with significant heterogeneity. CMV infection/disease was also associated with an increase in the odds of GL and mortality compared to no CMV infection/disease without heterogeneity (Figure 1). A higher rate of all-cause hospital readmission and a greater mean number of OI episodes were reported with CMV infection/disease in a single study. Pooled Estimates on the Association between Outcomes and CMV Infection/Disease among Individuals undergoing Kidney Transplant Conclusion CMV infection/disease was associated with increased mortality and GL in adults with KT. The association between CMV and AR remained similar in direction with high heterogeneity limiting the robustness of the conclusion. Nonetheless, our analysis underscores the importance of interventions to reduce the incidence of CMV infection/disease to reduce mortality and GL in KTRs even in the current era. Disclosures Amit D. Raval, PhD, Merck and Co., Inc (Employee) Kristin Kistler, PhD, Evidera, Inc. (Employee, Evidera, Inc. received the funding to conduct this study.) Yuexin Tang, PhD, Merck and Co., Inc. (Employee) Yoshihiko Murata, MD, PhD, Merck and Co., Inc. (Employee) David R. Snydman, MD, Merck (Consultant)Merck (Advisor or Review Panel member)Pfizer (Consultant)Reviral, Anthrax Vaccine, Influenza Vaccine (Other Financial or Material Support, Data Safety Monitoring Board)Takeda/Shire (Advisor or Review Panel member)
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Bell-Syer, Sally E. M., Lucy N. Thorpe, Kate Thomas, and Hugh MacPherson. "GP Participation and Recruitment of Patients to RCTs: Lessons from Trials of Acupuncture and Exercise for Low Back Pain in Primary Care." Evidence-Based Complementary and Alternative Medicine 2011 (2011): 1–7. http://dx.doi.org/10.1093/ecam/nen044.
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The objective of this study was to identify factors associated with general practitioner (GP) participation and the recruitment of people to trials in primary care, based on data from two trials of interventions for treating chronic low back pain. The study was based on data from two randomized controlled trials (RCTs), one involving exercise, the other acupuncture, and subsequent reporting by GPs in a postal questionnaire. The exercise trial achieved 62% recruitment whereas the acupuncture trial achieved 100% recruitment. In both trials GPs most efficient at referring patients were those with a special interest in the subject area, and those known personally to the research team. A follow-up GP questionnaire found that both trials had maintained a high profile with over 80% of GPs, and successful recruitment strategies included project reminder letters, updates and personal contacts. Achieving target recruitment of patients in the acupuncture trial was aided by the deliberate application of lessons learned in the exercise trial, in particular the need to keep initial study entry criteria broad, with subsequent filtering undertaken by the study researcher. In addition the use of effective methods of maintaining the trial profile, the involvement of a GP advisor, the decision to maximize the recruitment of GPs early in the trial and the direct recruitment of interested individual GPs. The successful recruitment of patients to trials in primary care requires careful planning and continuous monitoring from the outset. Prior to starting recruitment, it is useful to identify previous trials in a similar environment in order to learn from their experience and optimize patient recruitment.
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Austin, Erika L., Lisa L. Lindley, Leandro A. Mena, Richard A. Crosby, and Christina A. Muzny. "Families of choice and noncollegiate sororities and fraternities among lesbian and bisexual African-American women in a southern community: implications for sexual and reproductive health research." Sexual Health 11, no. 1 (2014): 24. http://dx.doi.org/10.1071/sh13145.
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Background Self-identified lesbian and bisexual African-American women living in the southern United States are a relatively hidden subpopulation within the lesbian, gay, bisexual and transgender (LGBT) community. Existing research suggests that African-American lesbian and bisexual women are at high risk for sexually transmissible infections (STIs), but the sexual and reproductive health needs of this population are just beginning to be understood. Methods: We conducted four focus groups and five individual interviews with 24 lesbian and bisexual African-American women living in the Jackson, Mississippi, metropolitan area, recruited through the local STI clinic and through word of mouth. We aimed to characterise the role of two types of social organisations (lesbian families and noncollegiate lesbian sororities and fraternities) among the local LGBT community, and their influence on the sexual health of their members. Results: Both types of social organisations serve positive functions for their members. Lesbian families provide support and stability; this appears beneficial for younger individuals, who may lack support from biological families. Lesbian sororities and fraternities are visible due to their emphasis on community service, and offer a strong sense of solidarity and belonging. In both organisation types, discussions about sex were common, although members acknowledged a lack of information regarding safer sex among lesbian and bisexual women. Conclusions: Existing social organisations within the LGBT community, such as lesbian families and lesbian sororities and fraternities, should be incorporated into community-based popular opinion leader or lay heath advisor interventions in an effort to meet the sexual and reproductive health needs of marginalised populations.
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Soriano-Serrano, Manuel, Jesús Antonio Carrillo-Castrillo, Juan Carlos Rubio-Romero, and Manuel García-Jiménez. "The Impact of Enforcement Capabilities on the Effectiveness of Public Assessment on Occupational Safety." International Journal of Environmental Research and Public Health 17, no. 17 (2020): 6426. http://dx.doi.org/10.3390/ijerph17176426.
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(1) Objective: The objective of this study was to evaluate the effect of enforcement capabilities on the efficacy of two public interventions to improve occupational safety in olive mills. (2) Method: The difference in efficacy was evaluated by comparing the risks detected in two groups in an initial assessment (with visits in the 2006–2008 period) to the risks detected in a later assessment, either after an intervention by Authorized Technicians with enforcement capabilities or after an intervention by Technical Advisors without enforcement capabilities (2011–2013). The assessments identified risks in the companies, according to a specific risk map for olive oil mill enterprises. (3) Results: Statistically significant differences were observed in the comparison of the risk reductions of the two groups, with regard to the initial assessment. The greatest reductions in risk were found in the companies that received interventions by Authorized Technicians with enforcement capabilities, in the sections of individual protection equipment and the storage of dangerous products. (4) Conclusion: Interventions by Authorized Technicians with enforcement capabilities are more effective than interventions by Technical Advisors without enforcement capabilities.
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Perozziello, A., F. X. Lescure, A. Truel, et al. "Prescribers’ experience and opinions on antimicrobial stewardship programmes in hospitals: a French nationwide survey." Journal of Antimicrobial Chemotherapy 74, no. 8 (2019): 2451–58. http://dx.doi.org/10.1093/jac/dkz179.
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Abstract Objectives To assess prescribers’ experiences and opinions regarding antimicrobial stewardship programme (ASP) activities. Methods A cross-sectional paper-based survey was conducted among prescribers in 27 out of 35 randomly selected large hospitals in France. Results All 27 investigated hospitals (20 non-university public, 4 university-affiliated and 3 private hospitals) had an ASP and an appointed antibiotic advisor (AA), with a median of 0.9 full-time equivalents per 1000 acute-care beds (IQR 0–1.4). Of the 1963 distributed questionnaires, 920 were completed (46.9%). Respondents were mainly attending physicians (658/918, 71.7%) and medical specialists (532/868, 61.3%). Prescribers identified two main ASP objectives: to limit the spread of resistance (710/913, 77.8%) and to improve patient care and prognosis (695/913, 76.1%). The presence of an AA constituted a core element of ASP (96.2% agreement between answers of ASP leader and respondents). Respondents acknowledged an AA’s usefulness especially on therapeutic issues, i.e. choosing appropriate antibiotic (agreement 84.7%) or adapting treatment (89.6%), but less so on diagnostic issues (31.4%). Very few respondents reported unsolicited counselling and post-prescription controls. Three-quarters of prescribers identified local guidelines (692/918, 75.4%). Prescribers did not approve of measures counteracting their autonomy, i.e. automatic stop orders (agreement 23.4%) or pre-approval by AAs (28.8%). They agreed more with educational interventions (73.0%) and clinical staff meetings (70.0%). Conclusions Prescribers perceived ASP mainly through its ‘on-demand’ counselling activities. They preferred measures that did not challenge their clinical autonomy. High levels of antibiotic consumption in French hospitals bring into question the effectiveness of such an approach. However, limited ASP staffing and resources may preclude extended activities.
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Anderson, Wendy G., Monique Parrish, Kathleen Kerr, et al. "Generalist Palliative Care in the California Safety Net: A Structured Assessment to Design Interventions for a Range of Care Settings." American Journal of Hospice and Palliative Medicine® 38, no. 1 (2020): 4–11. http://dx.doi.org/10.1177/1049909120915461.
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Background: To provide high quality care to all patients who have serious illness, health-care systems must develop effective generalist palliative care strategies. Objective: To identify palliative care quality gaps within a range of settings in the California safety net and to develop theory-based interventions to address them. Design: Structured assessment using the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines and a Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation intervention planning model-based worksheet, which integrates behavior theories to identify factors that predispose, enable, and reinforce clinicians to perform recommended behaviors. Setting and Participants: Adviser pairs—one from palliative care and one from a partner service line—from 10 California public health-care systems conducted assessments at their sites. A steering committee provided educational webinars, best practices, and assessment tools. Measurements: Adviser pairs interviewed at least 6 partner service line stakeholders to identify palliative care quality gaps, behaviors clinicians should perform to close gaps, and factors that predispose, enable, and reinforce those behaviors. Results: Partner service lines were primary care (n = 4), surgery (n = 3), emergency department (n = 2), and radiation oncology (n = 1). Selected gaps were advance care planning and goals of care communication (n = 6), identifying patients with serious illness (n = 3), and pain management (n = 1). All sites designed multiple interventions to address gaps, based on factors that predispose, enable, and reinforce a target audience to perform a target behavior. Advisers reported that the program strengthened relationships between palliative care and the partner service line Conclusion: This structured assessment helped busy clinicians develop theory-based generalist palliative care interventions.
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Picard, Christopher, Domhnall O'Dochartaigh, Richard Drew, Warren Ma, Matthew Douma, and Candice Keddie. "Implementing a multi-site cardiac arrest quality improvement initiative." Canadian Journal of Emergency Nursing 43, no. 2 (2020): 17–18. http://dx.doi.org/10.29173/cjen54.
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Background: 
 Medical cardiac arrest care in Edmonton Zone Emergency Departments does not undergo structured quality monitoring or continuous improvement. Prior to this work, quality indicators had not been selected, nor had tracking or reporting activities been undertaken. This work brings the Edmonton Zone EDs to the forefront of the continuous quality improvement recommendations made by Heart and Stroke Canada and the American Heart Association that are believed to improve both patient outcomes and overall system performance.
 For this project quality indicator development and implementation takes three perspectives: patients and families, frontline staff and the health care system. This work is informed by the Institute for Healthcare Improvement, the National Institute of Science and the International Liaison Committee on Resuscitation’s work on Systems of Care and Continuous Quality Improvement for Emergency Cardiovascular Care. This work is motivated by the desire to improve patient/family experience and outcome, provider experience while improving system performance.
 
 Implementation: 
 An iterative process identified the lowest resource/highest impact areas for improvement. This process was informed through a Delphi survey conducted by the Alberta Cardiac Arrest Stakeholders group and stakeholder engagement. Four areas for improvement were identified: support of patients and families, support of staff, improvement in care metrics, and system level interventions. Support of patients and families was accomplished through the development of an advisory network, by linking families with existing supports, and through the implementation of a bereavement package. Supporting staff was accomplished through the development of a formal and informal debriefing processes. Improving clinical care was accomplished through the integration of chest compression feedback devices into clinical care. Improvements at the system level will be accomplished through the creation of a cardiac arrest registry.
 
 Evaluation Methods:
 Mixed methods approaches are used to evaluate this project. Post cardiac arrest quality track forms are being filled out. Chest compression feedback device data was obtained through simulated patient-care scenarios, staff experiences were obtained through a structured survey. Clinically chest compression data was collected from the feedback devices by Clinical educators, through tracking forms, and pre-and-post surveys of frontline staff measuring burnout and occupational stress are underway. Data is being collected in a local registry to generate accurate incidence and survival rates. Eventual post-implementation interviews with providers, survivors and families will be conducted.
 
 Results:
 A patient/family advisor network has been established. Survivor and families can be connected with the Bystander Support Network and the Heart and Stroke Foundation portal through the bereavement packages being offered at one of the QI sites. Two sites have developed staff debriefing processes: an interdisciplinary Critical Incident Stress Management (CISM) team at one site, and referral to an existing CISM team at two other sites. Chest compression feedback is being used at two sites, staff feedback has been positive. One site is tracking resuscitation metrics which are being used to guide and evaluate the interventions: continued improvement in chest compression quality has been noted. Data analytics are being used at all sites to identify additional opportunities to improve resuscitation care and efforts are underway to expand data collection to other sites and to unify pre-hospital and in-hospital cardiac arrest data.
 
 Advice and Lessons Learned:
 
 Pre-intervention data would have allowed for more meaningful comparisons in patient care. Efforts should be put into identifying what these measures could be.
 High levels of staff engagement at one site appear to have influenced the uptake of chest compression feedback. Effort should identify key stakeholders and gain buy in to increase uptake
 There are significant barriers to unifying pre-hospital and in-hospital cardiac arrest data. It is our belief that a continuous record offers some greatest opportunity to collect data on resuscitation care. Efforts should focus on building a linkage between these data sources and creating a shared data set.
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Loewenstein, George, Daylian M. Cain, and Sunita Sah. "The Limits of Transparency: Pitfalls and Potential of Disclosing Conflicts of Interest." American Economic Review 101, no. 3 (2011): 423–28. http://dx.doi.org/10.1257/aer.101.3.423.
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We review evidence from our published and ongoing research that disclosing conflicts of interest has unintended consequences, helping conflicted advisors and harming their advisees: With disclosure, advisors feel comfortable giving more biased advice, but advisees do not properly adjust for this and generally fail to sufficiently discount biased advice. Disclosure also increases pressure on advisees to comply with advice; following disclosure, advisees feel more uncomfortable in turning down advice (e.g., it signals distrust of the advisor's motives). Finally, we examine the effectiveness of policy interventions aimed at reducing these unintended consequences and discuss how to realize potential benefits of disclosure.
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Kishen, Roop. "Call for Volunteers: Specialist Advisors to Interventional Procedures Advisory Committee of National Institute of Clinical Excellence." Journal of the Intensive Care Society 5, no. 2 (2004): 84. http://dx.doi.org/10.1177/175114370400500224.
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Zupančič, Alenka. "Sex in the Cut." Identities: Journal for Politics, Gender and Culture 17, no. 2-3 (2020): 20–26. http://dx.doi.org/10.51151/identities.v17i2-3.465.
Full textAbstract:
The talk will attempt to explore the nature of the division or cut implied, also etymologically, in the term “sex”. It will attempt to develop a concept of division that does not imply any pre-existing whole, but rather exists as a self-standing entity, endowed by a reality of its own. What if the division implied in “sex” is not simply that between two sexes (or more), but rather something that marks the unrest of sexuality itself? How could this be related to the contemporary feminist struggle, and what kind of concept of universality would it imply?
 Author(s): Alenka Zupančič 
 Title (English): Sex in the Cut
 Journal Reference: Identities: Journal for Politics, Gender and Culture, Vol. 17, No. 2-3 (Winter 2020)
 Publisher: Institute of Social Sciences and Humanities - Skopje
 Page Range: 20-26
 Page Count: 7
 Citation (English): Alenka Zupančič, “Sex in the Cut,” Identities: Journal for Politics, Gender and Culture, Vol. 17, No. 2-3 (Winter 2020): 20-26.
 Author Biography
 Alenka Zupančič, Institute of Philosophy, Scientific Research Center of the Slovene Academy of Sciences
 Alenka Zupančič is a Slovene philosopher and social theorist. She works as research advisor at the Institute of Philosophy, Scientific Research Center of the Slovene Academy of Sciences. She is also professor at the European Graduate School in Switzerland. Notable for her work on the intersection of philosophy and psychoanalysis, she is the author of numerous articles and books, including Ethics of the Real: Kant and Lacan; The Shortest Shadow: Nietzsche’s Philosophy of the Two; Why Psychoanalysis: Three Interventions; The Odd One In: On Comedy; and, most recently, What Is Sex?
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Boulet, Marie-Michèle, Luc Barbeau, and Sergio Slobodrian. "Advisor system: Conception of an intervention module." Computers & Education 14, no. 1 (1990): 17–29. http://dx.doi.org/10.1016/0360-1315(90)90018-3.
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Lyratzopoulos, Georgios, Andrew R. Hoy, Darmarajah Veeramootoo, Nava V. Shanmuganathan, and Bruce Campbell. "Influence of expert clinical adviser characteristics on opinions about interventional procedures." International Journal of Technology Assessment in Health Care 24, no. 02 (2008): 166–69. http://dx.doi.org/10.1017/s0266462308080239.
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Objectives:The aim of this study was to examine potential associations between the professional background and experience of expert clinicians and their opinions about the clinical utility of interventional procedures.Methods:A retrospective survey of expert clinician characteristics and their opinions was conducted. Information was collected on expert clinical adviser self-declared “operator,” “researcher,” and conflict of interest status. Associations were sought between expert clinical adviser characteristics and their opinions on whether procedures were “established,” “efficacious,” and “safe.” The setting was the Interventional Procedures Programme of the UK's National Institute for Health and Clinical Excellence (NICE). A total of 598 expert clinician questionnaires relating to 182 different interventional procedures were analyzed.Results:Expert clinical advisers with operative experience of procedures were significantly more likely to consider them as established (odds ratio [OR] 3.93; 95 percent confidence interval [CI], 2.43 to 6.36;p&lt; .001), efficacious (OR 1.76; 95 percent CI, 1.00 to 3.08;p= .049), and safe (OR 2.28; 95 percent CI, 1.43 to 3.65;p= .001). Once adjusted for other characteristics, there was no association between either researcher or conflict of interest status and opinions about the clinical utility of procedures.Conclusions: Expert clinical advisers are an important source of information for decision makers producing guidance about the use of procedures, especially when published evidence is sparse or of poor quality. This study suggests that those who are operators, but not those who are researchers or declare a conflict of interest, are more likely to have a favorable opinion of a procedure's clinical utility. Use of expert clinical advisers with a variety of experience and backgrounds seems a reasonable approach to obtaining authoritative opinions about interventional procedures, to supplement and help interpret evidence from published data.
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Jones, Bruce M., Emily Plauche, Susan E. Smith, and Christopher M. Bland. "57. Evaluating the Utility of a Penicillin Allergy Reconciliation Program within an Infectious Diseases Consult Population in a Community Health System." Open Forum Infectious Diseases 7, Supplement_1 (2020): S49—S50. http://dx.doi.org/10.1093/ofid/ofaa439.102.
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Abstract Background Penicillin allergy reconciliation is an important aspect of antimicrobial stewardship with ~10% of the population reporting a penicillin allergy. Our facility utilizes a Penicillin Allergy Reconciliation Program (PARP) led by an Infectious Diseases (ID) Pharmacist and pharmacy students to identify patients with penicillin allergies to reconcile and intervene when necessary. Information is collected by interview, electronic medical record (EMR) review, prescription outpatient fill history. This study evaluated reconciliations with and without a PARP in patients in a community health system. Methods This was a retrospective study that compared reconciliations performed on adult patients admitted at least once in 2019 with a self-reported penicillin allergy and ID physician consult at a hospital with a PARP (Institution 1) and one without a formal evaluation and intervention program (Institution 2) within the same community health system with same ID physicians. The primary outcome was documented reconciliation of a patient’s penicillin allergy during an inpatient visit in 2019. Reconciliation was defined as an edit or clarification (updating the severity, reaction, or comments section, as well as deleting) to a patient’s penicillin allergy in the EMR. The secondary outcome evaluated the percentage of total and ID consult patients with a penicillin allergy. Results There were 245 patients who met criteria and were included in the study, 113 from Institution 1 and 132 from Institution 2. For the primary outcome, there were 82 (72.6%) reconciliations at Institution 1 and 15 (11.4%) reconciliations at Institution 2 (p &lt; 0.001). Interventions at Institution 1 and 2 resulted in 74 EMR updates and 8 removals and 14 EMR updates and 1 removal, respectively. Reconciliation was performed on the same visit as the ID consult in 59/82 patients (72%) at Institution 1 and 11/15 patients (73.3%) at Institution 2. All reconciliations at Institution 2 were made by pharmacist (10) or nurses (5). For the secondary outcome, 10.9% of patients with an ID consult and 12.6% of all patients admitted in 2019 had a penicillin allergy (p=0.027). Conclusion A PARP led by an ID pharmacist and students was an effective method to perform penicillin allergy reconciliations, even in the presence of active ID consultation. Disclosures Bruce M. Jones, PharmD, BCPS, ALK-Abello (Research Grant or Support)Allergan/Abbvie (Speaker’s Bureau) Christopher M. Bland, PharMD, FCCP, FIDSA, BCPS, ALK Abello, Inc. (Grant/Research Support)Biomerieux (Consultant)Merck (Consultant, Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau)Tetraphase (Speaker’s Bureau)
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Handley, Nathan, Kuang-Yi Wen, Sameh Gomaa, et al. "Outcomes of a pilot study exploring the role of digital health coaching for men with prostate cancer." Journal of Clinical Oncology 39, no. 28_suppl (2021): 102. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.102.
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102 Background: As the most common cancer among men in the US, prostate cancer (PCa) affects nearly 250,000 men annually, accounting for over 13% of all new cancer cases. Health-related quality of life (HRQoL) during and post-treatment is impacted by sexual, urinary and bowel function which can persist for months or years after treatment completion. As individuals primarily manage such symptoms in the community setting there is a need for interventions that can address overall health and wellness concerns needs of men with PCa beyond the clinical setting. Digital health coaching (DHC) is one such solution that has potential to address HRQoL for individuals with cancer. Methods: The aim of this pilot study was to evaluate the feasibility of a DHC program for individuals with PCa. One hundred English-speaking men with PCa requiring active treatment within the past 2 years were recruited from across the Delaware Valley. Consented individuals were enrolled in a 3-month DHC program, consisting of a weekly call from a health advisor along with delivery of evidence-based supplemental content via text or email focused on exercise nutrition, physical, emotional and sexual health, as well as financial toxicity. Secondary endpoints evaluated the relationship between the DHC intervention and health self-efficacy, as measured by the Cancer Behavior Inventory-Brief Form (CBI-B), quality of life (EPIC-CP), financial toxicity (COST) and global health (PROMIS- SF10). Results: 82 individuals enrolled in the study for which the mean age was 68 years old (1.2 % Black, 2.4% Rural). The feasibility threshold of 60% was met with 58 individuals completing the 3-month program (proportion = 70.7%, 90% CI: 61.4, 78.9). Health self-efficacy improved with a mean change in CBI-B of 4.1 (95% CI: 0.4, 7.8). The financial toxicity improved with a mean score change of 2.5 (95% CI: 1.0, 4.0). All symptom scores of EPIC-CP were improved by showing a decrease of mean scores. PROMIS-GH also improved in both mental and physical health domains with mean changes of 0.5 and 1.4 (95% CIs for mental: -1.6, 2.6, for physical: -0.1, 2.8). Conclusions: DHC demonstrated feasibility in a cross-sectional population of men with PCA recruited in the community setting. Data suggest that HRQoL, health-self efficacy and global health can be positively impacted by DHC. Results support the further evaluation of DHC in larger RCTs.
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Fahrenwald, Nancy L., Christine Belitz, and Arliss Keckler. "“Tribes Sharing Life”." Western Journal of Nursing Research 33, no. 7 (2011): 901–15. http://dx.doi.org/10.1177/0193945911401431.
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“Tribes Sharing Life” is an educational intervention about deceased organ donation for American Indian Tribal College and University (TCU) students. The classroom and web-based program was derived from cultural values and beliefs, and the Transtheoretical Model. The aim of this study was to develop and formatively evaluate the intervention for acceptability and satisfaction among advisory council members ( n = 10) and TCU students ( n = 22). Council evaluation results were strong. All items met the <3.0 mean acceptability criterion using an intervention materials review form. Content validity indices met criterion of 0.80 overall and for each item. Dialogue among tribal advisors led to culturally based changes in the images that portrayed the need for organ donation. TCU student evaluation of the revised intervention resulted in overall mean scores that met criterion for acceptability and satisfaction. Tribes Sharing Life is a formatively evaluated intervention that should undergo efficacy testing.