Multidisciplinary Team Of Investigators Research Articles

Building a sharable literature collection to advance the science and practice of implementation facilitation.

Implementation science seeks to produce generalizable knowledge on strategies that promote the adoption and sustained use of evidence-based innovations. Literature reviews on specific implementation strategies can help us understand how they are conceptualized and applied, synthesize findings, and identify knowledge gaps. Although rigorous literature reviews can advance scientific knowledge and facilitate theory development, they are time-consuming and costly to produce. Improving the efficiency of literature review processes and reducing redundancy of effort is especially important for this rapidly developing field. We sought to amass relevant literature on one increasingly used evidence-based strategy, implementation facilitation (IF), as a publicly available resource. We conducted a rigorous systematic search of PubMed, CINAHL, and Web of Science citation databases for peer-reviewed, English-language articles with "facilitation" and a combination of other terms published from January 1996 to December 2021. We searched bibliographies of articles published from 1996 to 2015 and identified articles during the full text review that reported on the same study. Two authors screened 3,168 abstracts. After establishing inter-rater reliability, they individually conducted full-text review of 786 relevant articles. A multidisciplinary team of investigators provided recommendations for preparing and disseminating the literature collection. The literature collection is comprised of 510 articles. It includes 277 empirical studies of IF and 77 other articles, including conceptual/theoretical articles, literature reviews, debate papers and descriptions of large-scale clinical initiatives. Over half of the articles were published between 2017 and 2021. The collection is publicly available as an Excel file and as an xml file that can be imported into reference management software. We created a publicly accessible collection of literature about the application of IF to implement evidence-based innovations in healthcare. The comprehensiveness of this collection has the potential to maximize efficiency and minimize redundancy in scientific inquiry about this strategy. Scientists and practitioners can use the collection to more rapidly identify developments in the application of IF and to investigate a wide range of compelling questions on its use within and across different healthcare disciplines/settings, countries, and payer systems. We offer several examples of how this collection has already been used.

Intensive glycaemic targets in overweight and obese individuals with gestational diabetes mellitus: clinical trial protocol for the iGDM study

IntroductionThe prevalence of both obesity and gestational diabetes mellitus (GDM) has increased, and each is associated with adverse perinatal outcomes including fetal overgrowth, neonatal morbidity, hypertensive disorders of pregnancy and...

Abstract A041: The iCCARE Consortium for Prostate Cancer in Black men: Evaluability assessment of the implementation of a care plan for black prostate cancer survivors

Abstract Despite notable progress in early detection, prevention, and treatment of prostate cancer within the United States, racial disparities are present very early in the patient journey of Black men, starting with the shared decision-making process. The disproportionately higher number of Black men diagnosed with prostate cancer also suggests that Black men must also contend with the management of associated physiological and psychosocial symptoms. The survivorship care plan was designed to communicate critical information that cancer survivors and their health care advocates need as a guidebook for long term post treatment care, and improved survivorship. An associated systematic literature review conducted by our multidisciplinary investigative team revealed there was a severe underutilization of survivorship care plans within cancer survivorship care especially with Black men. The considerable lack of utilization and/or tailoring of survivorship care plans may be a significant contributor to the worsening of health disparities in this population. Co-designing survivorship care plans with key stakeholders, specifically Black survivors and their health care advocates, is imperative to ensure that the plan meets the needs and preferences that Black men have for survivorship care. This presentation will discuss the steps the investigative team used to address the disparities in shared decision-making, and the subsequent underutilization of survivorship care plans. The investigative team utilized semi-structured interviews and focus group methodology to explore how the lived experiences of Black male prostate cancer survivors are incorporated and addressed in the construction and contents of a culturally tailored survivorship care plan (CaP_SCP- Black Men). An evaluability assessment was conducted to determine whether implementation of the newly created survivorship care plan is feasible, appropriate, and addresses the specific needs of the population before full implementation. This presentation will discuss how this combination of approaches allowed the investigative team to understand how survivorship care plans affect the unique complexities of survivorship in Black men, and allows for the feasibility study of the implementation of a culturally relevant survivorship care plan (CaP_SCP- Black Men) in a population that bears the greatest burden nationally and globally. Citation Format: Timethia Bonner, Kimlin Ashing, Folakemi Odedina. The iCCARE Consortium for Prostate Cancer in Black men: Evaluability assessment of the implementation of a care plan for black prostate cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A041.

Use of Postmortem Computed Tomography in Disaster Victim Identification: Current Japanese Methods and Challenges

Introduction:In Japan, victims of large-scale disasters are usually identified by non-objective means. In the case of the 2011 Great East Japan Earthquake, ~90% of the bodies were identified based on nonobjective means such as facial features or belongings, which resulted in misidentification. At present, the situation remains the same. However, according to global standards, a method referred to as “disaster victim identification” (DVI; individual identification of disaster victims) is recommended by the International Criminal Police Organization; in this method, a multidisciplinary investigation team integrates objective information such as dental charts and DNA. Furthermore, recently, there has been a movement to employ postmortem computed tomography (CT) for personal identification, and radiologists are expected to be included in the DVI team.Method:In the Department of Legal Medicine of Chiba University in Japan, individual identification via CT or magnetic resonance imaging was conducted in forensic autopsy cases of unknown identities when there was an assumed person for the body and the antemortem image of the person could be acquired. Two certified radiologists interpreted and compared the antemortem CT with the postmortem CT taken prior to autopsy and assessed whether the two images were compatible to indicate the same person.Results:A total of 20 cases were judged. In all cases, two images were compatible, indicating the same person. Image-based identification was particularly useful when dental findings or fingerprints were unavailable for comparison and there were no family members available for DNA testing.Conclusion:In the future, this method will be applied to large-scale disasters.

Using the TIDieR checklist to describe development and integration of a web-based intervention promoting healthy eating and regular exercise among older cancer survivors.

To facilitate replication and future intervention design of web-based multibehavior lifestyle interventions, we describe the rationale, development, and content of the AiM, Plan, and act on LIFestYles (AMPLIFY) Survivor Health intervention which provides healthy eating and exercise behavior change support for older cancer survivors. The intervention promotes weight loss, improvements in diet quality, and meeting exercise recommendations. The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a comprehensive description of the AMPLIFY intervention, consistent with CONSORT recommendations. A social cognitive theory web-based intervention founded on the core components of efficacious print and in-person interventions was conceptualized and developed through an iterative collaboration involving cancer survivors, web design experts, and a multidisciplinary investigative team. The intervention includes the AMPLIFY website, text and/or email messaging, and a private Facebook group. The website consists of: (1) Sessions (weekly interactive e-learning tutorials); (2) My Progress (logging current behavior, receiving feedback, setting goals); (3) Tools (additional information and resources); (4) Support (social support resources, frequently asked questions); and (5) Home page. Algorithms were used to generate fresh content daily and weekly, tailor information, and personalize goal recommendations. An a priori rubric was used to facilitate intervention delivery as healthy eating only (24 weeks), exercise only (24 weeks), or both behaviors concurrently over 48 weeks. Our TIDieR-guided AMPLIFY description provides pragmatic information helpful for researchers designing multibehavior web-based interventions and enhances potential opportunities to improve such interventions.

Implementation of patient-reported outcomes for symptom management in oncology practice through the SIMPRO research consortium: a protocol for a pragmatic type II hybrid effectiveness-implementation multi-center cluster-randomized stepped wedge trial

BackgroundMany cancer patients experience high symptom burden. Healthcare in the USA is reactive, not proactive, and doctor-patient communication is often suboptimal. As a result, symptomatic patients may suffer between clinic visits. In research settings, systematic assessment of electronic patient-reported outcomes (ePROs), coupled with clinical responses to severe symptoms, has eased this symptom burden, improved health-related quality of life, reduced acute care needs, and extended survival. Implementing ePRO-based symptom management programs in routine care is challenging. To study methods to overcome the implementation gap and improve symptom control for cancer patients, the National Cancer Institute created the Cancer-Moonshot funded Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium.MethodsSymptom Management IMplementation of Patient Reported Outcomes in Oncology (SIMPRO) is one of three research centers that make up the IMPACT Consortium. SIMPRO, a multi-disciplinary team of investigators from six US health systems, seeks to develop, test, and integrate an electronic symptom management program (eSyM) for medical oncology and surgery patients into the Epic electronic health record (EHR) system and associated patient portal. eSyM supports real-time symptom tracking for patients, automated clinician alerts for severe symptoms, and specialized reports to facilitate population management. To rigorously evaluate its impact, eSyM is deployed through a pragmatic stepped wedge cluster-randomized trial. The primary study outcome is the occurrence of an emergency department treat-and-release event within 30 days of starting chemotherapy or being discharged following surgery. Secondary outcomes include hospitalization rates, chemotherapy use (time to initiation and duration of therapy), and patient quality of life and satisfaction. As a type II hybrid effectiveness-implementation study, facilitators and barriers to implementation are assessed throughout the project.DiscussionCreating and deploying eSyM requires collaboration between dozens of staff across diverse health systems, dedicated engagement of patient advocates, and robust support from Epic. This trial will evaluate eSyM in routine care settings across academic and community-based healthcare systems serving patients in rural and metropolitan locations. This trial’s pragmatic design will promote generalizable results about the uptake, acceptability, and impact of an EHR-integrated, ePRO-based symptom management program.Trial registrationClinicalTrials.gov NCT03850912. Registered on February 22, 2019. Last updated on November 9, 2021.

Evaluating a system-wide, safety investigation in healthcare course in Norway: a qualitative study

Objective and settingNational, system-wide safety investigation represents a new approach to safety improvement in healthcare. In 2019, a new master’s level course in Safety Investigation in Healthcare was established to...

Development and validation of self-efficacy and intention measures for spending time in nature

PurposeThe purpose of this study was to develop and evaluate the reliability and validity of self-efficacy and intentions measures for time spent in nature (TSN). TSN is related to improvement in psychological well-being and health, yet most American adults spend very little time in such settings. Theory-based interventions have been effective in increasing physical activity, a related behavior, and may be one mechanism to increase TSN. Self-efficacy and intentions have been shown to be strong predictors of health behaviors and are used across several theories. However, scales to measure these factors have not yet been developed and are needed to facilitate effective interventions.MethodsTSN self-efficacy and intentions scales were developed using a sequential nine-step procedure: identification of the domain and item generation; content validity; pre-testing of questions; sampling and survey administration; item reduction; extraction of factors; tests of dimensionality; tests of reliability; and tests of validity. The 14-member multidisciplinary, researcher and practitioner investigative team generated 50 unique items for self-efficacy and 24 unique items for intentions. After subjecting items to content validity and pre-testing, item sets were reduced to 21 assessing self-efficacy and nine assessing intentions. A nationwide sample of 2109 adult participants (49.7% female, Mean Age = 58.1; 59.8% White, 18.4% Hispanic, 13.3% Black) answered these items via an on-line survey.ResultsUsing split-half measures, principal components analysis indicated a one-factor solution for both scales. The factor structure was upheld in confirmatory factor analyses and had high internal consistency (α = .93 self-efficacy; .91 intentions). The scales were moderately correlated with each other (r = .56, p < .001) and were strongly related to TSN with large effect sizes (eta2 > .20).ConclusionsThe study resulted in reliable and valid self-efficacy (14 items) and intentions (8 items) scales that can be used to develop future theory-based interventions to increase TSN and thereby improve population health.

Analysing the impact of taxi violence on commuters in South Africa

Taxi violence in South Africa was the tool that the apartheid regime used to pursue their interest by dividing the people so that they could acquire what they needed (Sekhonyane and Dugard, 2004:15). Taxi violence is one of the most burning issues faced by Department of Transport, Police, commuters and taxi industry in South Africa. This industry plays a vital role in commuting people to and from work or different destinations, and in most cases it is caught in the wrong doing in terms of fighting for routes where many innocent lives are lost due to infighting. The inability by government to regulate taxi industry is a serious problem for taxi operators, taxi associations, commuters and society. The deregulation of taxi industry brought many problems such as conflict, violence and mafia type assassinations in South Africa. This article focus on preventive measures to curb taxi violence in South Africa. This article utilised qualitative, case study based approach and the approach is supported by analysis of primary and secondary sources. The article further draws on the findings from the world on taxi violence and formulate steps to counteract taxi violence in South Africa. The research based key steps leading to the prevention of taxi violence in South Africa. The first process related to regulation of taxi industry, awareness campaigns on taxi operations, the control of routes and multidisciplinary investigation team should be established to overcome taxi violence in South Africa.

Psychostimulant Use Among Myeloproloferative Neoplasm Patients

Background: Fatigue remains one of the most severe and disabling symptoms experienced by patients with myeloproliferative neoplasms (MPNs) resulting in impaired social, role, and physician functioning and reduced quality of life (Cancer 2007). Current NCCN Clinical Practice Guidelines in Oncology recommend consideration of use of psychostimulants (PSs) if other causes of fatigue have been ruled out. In this analysis, we evaluate the role of pharmacologic PSs in this population utilizing data from a previously conducted a survey regarding fatigue in MPN patients (Cancer 2016).Methods: A 70-item internet-based survey was developed by a multidisciplinary team of MPN investigators, patients, and patient advocates that included questions on medication PS use. The survey was promoted online via multiple MPN-related websites during late February to March of 2014. Survey data was immediately captured, downloaded, and stored on secure servers at the Mayo Clinic Survey Research Center. Success of PSs was patient-reported on a 5-level tiered response range from not at all successful to very successful. Categorical variables were compared using chi-square tests, continuous variables using T-tests, and Pearson's rho estimated correlations. P values < 0.05 were considered statistically significant.Results: Respondents : 1788 MPN patients participated in the online survey. Of these, 1748 consented to the survey and 1676 were included for completing 10 or more survey questions. 116 patients (8.4%) of the 1377 patients who responded to the question regarding PS use reported use of these medications. Use among MPN subtypes varied (9.9% of essential thrombocythemia patients, 9.1% of polycythemia vera patients, and 5.8% of myelofibrosis patients).Characteristics : Females used PSs more frequently than males (9.9% females vs 5.4% males, P= 0.006). Use of PSs was most often observed among individuals with severe fatigue (mean brief fatigue inventory (BFI) score 5.7 among those using PSs versus 4.4 among those not using, P < 0.001). Individuals who reported that fatigue impaired sleep were more often PS users (12% of users had impaired sleep versus 6% of users without impaired sleep, P < 0.001). Patients who used PSs were also more symptomatic for the 10 most MPN-specific symptoms assessed via the MPN Total Symptom Score (MPN-TSS; mean 36.3 vs 28.4, P < 0.001). Individual MPN Symptom Assessment Form (MPN-SAF) item scores are shown in Figure 1.Efficacy : We then evaluated the characteristics of PS users by their reported success in reducing fatigue (102/166). Success in reducing fatigue was reported more often in older respondents (mean age of 58.9 years in those reporting that PSs were somewhat to very helpful vs 53.9 years for not helpful, P = 0.03). Although not significant, patients who reported success in reducing fatigue tended to have a diagnosis of PV (somewhat or very successful in 34/45 for PV; 7/13 for MF, 21/42 for ET, P= 0.05) or female (somewhat or very successful in 54/80 vs 9/20 for male, P= 0.06).Correlates : Of PS users who completed the secondary portion on fatigue reduction success level (n=102), there was no apparent correlation between MPN-TSS (0-10) and reported success in reduction of fatigue (rho = -0.1; P= 0.5).Conclusions: Medication PSs are utilized in a notable proportion of MPN patients. MPN patients who use PSs often had significantly worse fatigue than their peers, which may reflects the population in which PSs are most likely to be of suspected benefit. Given the severity of fatigue in this population and the lack of effective fatigue-alleviating strategies, more studies regarding the efficacy of PSs are needed. [Display omitted] DisclosuresHarrison:CTI: Speakers Bureau; Novartis: Honoraria, Research Funding, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; Shire: Speakers Bureau; Celgene: Consultancy. Mesa:Celgene Corporation: Research Funding; Ariad: Consultancy; Promedico: Research Funding; Incyte Corporation: Research Funding; Galena Biopharma, Inc.: Consultancy; Novartis Pharmaceuticals Corporation: Consultancy; CTI BioPharma Corp.: Research Funding; Gilead Sciences, Inc.: Research Funding.

ES19.05 Incorporating Patient Reported Outcomes into the Lung Cancer Registry

Coupled with advances in early detection, the rapid pace of innovation in lung cancer research is beginning to improve survival rates and extend lives for those diagnosed with lung cancer. Many more people are surviving with the disease long-term and facing new challenges (Vavala et al., Respirology, 2020). As survivorship increases, there is a growing imperative to more completely understand health-related quality of life issues that people with lung cancer are facing. This is compounded by the plethora of new treatment options – many of which do not yet have sufficient follow-up data to understand long-term side-effects and impacts on health and well-being. Patient reported outcomes are an essential part of understanding the true patient experience. Physician and patient reporting of symptomatic toxicities are often not concordant (DiMaio et al., Journal of Clinical Oncology, 2015). Incorporating patient reported symptom reporting into clinical workflow has even been demonstrated to not only reduce emergency department visits but to improve overall survival (Basch et al, Journal of Clinical Oncology, 2016). Real-world data sources like the Lung Cancer Registry (www.lungcancerregistry.org) provide access to thousands of patients globally that are living with lung cancer. Multiple studies have now been incorporated into the Lung Cancer Registry to demonstrate the feasibility and accessibility of collecting patient reported outcomes in a real-world setting as well as to better understand quality of life issues. An initial study examining the feasibility of collecting patient-reported outcomes from people diagnosed with lung cancer taking PD-1/PD-L1 immune checkpoint inhibitors in a real-world setting was performed in the Registry in 2018-2019 (Jim et al., manuscript submitted). This examination of 226 people revealed that 25% of patients experienced a treatment delay, 12% had an emergency room visit, and 9% were hospitalized due to toxicity. There was no significant difference in health-related quality of life events between the four immune checkpoint inhibitors examined. Notably, patients reported a lower overall health related quality of life, functional well-being, and emotional well-being compared to general population and cancer norms (Brucker et al., Eval Health Prof, 2005). Fatigue, aching joints, aching muscles, insomnia, shortness of breath, itching, and skin dryness were reported by more than half of study participants. These data indicate key areas of concern for those who are may be living long-term on or after treatment with immune checkpoint inhibitor therapy and underscore the importance of appropriate palliative and survivorship care. After confirming the feasibility of the immunotherapy study, the Lung Cancer Registry incorporated longitudinal tracking of patient-reported outcomes on a quarterly basis, starting in late November, 2019. Multiple stakeholders, including patients, caregivers, academic, and industry collaborators were consulted in the design of the questionnaires. After providing informed consent for an IRB-approved, observational research study, participants are asked about symptoms and side-effects every three months and complete the EORTC QLQ-C30 quality of life survey instrument (Aaronsen et al, J Natl Cancer Inst, 1993) as well as the EORTC LC-29 survey (Koller et al., Lancet Oncol, 2020). This data is coupled with patient-provided information about changes in cancer status (such as stage, recurrence, and biomarker testing) and information on treatment changes. Early analyses of these data show that the questionnaires are feasible and demonstrate expected trends, such as reduced physical functioning in stage IV patients currently taking first or second line chemotherapy compared to similar patients currently taking a targeted therapy or immunotherapy. Finally, the Lung Cancer Registry has partnered with a multidisciplinary team of investigators (including patients and patient advocates) to launch a landmark study on Women’s sexual health (https://www.iaslc.org/iaslc-news/ilcn/shawl-largest-study-its-kind-evaluates-sexual-dysfunction-women-lung-cancer). Initially prompted by patient experiences that were expressed to the principal investigator, this study utilizes PROMIS measures assessing sexual health (Flynn et al., J Sex Med, 2013) to understand sexual side effects after lung cancer treatment. To date, there is very little known on this topic. Clinical trials for new lung cancer therapeutics generally do not collect this information. The study will be actively accruing until the end of Q1 2021. The investigators aim to learn more about the problems being faced with the goal of providing effective management strategies in the future. Taken together, all of these studies underscore the need to learn directly from people living with lung cancer to ensure that we are effectively designing and implementing appropriate supportive care and side-effect management within clinical care pathways. Utilizing real-world sources such as registries to complement quality of life data being collected in lung cancer clinical trials will improve knowledge around toxicities and side-effects and can lead to new management strategics and overall improved well-being for those diagnosed with lung cancer. patient reported outcomes, quality of life, Survivorship

A Multi-Method Approach to a Comprehensive Examination of the Psychiatric and Neurological Consequences of Intimate Partner Violence in Women: A Methodology Protocol.

The number of women in the United States that experience blows to the head during assaults by intimate partners is substantial. The number of head blows that result in a traumatic brain injury (TBI) is virtually unknown, but estimates far exceed numbers of TBI in parallel populations (e.g., blast exposure, accidents, sports) combined. Research on the impact of TBI on post-traumatic stress disorder (PTSD) in survivors of intimate partner violence (IPV) is sparse. This methodology paper describes the comprehensive, multi-method approach used by a multi-disciplinary team of investigators from several different fields of expertise to assess the interaction of psychiatric, cognitive, psychological, and physical conditions that result from IPV. Using state-of-the-art instruments, a comprehensive assessment of lifetime trauma exposure, lifetime history of TBI, psychiatric history, and a full assessment of current cognitive, neuropsychological and biomedical function was conducted with 51 female survivors of IPV who screened positive for PTSD. This multi-method assessment included clinician-administered diagnostic interviews modified to specifically assess the sequelae of IPV, standardized self-report surveys, neuropsychological tests, structural, diffusion, and functional neuroimaging and blood-based biomarkers. The specific details and full report of the results of the full study are beyond the scope of this methodology paper. Descriptive characteristics of the complex clinical presentation observed in this unique sample are described. The sample reported high rates of trauma exposure across the lifespan and 80% met full criteria for current PTSD. Women also reported high rates of lifetime subconcussive head injury (88.2%) and TBI (52.9%) from various etiologies (35.3% secondary to IPV). Descriptive findings from the methodological protocol described here have begun to reveal information that will advance our understanding of the impact of subconcussive head injury and TBI on recovery from mental injury among IPV survivors.

Transforming the paradigm of child welfare.

As a founder of the field of applied developmental psychology, Dr Edward Zigler promoted public policy that translated scientific knowledge into real-world programs to improve the outcomes of high-risk children and families. Many researchers, practitioners, and public policy proponents have sought to carry on his legacy through integration of empirical research, evidence-based prevention and intervention, and advocacy to address a range of challenges facing families with young children. To advance the field of child maltreatment, a multidisciplinary team of investigators from the Universities of Rochester and Minnesota partnered with the Eunice Kennedy Shriver National Institute of Child Health and Human Development to create the Translational Research that Adapts New Science FOR Maltreatment Prevention Center (Transform). Building on state-of-the-art research methodologies and clinical practices, Transform leverages theoretically grounded research and evidence-based interventions to optimize outcomes for individuals across the life span who have experienced, or may be at risk for, maltreatment. Inspired by the work of Dr Zigler, Transform is committed to bridging science and real-world practice. Therefore, in addition to creating new science, Transform's Community Engagement Core provides translational science to a broad audience of investigators, child-serving professionals, and parental and governmental stakeholders. This article describes Transform's purpose, theoretical framework, current activities, and future directions.

Care4Value: medição de valor em saúde em Unidades de Cuidados Continuados Integrados

Resumo Objetivo: Desenvolver uma plataforma digital para a otimizacao do processo de coleta de dados de escalas clinicas e monitoramento desses dados com vista a medicao do valor em saude. Metodos: Por meio de uma metodologia de investigacao-acao, o desenvolvimento da plataforma incluiu abordagens qualitativas e quantitativas, em tres fases: grupos focais com uma equipe multidisciplinar de investigadores e profissionais de saude da UCCI do estudo-piloto; analise dos dados clinicos em formato de pre-teste de uma amostra de 21 usuarios da UCCI para categorizar diferentes graus de complexidade; e, analise de informacao financeira, aos custos operacionais da UCCI, relativa ao momento de permanencia dos mesmos 21 usuarios. O desenvolvimento iterativo e incremental da plataforma permitiu coletar feedback dos usuarios como forma de melhoria. Resultados: A plataforma inclui 3 modulos: aplicativo movel; dashboard; e modulo de importacao. A plataforma centraliza os dados coletados e disponibiliza-os por meio de um dashboard . Os dados sao coletados por aplicativo movel e/ou por um modulo de importacao que consome dados de sistemas clinicos existentes. Conclusao: O aplicativo movel esta apto a ser utilizado por profissionais de saude e cuidadores, e o dashboard apresenta informacoes de acompanhamento clinico dos usuarios e monitoramento dos seus ganhos em saude.

Depressive symptoms and myeloproliferative neoplasms: Understanding the confounding factor in a complex condition.

BackgroundPhiladelphia chromosome negative myeloproliferative neoplasms (MPNs), including essential thrombocythemia, polycythemia vera, and myelofibrosis, have severe function‐limiting symptom burden that is experienced by the majority of patients. Previous studies have suggested that depression may be present in over a quarter of MPN patients, but to date no studies have evaluated the relationship between depression and other variables such as symptoms.MethodsA 70‐item internet based survey regarding fatigue and mood symptoms was developed by a multidisciplinary team of MPN investigators, patients and patient advocates including Patient Health Questionnaire and the Myeloproliferative Neoplasm Symptom Assessment Form was completed by over 1300 patients with MPN diagnosis.ResultsThere were 309 respondents (23%) with PHQ‐2 scores ≥ 3. In this analysis, we found worse systemic symptom burden in individuals reporting depressive symptoms.ConclusionThis analysis suggests the importance of depression in contributing to as well as confounding symptomatology in MPN patients, and suggests that this critical variable should also be addressed by clinicians and researchers alike when comprehensively assessing symptom burden etiologies.

Bioprinting Approaches to Engineering Vascularized 3D Cardiac Tissues.

3D bioprinting technologies hold significant promise for the generation of engineered cardiac tissue and translational applications in medicine. To generate a clinically relevant sized tissue, the provisioning of a perfusable vascular network that provides nutrients to cells in the tissue is a major challenge. This review summarizes the recent vascularization strategies for engineering 3D cardiac tissues. Considerable steps towards the generation of macroscopic sizes for engineered cardiac tissue with efficient vascular networks have been made within the past few years. Achieving a compact tissue with enough cardiomyocytes to provide functionality remains a challenging task. Achieving perfusion in engineered constructs with media that contain oxygen and nutrients at a clinically relevant tissue sizes remains the next frontier in tissue engineering. The provisioning of a functional vasculature is necessary for maintaining a high cell viability and functionality in engineered cardiac tissues. Several recent studies have shown the ability to generate tissues up to a centimeter scale with a perfusable vascular network. Future challenges include improving cell density and tissue size. This requires the close collaboration of a multidisciplinary teams of investigators to overcome complex challenges in order to achieve success.

Investigation of the public health event in the Cafunfu town, Lunda-Norte, December 2017

Purpose: On November 22th, 2017, the people from Cafunfu municipality in Lunda-Norte Province, alerted through the media, “the occurrence of unidentified disease, manifested mainly by high fevers, among other symptoms”. After verification of the alert, a multidisciplinary outbreak investigation team was sent to the town in December to investigate this public health event. Methods & Materials: In order to investigate the etiology of this public health event, 370 febrile children were randomly selected for testing with rapid diagnostic tests (RDT) for malaria. Further, 25 RDT for dengue and chikunguya were performed. In order to evaluate the factors associated with the disease, a 1:2 age-matched case-control study was conducted in the neighborhoods of Elevação and Bala bala. The target population were children under 15 years old. The sample size was calculated using the EPI Info Calculator: 60 cases and 120 controls were recruited. Significance level was set at p < 0.05 for all hypothesis tests. Results: The RDT positivity rate was 70% for malaria. Of the 60 cases analyzed, 39 (65%) were male; 34 (57%)> 5 years, 36 (60%) lived in Bala bala. The epidemic curve was typical of vector-borne disease and revealed the occurrence of underreporting with the arrival of the external teams and the beginning of the outbreak investigation. Logistic regression identified the following associated factors for contracting malaria: having an open dump close to home, OR of 11.3 [4.54–28.32] (p < 0.001); not sleeping under mosquito net, OR = 16.3 [6.23–42.49] (p < 0.001). Conclusion: The upsurge in malaria cases was the trigger for the rumor that circulated through the media by the population of Cafunfo. Control measures taken included: distribution of LLITNs; vector control strategies, improved case management. It was further recommended that local health authorities strengthen the epidemiological surveillance system, improve basic sanitation, maintain vector control strategies and develop risk communication strategies.

Outbreak of leptospirosis during a canyoning weekend, France, 2017

Introduction On 27 September 2017, a local hospital reported to the Regional Health Agency (RHA) Auvergne-Rhone-Alpes, 5 suspected cases of leptospirosis. These cases (5 young men) took part in a canyoning weekend with a group of 26 persons in the Grenant River (Savoie, 73) during the second weekend of September. Four of them were hospitalized with fever, myalgia, arthralgia, thrombocytopenia and kidney, liver or neurological disorders. A multidisciplinary investigation team was set up in order to describe the outbreak, identify the likely source of infection and implement the necessary control measures. Methods The RHA asked canyoning clubs, laboratories, hospitals and general practitioners around the Grenant River to report possible cases to ensure all of them were identified. A possible case was a person of the group with symptoms compatible with leptospirosis between 9 September and 15 October 2017, and a confirmed case was a possible case with laboratory evidence (a biological test was proposed to each possible case). Each positive case was confirmed by the national reference center for leptospirosis (Institut Pasteur). A standardized questionnaire was used to interview each member of the group and collect demographic characteristics, clinical and biological information, recreational exposures during the whole weekend and information on individual protective measures used against leptospirosis. In the same time, environmental investigation was performed to explore potential infectious reservoirs and environmental conditions near to the canyoning site. Results Twenty-three participants of the group answered to the questionnaire. Three were unreachable. Five confirmed cases of leptospirosis were identified, either by PCR or serology. For two cases, the species L. kishneri was identified by sequencing and Microscopic Agglutination Test (MAT) analysis detected the serogroup grippotyphosa. The only environmental risk exposure identified was canyoning in the Grenant river water. During the activity, all the participants wore a full body wetsuit. Only the absence of gloves could be notice. Two cases reported some skin lesions, but no significant wounds. Several members mentioned the presence of cows on the riverside, which are a possible reservoir of leptospira. No wild animals were seen around the canyoning site or near the camping where the participants were staying during the weekend. However, the river surroundings are known as hunting areas where hunters eviscerate wilds animals. A significant flow with muddy water was also described by all of them. Moreover, this weekend has been preceded by heavy rainfall after a long dry period and environmental investigation pointed out the spreading of manure on the edge of the river. Conclusion According to the results, the most appropriate hypothesis is a contamination by contact of water with mucous membranes during canyoning activity. We observed many favorable environmental conditions including significant rainfall, presence of cows and manure spreading near to the canyoning site. The formal identification of the contamination source was not possible, but it was reported that in this region, Grippotyphosa is the third serogroup responsible for bovine leptospirosis. The RHA immediately suspended the canyoning activities in the Grenant until the end of the season. This request has also been related by social and professional networks. In addition, health professionals and all canyoning sites were informed about the outbreak, leptospirosis risk and individual prevention measures. We recommend to check compliance with the regulations on manure spreading, improve the application of preventive measures to practice fresh water sport, raise awareness about importance and benefit of a rapid medical consultation in case of symptoms, and recommend to health professionals in the region an active surveillance of cases to rapidly identify areas of transmission.

Using ecology and technology to Control Weeds

Using ecology and technology to Control Weeds

Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process

ObjectiveThe purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. MethodsThe research method used was a consensus process. A multidisciplinary investigative team reviewed clinical guidelines and Veterans Affairs pain and mental health initiatives to develop seed statements and care algorithms to guide chiropractic management and collaborative care of veterans with low back pain. A 5-member advisory committee approved initial recommendations. Veterans Affairs-based panelists (n = 58) evaluated the pathway via e-mail using a modified RAND/UCLA methodology. Consensus was defined as agreement by 80% of panelists. ResultsThe modified Delphi process was conducted in July to December 2016. Most (93%) seed statements achieved consensus during the first round, with all statements reaching consensus after 2 rounds. The final care pathway addressed the topics of informed consent, clinical evaluation including history and examination, screening for red flags, documentation, diagnostic imaging, patient-reported outcomes, adverse event reporting, chiropractic treatment frequency and duration standards, tailored approaches to chiropractic care in veteran populations, and clinical presentation of common mental health conditions. Care algorithms outlined chiropractic case management and interprofessional collaboration and referrals between doctors of chiropractic and primary care and mental health providers. ConclusionThis study offers an integrative care pathway that includes chiropractic care for veterans with low back pain.