Multiple Subcategories Research Articles

Is Real-World Evidence Used in P&T Monographs and Therapeutic Class Reviews?

Payers are faced with making coverage and reimbursement decisions based on the best available evidence. Often these decisions apply to patient populations, provider networks, and care settings not typically studied in clinical trials. Treatment effectiveness evidence is increasingly available from electronic health records, registries, and administrative claims. However, little is known about when and what types of real-world evidence (RWE) studies inform pharmacy and therapeutic (P&T) committee decisions. To evaluate evidence sources cited in P&T committee monographs and therapeutic class reviews and assess the design features and quality of cited RWE studies. A convenience sample of representatives from pharmacy benefit management, health system, and health plan organizations provided recent P&T monographs and therapeutic class reviews (or references from such documents). Two investigators examined and grouped references into major categories (published studies, unpublished studies, and other/unknown) and multiple subcategories (e.g., product label, clinical trials, RWE, systematic reviews). Cited comparative RWE was reviewed to assess design features (e.g., population, data source, comparators) and quality using the Good ReseArch for Comparative Effectiveness (GRACE) Checklist. Investigators evaluated 565 references cited in 27 monographs/therapeutic class reviews from 6 managed care organizations. Therapeutic class reviews mostly cited published clinical trials (35.3%, 155/439), while single-product monographs relied most on manufacturer-supplied information (42.1%, 53/126). Published RWE comprised 4.8% (21/439) of therapeutic class review references, and none (0/126) of the monograph references. Of the 21 RWE studies, 12 were comparative and assessed patient care settings and outcomes typically not included in clinical trials (community ambulatory settings [10], long-term safety [8]). RWE studies most frequently were based on registry data (6), conducted in the United States (6), and funded by the pharmaceutical industry (5). GRACE Checklist ratings suggested the data and methods of these comparative RWE studies were of high quality. RWE was infrequently cited in P&T materials, even among therapeutic class reviews where RWE is more readily available. Although few P&T materials cited RWE, the comparative RWE studies were generally high quality. More research is needed to understand when and what types of real-world studies can more routinely inform coverage and reimbursement decisions. This project was funded by the National Pharmaceutical Council. Hurwitz, Brown, Peters, and Malone have nothing to disclose. Graff is employed by the National Pharmaceutical Council Part of this study was presented as a poster presentation at the AMCP Managed Care & Specialty Pharmacy 2016 Annual Meeting; April 19-22, 2016; San Francisco, CA. Study concept and design were primarily contributed by Malone and Graff, along with Hurwitz and Brown. All authors participated in data collection, and data interpretation was performed by Malone, Hurwitz, and Graff, with assistance from Brown and Peters. The manuscript was written primarily by Hurwitz and Malone, along with Graff, Brown, and Peters, and revised by Malone, Brown, Peters, Hurwitz, and Graff.

The interactions between multiple social subcategories in facial recognition

The interactions between multiple social subcategories in facial recognition

Sub-types of nonbelieved memories reveal differential outcomes of challenges to memories

ABSTRACTNonbelieved memories (NBMs) highlight the independence between distinct metamemorial judgements that contribute to the experience of remembering. Initial definitions of NBMs portrayed them as involving the withdrawal of belief in occurrence despite sustained recollection. While people rate belief for their NBMs as weaker than recollection, the average difference is too small to support the idea that autobiographical belief is completely withdrawn in all cases. Furthermore, autobiographical belief and recollection ratings vary considerably across NBMs. In two studies, we reanalysed data from prior studies to examine whether NBM reports reflect a single category or multiple sub-categories using cluster analytic methods. In Study 1, we identified three sub-types of NBMs. In Study 2 we incorporated the concept of belief in accuracy, and found that two of the clusters from Study 1 split into two clusters apiece. All clusters were characterised by higher recollection than belief in occurrence ratings, and clusters were differentiated by the degree of difference between these variables. In both studies the clusters were discriminated by a number of memory characteristic ratings and by reasons reported as leading to the alteration of belief. Implications for understanding the remembering of past events and predicting the creation of NBMs are discussed.

Window of Opportunity for New Disease Surveillance: Developing Keyword Lists for Monitoring Mental Health and Injury Through Syndromic Surveillance.

Studies have documented the impact that hurricanes have on mental health and injury rates before, during, and after the event. Since timely tracking of these disease patterns is crucial to disaster planning, response, and recovery, syndromic surveillance keyword filters were developed by the New York State Department of Health to study the short- and long-term impacts of Hurricane Sandy. Emergency department syndromic surveillance is recognized as a valuable tool for informing public health activities during and immediately following a disaster. Data typically consist of daily visit reports from hospital emergency departments (EDs) of basic patient data and free-text chief complaints. To develop keyword lists, comparisons were made with existing CDC categories and then integrated with lists from the New York City and New Jersey health departments in a collaborative effort. Two comprehensive lists were developed, each containing multiple subcategories and over 100 keywords for both mental health and injury. The data classifiers using these keywords were used to assess impacts of Sandy on mental health and injuries in New York State. The lists will be validated by comparing the ED chief complaint keyword with the final ICD diagnosis code. (Disaster Med Public Health Preparedness. 2017;11:173-178).

Knowledge needs in the non-profit sector: an evidence-based model of organizational practices

Purpose – This paper aims to present findings from a study of non-profit organizations (NPOs), including a model of knowledge needs that can be applied by practitioners and scholars to further develop the NPO sector. Design/methodology/approach – A survey was conducted with NPOs operating in Canada and Australia. An analysis of survey responses identified the different types of knowledge essential for each organization. Respondents identified the importance of three pre-determined themes (quantitative data) related to knowledge needs, as well as a fourth option, which was a free text box (qualitative data). The quantitative and qualitative data were analyzed using descriptive statistical analyses and a grounded theory approach, respectively. Findings – Analysis of the quantitative data indicates that NPOs ' needs are comparable in both countries. Analysis of qualitative data identified five major categories and multiple sub-categories representing the types of knowledge needs of NPOs. Major categories are knowledge about management and organizational practices, knowledge about resources, community knowledge, sectoral knowledge and situated knowledge. The paper discusses the results using semantic proximity and presents an emergent, evidence-based knowledge management (KM)-NPO model. Originality/value – The findings contribute to the growing body of literature in the KM domain, and in the understudied research domain related to the knowledge needs and experiences of NPOs. NPOs will find the identified categories and sub-categories useful to undertake KM initiatives within their individual organizations. The study is also unique, as it includes data from two countries, Canada and Australia.

Steerable Catheters in Cardiology: Classifying Steerability and Assessing Future Challenges.

This review aims to provide a structured classification of the underlying steering mechanisms in steerable catheters and to assess their future challenges. Existing, patented, and experimental designs of steerable catheters are classified with respect to their steerability. Subsequently, the classification is used as a tool for defining future requirements and challenges for steerable cardiac catheters. The results of the classification provide two categories of steering at a fundamental level: 1) Force generation in the tip and 2) force transmission to the tip. The former group consists of force generating steering mechanisms as a result of 1) electric, 2) thermal, and 3) magnetic actuation. The latter group comprises force transmitting steering mechanisms as the result of 4) hydraulic chamber actuation or 5) mechanic cable actuation. Each category can be further subdivided into multiple subcategories. Future requirements and challenges are found for steering and positioning capabilities, cardiac applications and safety, and miniaturization potential. A structured classification is presented which identifies the different steering mechanisms in steerable catheters. The classification proves to be a useful tool in determining future requirements and challenges, being invaluable for future application-driven design. Using the applied classification as a tool for future design will not only provide insight into previously applied steering technology, it will identify new and unexplored options too. Additionally, insight into the requirements and challenges for catheter steering toward and inside the heart, will allow more dedicated systems, allowing intervention- and patient-specific instrument manipulation.

Multiple Subcategories Parts-Based Representation for One Sample Face Identification

Small sample set, occlusion, and illumination variations are the critical obstacles for a face identification system towards practical application. In this paper, we propose a probabilistic generative model for parts-based data representation to address these difficulties. In our approach, multiple subcategories corresponding to the individual face parts, such as nose, mouth, eye, and so forth, are modeled within a probabilistic graphical model framework to mimic the process of generating a face image. The induced face representation, therefore, encodes rich discriminative information. Model training is totally unsupervised. Once the training is completed, a test sample from the face class can be recognized as a novel combination of learned parts. In summary, the main contributions of this work are threefold: 1) A novel hierarchical probabilistic generative model is proposed, which is capable of achieving an efficient parts-based representation for robust face identification. 2) A constrained variational EM algorithm is developed to learn the model parameters and infer the variables. 3) Two similarity metrics are specially designed for the novel parts-based feature representation, which are effective for matching score guided one sample face identification. The models and similarity metrics are validated on three face databases. Experimental results demonstrate the capabilities of the model to deal with small sample set, occlusions, and illumination variances.

A Hierarchy of Personal Agency for People With Life-Limiting Illness

The purpose of the study was to discover how individuals diagnosed with a life-limiting illness experienced themselves as agents, even in the face of death. In this qualitative, multiple case study design, 4 female outpatient hospice patients with terminal illnesses received humanistic counseling to explore their experiences of themselves and their illness. A graded set of 8 levels of personal agency emerged from analyses of the texts of their sessions, ranging from a passive, objectified nonagentic mode to an active, autonomous fully agentic mode, with multiple subcategories representing further gradations within levels. Our results are consistent with guidelines for supportive and palliative care with advanced cancer, which specify that dying patients' needs be assessed and that they be involved in decisions about their care.

What Patients Want: Preferences Regarding Hospital Pharmacy Services

The role of hospital pharmacists has evolved over the past couple of decades from preparation and distribution of medications to active involvement in health care teams, through identification and resolution of patients' medication-related issues in an effort to improve patient outcomes. However, patients' preferences about pharmacy services are not well known. To use content analysis of open-ended survey responses from recently discharged patients to determine desired pharmacy services. Former inpatients were randomly selected for participation in a telephone survey following discharge from acute care hospitals in the Horizon Health Network in New Brunswick. The survey included the question, "What service or information would you like a pharmacist to provide in the hospital that would most help you in managing your medications?" For responses to this question, 2 raters established response categories, obtained acceptable inter-rater agreement, and independently scored the responses. Four global categories of responses were obtained, each having multiple subcategories. Of the 703 responses (from 325 respondents), 445 (63.3%) were related to the category "information about medications", including purpose, adherence, and side effects. The second most common response category was "self-disclosure" (167 [23.8%]), including experiences with pharmacies, medications, or hospitals. Less frequently, responses pertained to "pharmacy services" (54 [7.7%]), such as medication costs and continuity of care, and to "information source for medications" (37 [5.3%]). Most respondents to this survey wanted hospital pharmacists to provide a general medication overview, including information about side effects and interactions, during their admission. The results suggest that many patients are unaware of other potential clinical services that pharmacists can provide. A future study could assess patients' willingness to select from a guiding list of potential clinical services.

Exploring the integration of internationally educated occupational therapists into the workforce

British Columbia (BC) is a popular Canadian work destination for occupational therapists from around the world. This study explored the experiences of stakeholders involved in the integration of internationally educated occupational therapists (IEOTs) into the BC workforce. Semi-structured interviews were conducted with the three primary stakeholder groups (40 IEOTs, 12 supervising occupational therapists, seven managers), as well as with seven key informants. Participants were purposively sampled and thematic analysis was applied to the data. Three themes were identified that fit sequentially along a workforce-integration continuum: "coming to Canada," "registering with the college," and "integrating into the workplace." Within those themes, findings were organized into two categories, "ingredients for success" and "stumbling block," and multiple subcategories. The findings suggest that hiring IEOTs can bring benefits to the workplace and clients. However, changes made along the continuum would facilitate workforce integration, ultimately benefiting all stakeholders. These findings may be of interest to IEOTs, occupational therapists, and managers as well as individuals working in regulation and policy.

Methods for Structuring Scientific Knowledge from Many Areas Related to Aging Research

Aging and age-related disease represents a substantial quantity of current natural, social and behavioral science research efforts. Presently, no centralized system exists for tracking aging research projects across numerous research disciplines. The multidisciplinary nature of this research complicates the understanding of underlying project categories, the establishment of project relations, and the development of a unified project classification scheme. We have developed a highly visual database, the International Aging Research Portfolio (IARP), available at AgingPortfolio.org to address this issue. The database integrates information on research grants, peer-reviewed publications, and issued patent applications from multiple sources. Additionally, the database uses flexible project classification mechanisms and tools for analyzing project associations and trends. This system enables scientists to search the centralized project database, to classify and categorize aging projects, and to analyze the funding aspects across multiple research disciplines. The IARP is designed to provide improved allocation and prioritization of scarce research funding, to reduce project overlap and improve scientific collaboration thereby accelerating scientific and medical progress in a rapidly growing area of research. Grant applications often precede publications and some grants do not result in publications, thus, this system provides utility to investigate an earlier and broader view on research activity in many research disciplines. This project is a first attempt to provide a centralized database system for research grants and to categorize aging research projects into multiple subcategories utilizing both advanced machine algorithms and a hierarchical environment for scientific collaboration.

Self-Surveillance by Adolescents and Young Adults Transitioning to Self-Management of a Chronic Genetic Disorder

Adolescents and young adults with Marfan syndrome (MFS) use information from self-surveillance to manage their disorder. Thirty-seven male and female adolescents with MFS aged 14 to 21 years were interviewed. They identified 58 distinct self-surveillance behaviors that fell into four categories and multiple subcategories (SCs): tracking phenotype (SCs: physical appearance, physical fitness, medical problems, and other observations); tracking medical care (SCs: medical evaluations and treatments, and pharmacotherapy); tracking behavior (SCs: personal choices and social relations); and tracking emotions (SCs: positive emotional impact and negative emotional impact). The frequency and range of self-monitoring increased with the age of the child. On average, a child of 14 self-monitored from 1 to 3 times per day, whereas a person aged 21 might self-monitor many more times per day. The patient-parent-physician relationship is the context for teaching adolescents and young adults self-surveillance skills. Self-surveillance by patients is first-line symptom assessment and an adjunct to medical monitoring.

Y1-01: Toward A New Histological Classification Of Lung Tumors

Y1-01: Toward A New Histological Classification Of Lung Tumors

Risk factors for prostate cancer incidence and progression in the health professionals follow‐up study

Risk factors for prostate cancer could differ for various sub-groups, such as for "aggressive" and "non-aggressive" cancers or by grade or stage. Determinants of mortality could differ from those for incidence. Using data from the Health Professionals Follow-Up Study, we re-examined 10 factors (cigarette smoking history, physical activity, BMI, family history of prostate cancer, race, height, total energy consumption, and intakes of calcium, tomato sauce and alpha-linolenic acid) using multivariable Cox regression in relation to multiple subcategories for prostate cancer risk. These were factors that we previously found to be predictors of prostate cancer incidence or advanced prostate cancer in this cohort, and that have some support in the literature. In this analysis, only 4 factors had a clear statistically significant association with overall incident prostate cancer: African-American race, positive family history, higher tomato sauce intake (inversely) and alpha-linolenic acid intake. In contrast, for fatal prostate cancer, recent smoking history, taller height, higher BMI, family history, and high intakes of total energy, calcium and alpha-linolenic acid were associated with a statistically significant increased risk. Higher vigorous physical activity level was associated with lower risk. In relation to these risk factors, advanced stage at diagnosis was a good surrogate for fatal prostate cancer, but high-grade (Gleason >/= 7 or Gleason >/= 8) was not. Only for high calcium intake was there a close correspondence for associations among high-grade cancer, advanced and fatal prostate cancer. Tomato sauce (inversely) and alpha-linolenic acid (positively) intakes were strong predictors of advanced cancer among those with low-grade cancers at diagnosis. Although the proportion of advanced stage cancers was much lower after PSA screening began, risk factors for advanced stage prostate cancers were similar in the pre-PSA and PSA era. The complexity of the clinical and pathologic manifestations of prostate cancer must be considered in the design and interpretation of studies.

Adolescents’ Conceptions of Work

Anticipatory socialization is the process of gaining knowledge about work that begins in early childhood and continues until entering the workplace full-time. On self-administered questionnaires, 64 high school students answered open-ended questions about what they have learned about work from five sources: parents, educational institutions, part-time employment, friends, and the mass media. Responses were coded into four macro categories (general requirements of a job, positive aspects of work, negative aspects of work, advice or information about work/jobs), each of which included multiple subcategories. Parents, school, and part-time jobs were respondents’ main sources of knowledge about the requirements of performing a job, and parents provided the most advice about jobs and careers. Parents and friends communicated more negative than positive aspects, part-time jobs and the mass media conveyed both positives and negatives, and educational experiences conveyed neither. Interpretations of the findings and suggestions for future research are discussed.

What are the key attributes of primary care for patients? Building a conceptual 'map' of patient preferences.

Responding to the preferences of patients is a key focus of current health policy and is especially important in primary care. Responding effectively to patient preferences requires a clear understanding of the way in which patients assess primary care services. This study was designed to provide a 'map' of the content and structure of the key attributes of patient preferences concerning primary care. The development of the 'map' used secondary research methods. Electronic databases were searched for published conceptual reviews of patient preferences, which were used to develop a basic 'map' through content analysis. A search for recently published primary empirical studies of patient preferences was conducted to extend and develop the 'map'. The 'map' was tested by taking a random sample of patient assessment instruments and categorizing the item content. Seven major categories and multiple subcategories were described. The major categories were access, technical care, interpersonal care, patient-centredness, continuity, outcomes, and hotel aspects of care. The coverage of these attributes in a selection of patient assessment instruments varied widely, and the coding of a proportion of items in the patient assessment instruments according to the 'map' was problematic. The conceptual 'map' can be used to plan comprehensive assessment of patient preferences in primary care. It also raises many theoretical issues concerning the nature of attributes and their interrelationships. The implications for the measurement of patient preferences are discussed.

The Role of Alemtuzumab in the Management of T-Cell Malignancies

T-cell malignancies are rare, making up 10% to 15% of all lymphoid neoplasms in adults. They include many different types of disorders such as T-cell prolymphocytic leukemia, T-cell large granular lymphocytic leukemia, adult T-cell leukemia/lymphoma, cutaneous T-cell lymphoma, and peripheral T-cell lymphoma, which are themselves divided into multiple subcategories. Most T-cell malignancies arise as a result of chromosomal abnormalities, including T-cell receptor rearrangement anomalies. Viral infections are implicated in the development of adult T-cell leukemia/lymphoma and some cases of peripheral T-cell lymphoma have been linked to Epstein-Barr virus or human immunodeficiency virus infection. With the possible exception of T-cell large granular lymphocytic leukemia, which often has an indolent course, T-cell malignancies have not responded well to conventional chemotherapeutic treatment. The introduction of monoclonal antibodies for the treatment of cancer has changed the outlook for patients with T-cell malignancies. Recent studies with single-agent alemtuzumab, an anti-CD52 monoclonal antibody, have shown improved response rates and survival in patients with T-cell prolymphocytic leukemia and cutaneous T-cell lymphoma. Preliminary data also suggest that alemtuzumab may have activity in patients with heavily pretreated peripheral T-cell lymphoma who are refractory to conventional chemotherapy. Preclinical studies with mice bearing human adult T-cell leukemia/lymphoma cells suggest that alemtuzumab may have a potential therapeutic role in this setting. Treatment of T-cell hematologic malignancies with alemtuzumab appears promising. Earlier treatment and combination with chemotherapeutic agents may improve treatment outcome for patients with these malignancies and allow for consolidation with stem cell transplant strategies in selected patients.

Pathologic classification of focal segmental glomerulosclerosis

Focal segmental glomerulosclerosis (FSGS) is defined as a clinical-pathologic syndrome manifesting proteinuria and focal and segmental glomerular sclerosis with foot process effacement. The pathologic approach to the classification of FSGS is complicated by the existence of primary (idiopathic) forms and multiple subcategories with etiologic associations, including human immunodeficiency virus (HIV)-associated nephropathy, heroin nephropathy, familial forms, drug toxicities, and a large group of secondary FSGS mediated by structural-functional adaptations to glomerular hyperfiltration. A number of morphologic variants of primary and secondary focal sclerosis are now recognized, including FSGS not otherwise specified (NOS), perihilar, cellular, tip, and collapsing variants. The defining features of these morphologic variants and of the major subcategories of FSGS are discussed with emphasis on distinguishing light microscopic patterns and clinical-pathologic correlations. © 2003 Elsevier Inc. All rights reserved.

Activity Sampling Applied to Interactive System Design

In the design of interactive systems, it is desirable to obtain both qualitative and quantitative estimates of combined human/system performance as early as possible. Recent methodological extensions to the well-known technique of activity sampling can make simulation a more effective source of both kinds of data. Experience with these enhancements demonstrates that through the use of intensive videotape sessions, computer-naive subject-matter experts can be trained reasonably quickly to reliably exercise highly complex classification schemes that include simultaneous categories with multiple subcategories. In the context of knowledge engineering, this measurement technique, combined with scenario-driven simulations of proposed forms of interaction, can also be employed to spin off a variety of synergistic benefits, such as (a) critical-incident generation, (b) early “hard” estimates of personnel requirements and training costs, (c) explanatory (hypothesis-generating) power of a very application-specific nature, and (d) conversion of user-group resistance into user-group support.