Panel Of Healthcare Professionals Research Articles

Applying natural language processing to patient messages to identify depression concerns in cancer patients.

This study aims to explore and develop tools for early identification of depression concerns among cancer patients by leveraging the novel data source of messages sent through a secure patient portal. We developed classifiers based on logistic regression (LR), support vector machines (SVMs), and 2 Bidirectional Encoder Representations from Transformers (BERT) models (original and Reddit-pretrained) on 6600 patient messages from a cancer center (2009-2022), annotated by a panel of healthcare professionals. Performance was compared using AUROC scores, and model fairness and explainability were examined. We also examined correlations between model predictions and depression diagnosis and treatment. BERT and RedditBERT attained AUROC scores of 0.88 and 0.86, respectively, compared to 0.79 for LR and 0.83 for SVM. BERT showed bigger differences in performance across sex, race, and ethnicity than RedditBERT. Patients who sent messages classified as concerning had a higher chance of receiving a depression diagnosis, a prescription for antidepressants, or a referral to the psycho-oncologist. Explanations from BERT and RedditBERT differed, with no clear preference from annotators. We show the potential of BERT and RedditBERT in identifying depression concerns in messages from cancer patients. Performance disparities across demographic groups highlight the need for careful consideration of potential biases. Further research is needed to address biases, evaluate real-world impacts, and ensure responsible integration into clinical settings. This work represents a significant methodological advancement in the early identification of depression concerns among cancer patients. Our work contributes to a route to reduce clinical burden while enhancing overall patient care, leveraging BERT-based models.

Translation and validation of the international consultation on incontinence questionnaire-Bowel in Danish men and women with pelvic floor disorders.

We lack a comprehensive validated Danish questionnaire to evaluate symptoms and bother regarding anal incontinence (AI). The International Consultation on Incontinence Questionnaire-Bowel (ICIQ-B) is an internationally recommended questionnaire containing 21 items, of which 17 are scored in three subscales: bowel pattern, bowel control, and quality of life. To translate the ICIQ-B into Danish and to validate the Danish version in pelvic floor disorder (PFD) patients with and without AI. The ICIQ-B was translated by a panel of healthcare professionals followed by cognitive interviews with PFD patients attending an outpatient clinic. Revisions were undertaken using an iterative process, and a backward translation was performed for the final version. Pretesting and test-retest of the ICIQ-B were done online and administrated together with the St. Mark's score. Content, structural, convergent and discriminant validity were assessed, followed by an evaluation of relative and absolute reliability, including the smallest real difference (SRD). Thirty cognitive patient interviews were performed, resulting in three revisions. The Danish ICIQ-B was found to be comprehensible and relevant but lacked items addressing the psychological impact of bowel problems. The ICIQ-B was completed online by 227 PFD patients with and without AI. The structural validity of the bowel pattern subscale could not be retrieved. Patients indicating AI had significantly higher ICIQ-B and St. Mark's scores than patients without AI, and ICIQ-B subscale scores correlated moderately with St. Mark's scores. Internal consistency was good except for the bowel pattern subscale. Seventy-six patients completed test-retest. Relative reliability was excellent for subscale scores and moderate or good for single items except for the item concerning stool consistency, which was weak. The SRD was found to be 2.8 for the bowel pattern subscale, 4.3 for bowel control subscale, and 3.6 for the quality-of-life subscale. The Danish version of the ICIQ-B can be used for Danish patients with PFD, and discriminant validity is good. The structural validity and the internal consistency of the bowel pattern subscale are questionable, indicating that some items do not represent the underlying construct. Test-retest reliability of the ICIQ-B is acceptable, but the change needed to reflect a real change above the measurement error in each subscale is three to four points.

Cross-cultural adaptation, reliability and validity analysis of the Cantonese-Chinese Manchester Oxford Foot Questionnaire for Foot and Ankle Disorder (Manchester-Oxford Foot Questionnaire HK)

The Manchester–Oxford Foot Questionnaire is a validated English 16-item patient-reported outcome measure for evaluating foot and ankle function. This study aimed to translate a Cantonese Chinese version of the questionnaire and evaluate its validity and reliability among patients with foot and ankle disorders. The translation and cross-cultural adaptation were conducted by forward translation, synthesis of translated versions, backward translation, review, and pre-testing by a panel of healthcare professionals. The test-retest reliability was conducted within 2–4 weeks. Internal consistency and construct validity were evaluated using the Visual Analogue Scale and Short-Form 36. 135 participants were recruited to complete the validation process. The overall reliability coefficient constituted 0.86 (intraclass correlation coefficient = 0.72–0.93). A strong, statistically significant correlation was found between the bodily pain subscale of Short-Form 36 and the pain subscale of the Cantonese Chinese-Manchester-Oxford Foot Questionnaire ( r = −0.77, p < 0.001). This was similar to the pain subscale of the Cantonese Chinese-Manchester-Oxford Foot Questionnaire and visual analogue pain score ( r = 0.77, p < 0.001). The overall score for the Cantonese Chinese Manchester-Oxford Foot Questionnaire between the healthy control group and the pathological group was statistically different ( p < 0.001). A good consistency level was found in the questionnaire with a Cronbach's alpha coefficient of 0.78, 0.86, 0.78, 0.85 for pain, walking/standing, social interaction, and the overall domain of the Cantonese Chinese-Manchester-Oxford Foot Questionnaire, respectively. Therefore, this questionnaire can be adapted as a reliable clinical assessment and an outcome measure among the Cantonese Chinese-speaking population.

Leadership in interProfessional healthcare practice (IPHP): Readiness, roles, and compentencies for healthcare managers and human resource professionals

PurposeThis paper focuses on leadership in interprofessional healthcare practice in general; and the readiness of both healthcare management trainees in healthcare management programs and certified human resource management professionals to facilitate and/or lead interprofessional healthcare practice in particular. The authors identify and analyze consensus among two panels made up of 20 healthcare professionals and 35 healthcare management educators. The analysis covers the role human resource (HR) professionals should play in interprofessional healthcare practice (IPHP) and the competencies that both healthcare management trainees and human resource managers should possess in order to facilitate thetransformation of healthcare organizations from professional to interprofessional practice. Authors also assess the readiness of healthcare management education trainees and certified human resource management professionals to lead IPHP.Design/methodology/approach: This study adopted a cross-sectional design to guide the documentation and assessment of participants’ responses using a modified delphi technique, a nominal technique, and extant literature. Inductive and deductive methods in combination with open, axial, and selective coding were utilized to determine and analyze emerging consensus from the panel of experts. FindingsThere is a convergent of emergent themes on perceived roles and competencies for IPHP leadership from both the panel of healthcare professionals and the panel of healthcare management educators. The themes are also relevant to both organizational change variables and barriers to IPHP, documented in the literature. There is a gap between perceived roles and recommended competencies and the following: the standards for both the Society of Human Resource Management (SHRM) professional certifications, Commission on theAccreditationof Healthcare Management Education (CAHME) accreditation, recommended core competencies by the Interprofessional Education Collaborative(IPEC), and the degree of interprofessional education penetration in healthcare education programs. These findings underscore the deficit in interprofessional healthcare practice leadership readiness among healthcare management trainees and human resource professionals. Authors make specific recommendations on IPHP leadership for healthcare management training and human resource professional preparation.

TANGO: Development of Consumer Information Leaflets to Support TAperiNG of Opioids in Older Adults with Low Back Pain and Hip and Knee Osteoarthritis.

Globally, the rate of opioid prescription is high for chronic musculoskeletal conditions despite guidelines recommending against their use as their adverse effects outweigh their modest benefit. Deprescribing opioids is a complex process that can be hindered by multiple prescriber- and patient-related barriers. These include fear of the process of, or outcomes from, weaning medications, or a lack of ongoing support. Thus, involving patients, their carers, and healthcare professionals (HCPs) in the development of consumer materials that can educate and provide support for patients and HCPs over the deprescribing process is critical to ensure that the resources have high readability, usability, and acceptability to the population of interest. This study aimed to (1) develop two educational consumer leaflets to support opioid tapering in older people with low back pain (LBP) and hip or knee osteoarthritis (HoKOA), and (2) evaluate the perceived usability, acceptability, and credibility of the consumer leaflets from the perspective of consumers and HCPs. This was an observational survey involving a consumer review panel and an HCP review panel. 30 consumers (and/or their carers) and 20 HCPs were included in the study. Consumers were people older than 65 years of age who were currently experiencing LBP or HoKOA, and with no HCP background. Carers were people who provided unpaid care, support, or assistance to an individual meeting the inclusion criteria for consumers. HCPs included physiotherapists (n=9), pharmacists (n=7), an orthopaedic surgeon (n=1), a rheumatologist (n=1), nurse practitioner (n=1) and a general practitioner (n=1), all with at least threeyears of clinical experience and who reported working closely with this target patient population within the last 12 months. Prototypes of two educational consumer leaflets (a brochure and a personal plan) were developed by a team of LBP, OA, and geriatric pharmacotherapy researchers and clinicians. The leaflet prototypes were evaluated by two separate chronological review panels involving (1) consumers and/or their carers, and (2) HCPs. Data collection for both panels occurred via an online survey. Outcomes were the perceived usability, acceptability, and credibility of the consumer leaflets. Feedback received from the consumer panel was used to refine the leaflets, before circulating the leaflets for further review by the HCP panel. Additional feedback from the HCP review panel was then used to refine the final versions of the consumer leaflets. Both consumers and HCPs perceived the leaflets and personal plan to be usable, acceptable, and credible. Consumers rated the brochure against several categories, which scored between 53 and 97% positive responses. Similarly, the overall feedback provided by HCPs was 85-100% positive. The modified System Usability Scale scores obtained from HCPs was 55-95% positive, indicating excellent usability. Feedback for the personal plan from both HCPs and consumers was largely positive, with consumers providing the highest positive ratings (80-93%). While feedback for HCPs was also high, we did identify that prescribers were hesitant to provide the plan to patients frequently (no positive responses). This study led to the development of a leaflet and personal plan to support the reduction of opioid use in older people with LBP or HoKOA. The development of the consumer leaflets incorporated feedback provided by HCPs and consumers to maximise clinical effectiveness and future intervention implementation.

Assessing opinion on lower LDL-cholesterol lowering, and the role of newer lipid-reducing treatment options.

While statins are the gold standard for lipid-lowering therapies, newer therapies, such as PCSK9 inhibitors, have also demonstrated low-density lipoprotein cholesterol (LDL-C) reduction, but with a similar or better safety profile. Conflicting guidance has contributed to a low uptake. More up-to-date, evidence-led guidance supports greater use of newer therapies, particularly in combination with statins, to reduce LDL-C to levels shown to be effective in trials. The aim of this study was to determine how such guidance can be implemented more effectively in the UK. Using a modified Delphi approach, a panel of healthcare professionals with an interest in the management of dyslipidaemia developed 27 statements across four key themes. These were used to form an online survey that was distributed to healthcare professionals working in cardiovascular care across the UK. Stopping criteria included 100 responses received, a seven-month window for response (September 2021 to March 2022), and 90% of statements passing the predefined consensus threshold of 75%. A total of 109 responses were analysed with 23 statements achieving consensus (four statements <75%). Variance was observed across respondent role, and by UK region. From the high degree of consensus, seven recommendations were established as to how evidence-based guidance can be delivered, including a call for personalised therapy strategies and simplification of LDL-C goals, which should be achieved within as short a time as possible.

A Community and Hospital cAre Bundle to improve the medical treatment of severe cLaudIcation and critical limb iSchaemia (CHABLIS).

Patients with peripheral artery disease (PAD) often do not receive optimal best medical therapy (BMT). Through interaction with patients and healthcare-professionals (HCPs) we developed the LEaflet Gp letter Structured checklist (LEGS) complex clinical intervention to support HCPs in providing guideline-compliant PAD BMT. This was a prospective multicentre study assessing the feasibility and fidelity of delivering the LEGS intervention in primary and secondary care over six months. Intervention fidelity was scored based on the proportion of intervention components used correctly at discharge, 30 days, and six months. Overall, 129 individuals were screened and 120 took part (33% female, 74% with chronic limb threatening ischaemia; 93% recruitment rate). Of those, 118 (98% retention rate) completed follow-up. Mean intervention fidelity score at discharge (primary outcome measure) was 63% [95% Confidence Interval (CI): 39-68%, SD: 5%], exceeding the success criteria set at 60% by a panel of HCPs and patients. This, however, declined to 51% at six months. Eight patients (6.7%) died (all cardiovascular deaths), four (3.3%) had a major lower limb amputation, 12 (10%) had a cardiovascular event, and 13 (11%) were admitted due to limb ischaemia at six months. Incomplete lipid therapy prescriptions and LEGS intervention documents not received by primary care CHPs were the most common reasons for not complying with the LEGS intervention. The LEGS intervention can be delivered in PAD care pathways across different hospitals, primary, and community healthcare settings with acceptable fidelity, to streamline and improve PAD BMT short- and medium-term.

Evaluation of an interprofessional collaborative practice training module for the management of children with autism spectrum disorder

BackgroundProtocols instituted for behavioral treatment and skills training programs for the management of autism spectrum disorder (ASD) suffer from lack of collaborative approaches. The tenets of interprofessional collaborative practice (IPCP) focus on preparing a panel of health care professionals (HCPs) from different professions who can work together to enable the common goal of ensuring that children with ASD can participate in society. This study was designed to pilot this approach through an IPCP training module on ASD for care providers from multiple professions. MethodsAn interventional study with pre-post analysis began with formation of the interprofessional (IP) team, who developed an IPCP module, addressing the knowledge and skills needed for the collaborative management of neurodevelopmental issues of children with ASD. This module was delivered through an online training workshop using various teaching learning methods to the participants from seven different health professions after obtaining informed consent. Perceptions of interprofessional collaboration and competencies of IPCP were assessed using standard IP tools and reflective summaries and analyzed through a mixed-methods approach. ResultsA total of 42 HCPs from seven professions, including speech and hearing, occupational therapy, clinical psychology, physiotherapy, pediatrics, nursing, and pedodontics, participated in the study. Pre-post analysis of PINCOM-Q and Dow-IPEC data and thematic analysis revealed a significant difference in the perceptions of interprofessional collaboration and competencies’ levels of IPCP. ConclusionThis study suggests that use of IPCP principles in the training of professionals working with ASD is a promising and feasible option to develop more competent health professionals. The training enhanced the abilities of professionals to work in field of ASD as conveyed by the participants. They also expressed confidence in the knowledge of IP core competencies after the completion of the module.

ONS Guidelines™ to Support Patient Adherence to Oral Anticancer Medications.

This evidence-based guideline intends to support patients, clinicians, and others regarding interventions and processes to support patient adherence to oral anticancer medications (OAMs). A panel of healthcare professionals and patient representatives developed a clinical practice guideline to support patients taking OAMs. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology and criteria for trustworthy guidelines were followed. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. A quantitative or narrative synthesis of the evidence was completed. Certainty of the evidence was assessed using GRADE. The panel agreed on recommendations and suggested an adherence risk assessment, education addressing adherence, ongoing assessment, proactive follow-up, coaching, and motivational interviewing in addition to usual care. The panel suggested the implementation of a structured OAM program. As cancer treatment shifts from clinic to home settings, interventions and programs to support patients on OAMs are needed.

Development of a Consensus-Based Cross-Domain Protocol for the Management of Elastic Compression Stocking Therapy in Patients With Deep Venous Thrombosis and Chronic Venous Disease: A Modified Delphi Study.

ObjectiveElastic compression stocking (ECS) therapy is commonly used in patients with deep venous thrombosis (DVT) and chronic venous disease (CVD). The provision of ECS therapy is complex, and studies indicate a lack of practical guidance and suboptimal collaboration among health care professionals. We aimed to reach consensus on critical issues of ECS therapy among the involved health care professionals and patients.MethodsA three-round modified Delphi analysis was performed in the Netherlands in which 56 health care professionals (internists, dermatologists, general practitioners, emergency room nurses, home care nurses, medical stocking suppliers, and occupational therapists) and seven patients were invited. The 21 statements included in this analysis were based on information collected from a previously conducted Functional Resonance Analysis Method and Realist Evaluation. We used 7-point Likert scale questions and a 75% threshold for consensus.ResultsOf the 63 persons invited for this study, 59 (94%) agreed to participate and responded in the first questionnaire round; of whom 52 were health care professionals and seven were patients (five DVT and two CVD). The overall response rate for the three questionnaire rounds was 91%. After completion of the rounds, full consensus was achieved on 19 out of 21 statements. No consensus was reached on the need for a follow-up appointment for CVD patients and who should be responsible to determine the ECS type (custom-made or standard).ConclusionWe identified 19 consensus-driven recommendations on treatment decisions and collaboration in ECS therapy among an interdisciplinary panel of health care professionals and patients. These recommendations form a basis for consensus-driven optimization of ECS therapy and should ideally be incorporated in a general cross-domain protocol for ECS therapy in patients with DVT and CVD.

Impact of guideline awareness on the counseling of patients with acute cough among general practitioners and pharmacy personnel.

ObjectiveTo explore the awareness and knowledge of applicable guidelines on acute cough among general practitioners, pharmacists and pharmacy technicians and to compare their recommendation behavior and clinical decision making to the evidence-based recommendation in the applicable guidelines.MethodsAn anonymous online survey was performed among 303 members of an existing panel of healthcare professionals (HCPs). They were presented with a hypothetical case vignette representative of their daily practice and asked for their treatment recommendations. After being shown an excerpt from the applicable guidelines, these questions were repeated.ResultsForty-six % of participants reported to seek information on cough and respiratory conditions very often or often. Among 12 non-prescription treatments-commonly used over-the-counter-products for acute cough, HCPs most often recommended various plant extract-based products (phytotherapeutic remedies) for the acute cough case, whereas chemically defined options such as ambroxol or N-acetyl-cysteine were recommended less often. Following presentation of the guidelines excerpt, recommendations of the phytotherapeutic remedies decreased moderately whereas that of the guideline-recommended ambroxol more than doubled. Among stated reasons for the recommendation guideline conformity increased from 5% to 35% among the top-3 reasons.ConclusionsThe recommendations for the treatment of acute cough by professionals involved in primary healthcare deviated considerably from the applicable guideline recommendation but changed after presentation of a guidelines excerpt and knowledge thereof. We conclude that dissemination of applicable guideline knowledge is relevant to improve evidence-based healthcare and clinical decision making.

Operation theatre protocol for COVID-19 cases requiring orthopaedic surgery: A workflow without altering the existing infrastructure

IntroductionThe surge in the number of trauma cases following relaxation of lockdowns in the backdrop of COVID-19 pandemic, has strained the existing infrastructure to cater to these patients and also prevent the spread of infection. Moreover, with the rise of newer strains, the period ahead has to be tread carefully to prevent resurgence of infections. There have been recommendations regarding the ideal setup to operate orthopaedic cases in this pandemic scenario. However, many of the hospitals in India with financial and logistic constraints are unable to implement these structural changes into their existing setup. We propose a model which can be used in an existing operation theatre which has a single entry and exit corridor, which is the layout in many hospitals. MethodologyA protocol with the consultation of a panel of health care professionals was designed on the basis of WHO guidelines in a way so as to remain dynamic. Prior to its implementation, online classes were conducted and a dry run of the protocol was done with the whole team involved. The theatre layout is one with a single entry and exit and had predesignated rooms. The personnel were divided into 3 teams, each with a fixed set of people and preset workflow, to be followed during entry and exit. Five COVID positive cases have been operated since then using the protocol and has been used as a pilot study to further amend the protocol. ConclusionThis model can be used as a guideline by hospitals having a limited infrastructure, to develop their own protocol to operate on COVID positive cases, in the present situation of increasing trauma cases post the relaxation of lockdown and also in any subsequent waves of infection with newer strains. Simulation and periodic stringent audits with the entire team would prove successful in rectifying errors and avoiding any possible contamination.

Clinical attitude regarding denosumab drug-holiday for dental extraction in oncologic patients: a national survey

Introduction: Denosumab is indicated in oncology to reduce tumoral development. However, this medication may cause osteonecrosis of the jaw, especially after dental extractions. Drug holiday has been proposed to decrease the risk of osteonecrosis of the jaw. This survey aimed to assess the management of drug holidays for patients who needed both dental extraction and denosumab. Methods: A questionnaire was sent to a panel of healthcare professionals. Results: Of the 33 practitioners interviewed, 28 undertook or “were used to” dental extractions in patients on denosumab. 25% (7/28) of the practitioners questioned did not stop patients from taking denosumab before dental extraction and 75% (21/28) used a drug holiday. For those who stopped the treatment, 33% (7/21) waited 2 months before performing dental extraction and 38% (8/21) waited 2 months after the dental extraction before reintroducing the molecule; 2 months being the median duration in both cases. In addition, 89% (25/28) of practitioners, modified their surgical procedure for these patients. Conclusion: Despite a small number of responders, it seemed that a drug holiday of at least 2 months is mandatory before performing tooth extraction. The issue of the drug holiday should always be raised with the patient's oncologist.

The Digital/Virtual Diabetes Clinic: The Future Is Now-Recommendations from an International Panel on Diabetes Digital Technologies Introduction.

The increasing prevalence of diabetes, combined with a growing global shortage of health care professionals (HCP), necessitates the need to develop new approaches to diabetes care delivery to expand access to care, lessen the burden on people with diabetes, improve efficiencies, and reduce the unsustainable financial liability on health systems and payers. Use of digital diabetes technologies and telehealth protocols within a digital/virtual diabetes clinic has the potential to address these challenges. However, several issues must be resolved to move forward. In February 2020, organizers of the Advanced Technologies & Treatments for Diabetes Annual Conference convened an international panel of HCP, researchers, patient advocates, and industry representatives to review the status of digital diabetes technologies, characterize deficits in current technologies, and identify issues for consideration. Since that meeting, the importance of using telehealth and digital diabetes technologies has been demonstrated amid the global coronavirus disease (COVID-19) pandemic. This article summarizes the panel's discussion of the opportunities, obstacles, and requisites for advancing the use of these technologies as a standard of care for the management of diabetes.

ONS Guidelines™ for Cancer Treatment–Related Lymphedema

Purpose: Lymphedema is a chronic condition that may result from cancer-related surgery. The incidence of lymphedema varies greatly; however, patients remain at risk for life and may experience decreased quality of life and functional capacity. Providing recommendations for an evidence-based guideline for care of cancer treatment–related lymphedema will help to improve outcomes for patients with this chronic condition. Methodologic Approach: A panel of healthcare professionals with patient representation convened to develop a national clinical practice guideline on prospective surveillance, risk reduction, and conservative treatment of lymphedema. Systematic reviews of the literature were conducted and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology approach was used to assess the evidence. Findings: The panel made multiple recommendations for patients who are at risk for or experiencing lymphedema. Implications for Nursing: Early diagnosis and treatment of lymphedema may mitigate symptoms. This evidence-based guideline supports patients, clinicians, and other healthcare professionals in clinical decision making. Supplementary material can be found at https://onf.ons.org/supplementary-material-ons-guidelines-cancer-treatment-related-lymphedema.

ONS Guidelines™ for Cancer Treatment-Related Lymphedema.

Lymphedema is a chronic condition that may result from cancer-related surgery. The incidence of lymphedema varies greatly; however, patients remain at risk for life and may experience decreased quality of life and functional capacity. Providing recommendations for an evidence-based guideline for care of cancer treatment-related lymphedema will help to improve outcomes for patients with this chronic condition. A panel of healthcare professionals with patient representation convened to develop a national clinical practice guideline on prospective surveillance, risk reduction, and conservative treatment of lymphedema. Systematic reviews of the literature were conducted and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology approach was used to assess the evidence. The panel made multiple recommendations for patients who are at risk for or experiencing lymphedema. Early diagnosis and treatment of lymphedema may mitigate symptoms. This evidence-based guideline supports patients, clinicians, and other healthcare professionals in clinical decision making. //onf.ons.org/supplementary-material-ons-guidelines-cancer-treatment-related-lymphedema.

CanPROS Scientific Conference 2019 Oral Abstracts: Presented by CanPROS Congress, A Catalyst for Whole-Person Care; Hilton Garden Inn, Calgary, Alberta; 13-15 November 2019.

Background: Generic preference-based measures (pbms), though commonly used, may not be optimal for use in the economic evaluations assessing the impact of breast cancer interventions. Concerns that are unique to women with breast cancer (for example, body image, appearance, treatment-specific adverse effects) are not adequately captured by the existing generic measures. No breast cancer–specific pbm exists. The objective of this study was to construct a health state classification system specific to breast cancer which is amenable to valuation. Methods: We conducted semi-structured interviews in a heterogeneous sample of women with breast cancer [stages 0–4, any stage of treatment(s)]. Interviews were audio recorded, transcribed verbatim, and coded using the constant comparison approach to develop the conceptual framework. Patients were also asked to describe their most and least important concerns during the interview and to rate items in the related breast-q module (that is, mastectomy, breast-conserving therapy, or reconstruction) on a modified 5-point Likert scale (ranging from Not important to Very important). A faceto- face meeting with an expert panel of health care professionals, health economists, and hrqol researchers was used to obtain feedback on the health state classification system, response levels, and wording of the items. Results: Interviews (n = 59) with patients aged 59.9 years were completed. The resultant conceptual framework included site-specif ic (that is, abdomen, arm, breast) and overall (that is, body image, appearance, cancer, psychological, sexual, and social) domains. Triangulation of the qualitative and quantitative evidence led to the selection of key constructs for inclusion in the new pbm. The field test version of the breast-q utility health state classification system consisted of 13 attributes with 4 response levels each. Conclusions: The health state classification system for the preference-based module of the breast-q (breast-q-u) was derived using patient and expert feedback. The next phase will involve establishing psychometric properties of the breast-q-u, followed by a valuation study to generate utility weights.

Development of Key Performance Indicators for Capturing Impact of Pharmaceutical Care in Palestinian Integrative Healthcare Facilities: A Delphi Consensus Study

Background The current study was performed to develop a consensus-based core inventory of key performance indicators (KPIs) to be used in capturing the impact of pharmaceutical care in healthcare facilities that employ integrative medicine paradigm in Palestine. Methods A panel of healthcare professionals and risk/quality assurance managers was composed employing a judgmental sampling technique. The study tool was a questionnaire. Views and opinions of the panelists on the roles of pharmacists in caring for patients admitted to or visiting healthcare facilities that employ integrative medicine were collected using 11 statements. An initial inventory of activities and services that potentially can be used as KPIs was compiled from the literature and interviews with key contact experts in the domain. Three iterative Delphi rounds were conducted among the panelists (n = 50) to achieve formal consensus on the KPIs that should be used. The consensus-based KPIs were ordered by the scores of the panelists. Results A total of 8 consensus-based KPIs were developed. The KPIs related to the number of problems related to medications and complementary and alternative medicine (CAM) that were resolved by pharmacists and CAM practitioners (p < 0.0001), number of patients for whom reconciliations were documented (p < 0.0001), number of patients receiving direct, comprehensive, and/or collaborative care (p < 0.0001), and number of patients for whom pharmacists and CAM practitioners were involved in implementing a therapeutic plan (p < 0.05) were rated significantly higher than the KPI (#8) related to the participation in multi-healthcare provider discussions/deliberations. Conclusions Consensus-based KPIs that can be used in capturing the impact of evidence-based CAM and pharmaceutical care of patients in healthcare facilities that employ integrative medicine paradigm were developed. Future studies are still needed to investigate if implementing these KPIs might promote evidence-based CAM and pharmaceutical care in healthcare facilities that employ the integrative medicine paradigm.

Synaptic Proteome Alterations in the Primary Auditory Cortex of Individuals With Schizophrenia

Findings from unbiased genetic studies have consistently implicated synaptic protein networks in schizophrenia, but the molecular pathologic features within these networks and their contribution to the synaptic and circuit deficits thought to underlie disease symptoms remain unknown. To determine whether protein levels are altered within synapses from the primary auditory cortex (A1) of individuals with schizophrenia and, if so, whether these differences are restricted to the synapse or occur throughout the gray matter. This paired case-control study included tissue samples from individuals with schizophrenia obtained from the Allegheny County Office of the Medical Examiner. An independent panel of health care professionals made consensus DSM-IV diagnoses. Each tissue sample from an individual with schizophrenia was matched by sex, age, and postmortem interval with 1 sample from an unaffected control individual. Targeted mass spectrometry was used to measure protein levels in A1 gray matter homogenate and synaptosome preparations. All experimenters were blinded to diagnosis. Mass spectrometry data were collected from September 26 through November 4, 2016, and analyzed from November 3, 2016, to July 15, 2019. Primary measures were homogenate and synaptosome protein levels and their coregulation network features. Hypotheses generated before data collection were (1) that levels of canonical postsynaptic proteins in A1 synaptosome preparations would differ between individuals with schizophrenia and controls and (2) that these differences would not be explained by changes in total A1 homogenate protein levels. Synaptosome and homogenate protein levels were investigated in 48 individuals with a schizophrenia diagnosis and 48 controls (mean age in both groups, 48 years [range, 17-83 years]); each group included 35 males (73%) and 13 females (27%). Robust alterations (statistical cutoff set at an adjusted Limma P < .05) were observed in synaptosome levels of canonical mitochondrial and postsynaptic proteins that were highly coregulated and not readily explained by postmortem interval, antipsychotic drug treatment, synaptosome yield, or underlying alterations in homogenate protein levels. These findings suggest a robust and highly coordinated rearrangement of the synaptic proteome. In line with unbiased genetic findings, alterations in synaptic levels of postsynaptic proteins were identified, providing a road map to identify the specific cells and circuits that are impaired in individuals with schizophrenia A1.

Guidelines for Cervical Cancer Screening in Immunosuppressed Women Without HIV Infection.

Executive SummaryThe risk of cervical cancer (CC) among women immunosuppressed for a variety of reasons is well documented in the literature. Although there is improved organ function, quality of life and life expectancy gained through use of immunosuppressant therapy, there may be increased long-te