34 results on '"Tran, Dan N."'
Search Results
2. Incorporating respondent-driven sampling into web-based discrete choice experiments: preferences for COVID-19 mitigation measures
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Johnson, Courtney A., Tran, Dan N., Mwangi, Ann, Sosa-Rubí, Sandra G., Chivardi, Carlos, Romero-Martínez, Martín, Pastakia, Sonak, Robinson, Elisha, Jennings Mayo-Wilson, Larissa, and Galárraga, Omar
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- 2022
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3. How health systems can adapt to a population ageing with HIV and comorbid disease
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Kiplagat, Jepchirchir, Tran, Dan N, Barber, Tristan, Njuguna, Benson, Vedanthan, Rajesh, Triant, Virginia A, and Pastakia, Sonak D
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- 2022
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4. Integrating community-based HIV and non-communicable disease care with microfinance groups: a feasibility study in Western Kenya
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Kafu, Catherine, Wachira, Juddy, Omodi, Victor, Said, Jamil, Pastakia, Sonak D., Tran, Dan N., Onyango, Jael Adongo, Aburi, Dan, Wilson-Barthes, Marta, Galárraga, Omar, and Genberg, Becky Lynn
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- 2022
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5. The Relationship Between Household Microfinance Group Participation and Vaccine Adherence Among Children in Rural Western Kenya
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Deyoe, Jessica E., Amisi, James Akiruga, Szkwarko, Daria, Tran, Dan N., Luetke, Maya, Kianersi, Sina, and Lee, Shin H.
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Vaccination -- Surveys -- Social aspects -- Economic aspects ,Microfinance -- Health aspects -- Social aspects -- Surveys ,Child care -- Surveys -- Economic aspects -- Social aspects ,Family resource management -- Surveys -- Health aspects ,Health care industry - Abstract
Introduction High childhood vaccine adherence is critical for disease prevention, and poverty is a key barrier to vaccine uptake. Interventions like microfinance programs that aim to lift individuals out of poverty could thus improve vaccine adherence of the children in the household. BIGPIC Family Program in rural Western Kenya provides group-based microfinance services while working to improve access to healthcare and health screenings for the local community. The aim of the present paper is to evaluate the association between household participation in BIGPIC's microfinance program and vaccine adherence among children in the household. We hypothesize that microfinance group participation will have a positive impact on vaccine adherence among children in the household. Methods From 2018 to 2019, we surveyed a sample of 300 participants from two rural communities in Western Kenya, some of whom were participants in the BIGPIC Family's microfinance program. The primary outcome of interest was vaccine adherence of children in the household. Log-binomial models were used to estimate the relationship between microfinance group participation and vaccine adherence, adjusted for key covariates. We also assessed whether the relationship differed by gender of the adult respondent. Results Microfinance group members were more likely to have all children in their households fully vaccinated [aPR (95% CI): 1.68 (1.20,2.35)] compared to non-microfinance group members. Further, the association was stronger when women were the microfinance members [PR (95% CI): 1.87 (1.27,2.76)] compared to men [PR (95% CI): 1.24 (0.81,1.90)]. Conclusions Microfinance participation was associated with higher childhood vaccine adherence in rural Western Kenya. Microfinance interventions should be further explored as strategies to improve child health and well-being in low- and middle-income countries., Author(s): Jessica E. Deyoe [sup.1] , James Akiruga Amisi [sup.2] [sup.9] , Daria Szkwarko [sup.2] [sup.3] [sup.4] , Dan N. Tran [sup.2] [sup.5] , Maya Luetke [sup.1] , Sina Kianersi [...]
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- 2021
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6. Supply-chain strategies for essential medicines in rural western Kenya during COVID-19/Strategies d'approvisionnement en medicaments essentiels dans les regions rurales du Kenya occidental durant la pandemie de COVID-19/Estrategias de la cadena de suministro de medicamentos esenciales en las zonas rurales del oeste de Kenia durante la COVID-19
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Tran, Dan N., Were, Phelix M., Kangogo, Kibet, Amisi, James A., Manji, Imran, Pastakia, Sonak D., and Vedanthan, Rajesh
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Epidemics -- Kenya ,Chronic diseases -- Analysis ,Drugstores -- Analysis ,Drugs -- Analysis ,Pharmacy -- Analysis ,Public health -- Analysis ,Logistics -- Analysis ,Coronaviruses -- Analysis ,Health - Abstract
Problem The coronavirus disease 2019 (COVID-19) pandemic has disrupted health systems worldwide and threatened the supply of essential medicines. Especially affected are vulnerable patients in low- and middle-income countries who can only afford access to public health systems. Approach Soon after physical distancing and curfew orders began on 15 March 2020 in Kenya, we rapidly implemented three supply-chain strategies to ensure a continuous supply of essential medicines while minimizing patients' COVID-19 exposure risks. We redistributed central stocks of medicines to peripheral health facilities to ensure local availability for several months. We equipped smaller, remote health facilities with medicine tackle boxes. We also made deliveries of medicines to patients with difficulty reaching facilities. Local setting To implement these strategies we leveraged our 30-year partnership with local health authorities in rural western Kenya and the existing revolving fund pharmacy scheme serving 85 peripheral health centres. Relevant changes In April 2020, stocks of essential chronic and non-chronic disease medicines redistributed to peripheral health facilities increased to 835 140 units, as compared with 316 330 units in April 2019. We provided medicine tackle boxes to an additional 46 health facilities. Our team successfully delivered medications to 264 out of 311 patients (84.9%) with noncommunicable diseases whom we were able to reach. Lessons learnt Our revolving fund pharmacy model has ensured that patients' access to essential medicines has not been interrupted during the pandemic. Success was built on a community approach to extend pharmaceutical services, adapting our current supply-chain infrastructure and working quickly in partnership with local health authorities. Probleme La pandemie de maladie a Coronavirus 2019 (COVID-19) a bouleverse les systemes de sante du monde entier et menace l'approvisionnement en medicaments essentiels. Dans les pays a faible et moyen revenu, les patients vulnerables ayant uniquement acces aux soins de sante publics ont ete particulierement affectes. Approche Peu apres l'instauration de la distanciation physique et du couvre-feu le 15 mars 2020 au Kenya, nous avons rapidement mis en oeuvre trois strategies visant a assurer un approvisionnement continu en medicaments essentiels, tout en limitant les risques d'exposition des patients au coronavirus. Nous avons redistribue les principaux stocks de medicaments aux etablissements sanitaires peripheriques afin de garantir leur disponibilite pendant plusieurs mois. Nous avons fourni des boites de materiel medical aux petits centres de soins implantes dans des regions reculees. Nous avons egalement livre des medicaments aux patients incapables de se rendre dans un etablissement. Environnement local Pour deployer ces strategies, nous avons profite de nos trente annees de partenariat avec les autorites sanitaires locales dans les regions rurales du Kenya occidental et compte sur le modele existant de financement pharmaceutique renouvelable, qui dessert 85 centres de soins peripheriques. Changements significatifs Les stocks de medicaments essentiels servant au traitement de maladies chroniques et non chroniques redistribues aux centres de soins peripheriques sont passes de 316 330 unites en avril 2019 a 835 140 unites en avril 2020. Nous avons procure des boites de materiel medical a 46 centres de soins supplementaires. Notre equipe a reussi a livrer des medicaments a 264 des 311 patients (84,9%) souffrant de maladies non transmissibles que nous sommes parvenus a contacter. Lecons tirees Grace a notre modele de financement pharmaceutique renouvelable, les patients ont pu acceder aux medicaments essentiels sans interruption durant la pandemie. Ce succes repose sur une approche communautaire destinee a etendre les services pharmaceutiques en adaptant l'infrastructure de notre chaine d'approvisionnement actuelle, et en avancant rapidement par le biais de partenariats avec les autorites sanitaires locales. Situacion La pandemia de la enfermedad por Coronavirus 2019 (COVID-19)ha perturbado los sistemas sanitarios de todo el mundo y ha amenazado el suministro de medicamentos esenciales. Se ven especialmente afectados los pacientes vulnerables de los paises de ingresos bajos y medios que solo pueden acceder a los sistemas sanitarios publicos. Enfoque Poco despues de que comenzaran el distanciamiento fisico y las ordenes de toque de queda el 15 de marzo de 2020 en Kenia, pusimos en marcha rapidamente tres estrategias para garantizar un suministro continuo de medicamentos esenciales y minimizar al mismo tiempo los riesgos de exposicion de los pacientes al COVID-19. Redistribuimos las existencias centrales de medicamentos a los centros de salud perifericos para garantizar la disponibilidad local durante varios meses. Equipamos a los centros de salud mas pequenos y remotos con cajas de botiquin. Tambien hicimos entregas de medicamentos a pacientes con dificultades para llegar a los centros. Marco regional Para poner en practica estas estrategias, hemos aprovechado nuestra asociacion de 30 anos con las autoridades sanitarias locales de las zonas rurales del oeste de Kenia y nos hemos apoyado en el modelo existente de financiacion farmaceutica rotatoria, que atiende a 85 centros de salud perifericos. Cambios importantes Las existencias de medicamentos esenciales para el tratamiento de enfermedades cronicas y no cronicas redistribuidas a los centros de atencion periferica pasaron de 316.330 unidades en abril de 2019 a 835.140 unidades en abril de 2020. Hemos adquirido cajas de material medico para otros 46 centros de salud. Nuestro equipo pudo entregar medicamentos a 264 de los 311 pacientes (84,9%) con enfermedades no transmisibles con los que logramos contactar. Lecciones aprendidas Gracias a nuestro modelo de financiacion farmaceutica rotatoria, los pacientes pudieron acceder a los medicamentos esenciales sin interrupcion durante la pandemia. Este exito se basa en un enfoque comunitario para ampliar los servicios farmaceuticos adaptando nuestra infraestructura de cadena de suministro existente y avanzando rapidamente mediante asociaciones con las autoridades sanitarias locales., Introduction The Coronavirus disease 2019 (COVID-19) pandemic has challenged health systems worldwide as they cope with the demands of infection control and management of the disease while maintaining the delivery [...]
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- 2021
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7. Anthracimycin activity against contemporary methicillin-resistant Staphylococcus aureus
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Hensler, Mary E, Jang, Kyoung Hwa, Thienphrapa, Wdee, Vuong, Lisa, Tran, Dan N, Soubih, Evaristus, Lin, Leo, Haste, Nina M, Cunningham, Mark L, Kwan, Bryan P, Shaw, Karen Joy, Fenical, William, and Nizet, Victor
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Infectious Diseases ,Antimicrobial Resistance ,Genetics ,Emerging Infectious Diseases ,Infection ,Animals ,Anti-Bacterial Agents ,HeLa Cells ,Humans ,Methicillin ,Methicillin Resistance ,Methicillin-Resistant Staphylococcus aureus ,Mice ,Microbial Sensitivity Tests ,Molecular Structure ,Peritonitis ,Polyketides ,Staphylococcal Infections ,Vancomycin ,Vancomycin Resistance ,anthracimycin ,methicillin-resistant ,novel antibiotic ,Staphylococcus aureus ,Hela Cells ,Microbiology ,Pharmacology and Pharmaceutical Sciences ,Medicinal & Biomolecular Chemistry - Abstract
Anthracimycin is a recently discovered novel marine-derived compound with activity against Bacillus anthracis. We tested anthracimycin against an expanded panel of Staphylococcus aureus strains in vitro and in vivo. All strains of S. aureus tested, including methicillin-susceptible, methicillin-resistant (MRSA) and vancomycin-resistant strains of S. aureus, were susceptible to anthracimycin at MIC values of ⩽0.25 mg l(-1). Although its postantibiotic effects were minimal, anthracimycin exhibited potent and rapid bactericidal activity, with a >4-log kill of USA300 MRSA within 3 h at five times its MIC. At concentrations significantly below the MIC, anthracimycin slowed MRSA growth and potentiated the bactericidal activity of the human cathelicidin, LL-37. The bactericidal activity of anthracimycin was somewhat mitigated in the presence of 20% human serum, and the compound was minimally toxic to human cells, with an IC50 (inhibitory concentration 50)=70 mg l(-1) against human carcinoma cells. At concentrations near the MIC, anthracimycin inhibited S. aureus nucleic acid synthesis as determined by optimized macromolecular synthesis methodology, with inhibition of DNA and RNA synthesis occurring in the absence of DNA intercalation. Anthracimycin at a single dose of 1 or 10 mg kg(-1) was able to protect mice from MRSA-induced mortality in a murine peritonitis model of infection. Anthracimycin provides an interesting new scaffold for future development of a novel MRSA antibiotic.
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- 2014
8. The relationship between a microfinance-based healthcare delivery platform, health insurance coverage, health screenings, and disease management in rural Western Kenya
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Rosenberg, Molly, Amisi, James Akiruga, Szkwarko, Daria, Tran, Dan N., Genberg, Becky, Luetke, Maya, Kianersi, Sina, Namae, Jane, Laktabai, Jeremiah, and Pastakia, Sonak
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- 2020
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9. Interruptions to HIV Care Delivery During Pandemics and Natural Disasters: A Qualitative Study of Challenges and Opportunities From Frontline Healthcare Providers in Western Kenya.
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Tran, Dan N., Ching, Jennifer, Kafu, Catherine, Wachira, Juddy, Koros, Hillary, Venkataramani, Maya, Said, Jamil, Pastakia, Sonak D., Galárraga, Omar, and Genberg, Becky L.
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During public health crises, people living with HIV (PLWH) may become disengaged from care. The goal of this study was to understand the impact of the COVID-19 pandemic and recent flooding disasters on HIV care delivery in western Kenya. We conducted ten individual in-depth interviews with HIV providers across four health facilities. We used an iterative and integrated inductive and deductive data analysis approach to generate four themes. First, increased structural interruptions created exacerbating strain on health facilities. Second, there was increased physical and psychosocial burnout among providers. Third, patient uptake of services along the HIV continuum decreased, particularly among vulnerable patients. Finally, existing community-based programs and teleconsultations could be adapted to provide differentiated HIV care. Community-centric care programs, with an emphasis on overcoming the social, economic, and structural barriers will be crucial to ensure optimal care and limit the impact of public health disruptions on HIV care globally. [ABSTRACT FROM AUTHOR]
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- 2023
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10. A new pharmacological agent (AKB-4924) stabilizes hypoxia inducible factor-1 (HIF-1) and increases skin innate defenses against bacterial infection
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Okumura, Cheryl Y. M., Hollands, Andrew, Tran, Dan N., Olson, Joshua, Dahesh, Samira, von Köckritz-Blickwede, Maren, Thienphrapa, Wdee, Corle, Courtney, Jeung, Seung Nam, Kotsakis, Anna, Shalwitz, Robert A., Johnson, Randall S., and Nizet, Victor
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- 2012
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11. Interprofessional peer teaching: The value of a pharmacy student-led pharmacology course for physical therapy students
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Hsia, Stephanie, Tran, Dan N., Beechinor, Ryan, Gahbauer, Alice, Fitzsimmons, Amber, and Brock, Tina
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- 2020
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12. The reversal of amphetamine-induced locomotor activation by a selective neurotensin-1 receptor agonist does not exhibit tolerance
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Feifel, David, Melendez, Gilia, Murray, Rachel J., Tina Tran, Dan N., Rullan, Michelle A., and Shilling, Paul D.
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- 2008
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13. Community-based medication delivery program for antihypertensive medications improves adherence and reduces blood pressure.
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Tran, Dan N., Kangogo, Kibet, Amisi, James A., Kamadi, James, Karwa, Rakhi, Kiragu, Benson, Laktabai, Jeremiah, Manji, Imran N., Njuguna, Benson, Szkwarko, Daria, Qian, Kun, Vedanthan, Rajesh, and Pastakia, Sonak D.
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PATIENT compliance , *SYSTOLIC blood pressure , *ANTIHYPERTENSIVE agents , *BLOOD pressure , *DRUGS , *DISEASE management , *HYPERTENSION - Abstract
Non-adherence to antihypertensive medications is a major cause of uncontrolled hypertension, leading to cardiovascular morbidity and mortality. Ensuring consistent medication possession is crucial in addressing non-adherence. Community-based medication delivery is a strategy that may improve medication possession, adherence, and blood pressure (BP) reduction. Our program in Kenya piloted a community medication delivery program, coupled with blood pressure monitoring and adherence evaluation. Between September 2019 and March 2020, patients who received hypertension care from our chronic disease management program also received community-based delivery of antihypertensive medications. We calculated number of days during which each patient had possession of medications and analyzed the relationship between successful medication delivery and self-reported medication adherence and BP. A total of 128 patient records (80.5% female) were reviewed. At baseline, mean systolic blood pressure (SBP) was 155.7 mmHg and mean self-reported adherence score was 2.7. Sixty-eight (53.1%) patients received at least 1 successful medication delivery. Our pharmacy dispensing records demonstrated that medication possession was greater among patients receiving medication deliveries. Change in self-reported medication adherence from baseline worsened in patients who did not receive any medication delivery (+0.5), but improved in patients receiving 1 delivery (-0.3) and 2 or more deliveries (-0.8). There was an SBP reduction of 1.9, 6.1, and 15.5 mmHg among patients who did not receive any deliveries, those who received 1 delivery, and those who received 2 or more medication deliveries, respectively. Adjusted mixed-effect model estimates revealed that mean SBP reduction and self-reported medication adherence were improved among individuals who successfully received medication deliveries, compared to those who did not. A community medication delivery program in western Kenya was shown to be implementable and enhanced medication possession, reduced SBP, and significantly improved self-reported adherence. This is a promising strategy to improve health outcomes for patients with uncontrolled hypertension that warrants further investigation. [ABSTRACT FROM AUTHOR]
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- 2022
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14. Laparoscopic Heller myotomy for achalasia
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Cacchione, Robert N., Tran, Dan N., and Rhoden, Diane H.
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- 2005
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15. Microfinance, retention in care, and mortality among patients enrolled in HIV care in East Africa.
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Genberg, Becky L., Wilson-Barthes, Marta G., Omodi, Victor, Hogan, Joseph W., Steingrimsson, Jon, Wachira, Juddy, Pastakia, Sonak, Tran, Dan N., Kiragu, Zana W., Ruhl, Laura J., Rosenberg, Molly, Kimaiyo, Sylvester, and Galárraga, Omar
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- 2021
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16. Framework and case study for establishing impactful global health programs through academia - biopharmaceutical industry partnerships.
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Pastakia, Sonak D., Tran, Dan N., Manji, Imran, Schellhase, Ellen, Karwa, Rakhi, Miller, Monica L., Aruasa, Wilson, and Khan, Zeba M.
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Background: The field of global health has grown with multiple different public and private stakeholders engaging in the effort to improve health outcomes for underserved populations around the world. There is, however, only limited published guidance on how to promote successful partnerships between academia and the biopharmaceutical industry.Objective: This analysis will provide a framework for developing successful partnerships around five central principles. This framework will then be applied to two representative pharmacy collaboration case studies focused on training and donations.Framework Description and Case Study Findings: Within the Academic Model Providing Access to Healthcare (AMPATH), successful collaborations between the biopharmaceutical industry philanthropic entities and academic partners have consistently prioritized 1) contextualization, 2) collaboration, 3) local priorities, 4) institutional commitment, and 5) integration. In the first case study, the application of this framework to clinical pharmacy training activities sponsored by Celgene and implemented by the Purdue Kenya Partnership has helped the program transition from an entirely donor dependent training program to a revenue generating, locally administered program which is now recognized and accredited by the Kenyan government. In the second case study, medication donations from Eli Lilly and Company have been converted from a traditional donation program in one Kenyan health facility to a replicable and sustainable supply chain model which has been expanded to more than 70 public sector facilities across western Kenya.Conclusion: Adherence to the five core principles of the proposed framework can help guide partnerships between academic institutions and the biopharmaceutical industry to advance healthcare services for underserved populations around the world. As large-scale government-based development agencies continue to primarily focus on specific disease states, biopharmaceutical industry-based collaborations can help initiate activities in underfunded therapeutic areas such as non-communicable diseases. [ABSTRACT FROM AUTHOR]- Published
- 2020
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17. American College of Clinical Pharmacy Global Health Practice and Research Network's opinion paper: Pillars for global health engagement and key engagement strategies for pharmacists.
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Crowe, Susie J., Karwa, Rakhi, Schellhase, Ellen M., Miller, Monica L., Abrons, Jeanine P., Alsharif, Naser Z., Andrade, Christina, Cope, Rebecca J., Dornblaser, Emily K., Hachey, David, Holm, Michelle R., Jonkman, Lauren, Lukas, Stephanie, Malhotra, Jodie V., Njuguna, Benson, Pekny, Chelsea R., Prescott, Gina M., Ryan, Melody, Steeb, David R., and Tran, Dan N.
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PHARMACY education ,UNIVERSITIES & colleges ,HEALTH policy - Abstract
The scope of pharmacy practice in global health has expanded over the past decade creating additional education and training opportunities for students, residents and pharmacists. There has also been a shift from short‐term educational and clinical experiences to more sustainable bidirectional partnerships between high‐income countries (HICs) and low‐ to middle‐income countries (LMICs). As more institutional and individual partnerships between HICs and LMICs begin to form, it is clear that there is a lack of guidance for pharmacists on how to build meaningful, sustainable, and mutually beneficial programs. The aim of this paper is to provide guidance for pharmacists in HICs to make informed decisions on global health partnerships and identify opportunities for engagement in LMICs that yield mutually beneficial collaborations. This paper uses the foundations of global health principles to identify five pillars of global health engagement when developing partnerships: (a) sustainability, (b) shared leadership, (c) mutually beneficial partnerships, (d) local needs‐based care and (e) host‐driven experiential and didactic education. Finally, this paper highlights ways pharmacists can use the pillars as a framework to engage and support health care systems, collaborate with academic institutions, conduct research, and interface with governments to improve health policy. [ABSTRACT FROM AUTHOR]
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- 2020
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18. Therapeutic turnaround times for common laboratory tests in a tertiary hospital in Kenya.
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Mwogi, Thomas, Mercer, Tim, Tran, Dan N. (Tina), Tonui, Ronald, Tylleskar, Thorkild, and Were, Martin C.
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TURNAROUND time ,MIDDLE-income countries ,INPATIENT care ,HOSPITALS ,DIAGNOSIS methods ,MEDICAL laboratories ,LABORATORIES - Abstract
Access to efficient laboratory services is critical to patient care. Turnaround Time (TAT) is one of the most important measures when judging the efficiency of any laboratory and care system. Few studies on TAT exist for inpatient care settings within low- and middle-income countries (LMICs). Methods: We evaluated therapeutic TAT for a tertiary hospital in Western Kenya, using a time-motion study focusing specifically on common hematology and biochemistry orders. The aim was to determine significant bottlenecks in diagnostic testing processes at the institution. Results: A total of 356 (155 hematology and 201 biochemistry) laboratory tests were fully tracked from the time of ordering to availability of results to care providers. The total therapeutic TAT for all tests was 21.5 ± 0.249 hours (95% CI). The therapeutic TAT for hematology was 20.3 ± 0.331 hours (95% CI) while that for biochemistry tests was 22.2 ± 0.346 hours (95% CI). Printing, sorting and dispatch of the printed results emerged as the most significant bottlenecks, accounting for up to 8 hours of delay (Hematology—8.3 ± 1.29 hours (95% CI), Biochemistry—8.5 ± 1.18 hours (95% CI)). Time of test orders affected TAT, with orders made early in the morning and those in the afternoon experiencing the most delays in TAT. Conclusion: Significant inefficiencies exist at multiple steps in the turnaround times for routine laboratory tests at a large referral hospital within an LMIC setting. Multiple opportunities exist to improve TAT and streamline processes around diagnostic testing in this and other similar settings. [ABSTRACT FROM AUTHOR]
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- 2020
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19. Mitigating The Burden Of Diabetes In Sub-Saharan Africa Through An Integrated Diagonal Health Systems Approach.
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Mercer, Tim, Chang, Alice C, Fischer, Lydia, Gardner, Adrian, Kerubo, Immaculate, Tran, Dan N, Laktabai, Jeremiah, and Pastakia, Sonak
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DIABETES ,NON-communicable diseases ,COMMUNICABLE diseases ,SYSTEM integration ,WORLD health ,DISEASE management - Abstract
Diabetes is a chronic non-communicable disease (NCD) presenting growing health and economic burdens in sub-Saharan Africa (SSA). Diabetes is unique due to its cross-cutting nature, impacting multiple organ systems and increasing the risk for other communicable and non-communicable diseases. Unfortunately, the quality of care for diabetes in SSA is poor, largely due to a weak disease management framework and fragmented health systems in most sub-Saharan African countries. We argue that by synergizing disease-specific vertical programs with system-specific horizontal programs through an integrated disease-system diagonal approach, we can improve access, quality, and safety of diabetes care programs while also supporting other chronic diseases. We recommend utilizing the six World Health Organization (WHO) health system building blocks – 1) leadership and governance, 2) financing, 3) health workforce, 4) health information systems, 5) supply chains, and 6) service delivery – as a framework to design a diagonal approach with a focus on health system strengthening and integration to implement and scale quality diabetes care. We discuss the successes and challenges of this approach, outline opportunities for future care programming and research, and highlight how this approach can lead to the improvement in the quality of care for diabetes and other chronic diseases across SSA. [ABSTRACT FROM AUTHOR]
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- 2019
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20. Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness Analysis.
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Shih, Vanessa, ten Ham, Renske M., Bui, Christine T., Tran, Dan N., Ting, Jie, and Wilson, Leslie
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Purpose. Two BRAF
V600E targeted therapies, dabrafenib and vemurafenib, have received US approval for treatment of metastatic melanoma in BRAFV600E patients, a mutation that affects ~50% of patients. We evaluated the cost-effectiveness of BRAF inhibitors and traditional chemotherapy for treatment of metastatic melanoma. Methods. A Markov model was developed using a societal perspective. Transition probabilities were derived from two Phase III registration trials comparing each BRAF inhibitor against dacarbazine. Costs were obtained from literature, national databases, and Medicare fee schedules. Utilities were obtained from published literature. Deterministic and probabilistic sensitivity analyses were run to test the impact of uncertainties. Results. The incremental cost-effectiveness ratio of dabrafenib was $149,035/QALY compared to dacarbazine. Vemurafenib was dominated by dabrafenib. Probabilistic sensitivity analysis showed that, at a willingness-to-pay (WTP) threshold of ≤$100,000/QALY, dacarbazine was the optimal treatment in ~85% of simulations. At a WTP threshold of ≥$150,000/QALY, dabrafenib was the optimal treatment. Conclusion. Compared with dacarbazine, dabrafenib and vemurafenib were not cost-effective at a willingness-to-pay threshold of $100,000/QALY. Dabrafenib is more efficient compared to vemurafenib. With few treatment options, dabrafenib is an option for qualifying patients if the overall cost of dabrafenib is reduced to $30,000–$31,000 or a WTP threshold of ≥$150,000/QALY is considered. More comparative data is needed. [ABSTRACT FROM AUTHOR]- Published
- 2015
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21. Barriers and facilitators to the quality use of essential medicines for maternal health in low-resource countries: An Ishikawa framework.
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Tran, Dan N. and Bero, Lisa A.
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MATERNAL mortality ,PREGNANCY complication risk factors ,MATERNAL health ,POSTPARTUM depression ,ECLAMPSIA - Abstract
Background An estimated 800 women die every day due to complications related to pregnancy or childbirth. Complications such as postpartum haemorrhage (PPH) and pre-eclampsia and eclampsia can be prevented by the appropriate use of essential medicines. The objective of this study was to identify the common barriers and facilitators to the availability and use of oxytocin, ergometrine, and magnesium sulfate (MgSO
4 ) - essential medicines indicated for the prevention and treatment of PPH and pre-eclampsia and eclampsia. Methods We analyzed seven UNFPA/WHO reports published in 2008-2010. These reports summarized country-wide rapid assessments of access to and use of essential medicines for maternal health in Mongolia, Nepal, Laos, the Democratic People's Republic of Korea (DPRK), the Philippines, Vanuatu, and the Solomon Islands. We used a "fishbone" (Ishikawa) diagram as the analytic framework to identify facilitators and barriers at four health-system levels: government/ regulatory, pharmaceutical supply, health facility, and health professional. Results Common facilitators to the quality use of essential medicines for maternal health were observed at the government/regulatory and health professional level. A majority of countries had these medicines listed in their essential medicines lists. Awareness of the medicines was generally high among health professionals. Common barriers were identified at all health-system levels. First, standard treatment guidelines were not available, updated, or standardized. Second, there was an inadequate capacity to forecast and procure medicines. Third, a required MgSO4 antidote was often not available and the storage conditions for oxytocin were deficient. Conclusions The "fishbone" Ishikawa diagram is a useful tool for describing the findings of rapid assessments of quality use of essential medicines for maternal health across countries. The facilitators and barriers identified should guide the development of tailored intervention programs to improve and expand the use of these life-saving medicines. [ABSTRACT FROM AUTHOR]- Published
- 2015
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22. Activity of the thiopeptide antibiotic nosiheptide against contemporary strains of methicillin-resistant Staphylococcus aureus.
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Haste, Nina M, Thienphrapa, Wdee, Tran, Dan N, Loesgen, Sandra, Sun, Peng, Nam, Sang-Jip, Jensen, Paul R, Fenical, William, Sakoulas, George, Nizet, Victor, and Hensler, Mary E
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- 2012
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23. Activity of the streptogramin antibiotic etamycin against methicillin-resistant Staphylococcus aureus.
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Haste, Nina M, Perera, Varahenage R, Maloney, Katherine N, Tran, Dan N, Jensen, Paul, Fenical, William, Nizet, Victor, and Hensler, Mary E
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- 2010
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24. Building reliable supply chains for noncommunicable disease commodities: lessons learned from HIV and evidence needs.
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Pastakia, Sonak D., Tran, Dan N., Manji, Imran, Wells, Cassia, Kinderknecht, Kyle, and Ferris, Robert
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- 2018
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25. Involvement of angiotensin receptor subtypes in osmotically induced release of vasopressin
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Hogarty, David C., Tran, Dan N., and Phillips, M. Ian
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- 1994
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26. Food insecurity is associated with greater difficulty accessing care among people living with HIV with or without comorbid non-communicable diseases in western Kenya.
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Ardehali M, Kafu C, Vazquez Sanchez M, Wilson-Barthes M, Mosong B, Pastakia SD, Said J, Tran DN, Wachira J, Genberg B, Galarraga O, and Vedanthan R
- Subjects
- Humans, Kenya epidemiology, Male, Female, Adult, Cross-Sectional Studies, Middle Aged, Comorbidity, Young Adult, Food Supply statistics & numerical data, Food Insecurity, HIV Infections epidemiology, Health Services Accessibility statistics & numerical data, Noncommunicable Diseases therapy, Noncommunicable Diseases epidemiology
- Abstract
Introduction: The relationship between food insecurity and access to healthcare in low-resource settings remains unclear. Some studies find that food insecurity is a barrier to accessing care, while others report that food insecurity is associated with a greater need for care, leading to more care utilisation. We use data from the Harambee study in western Kenya to assess the association between food insecurity and difficulty accessing care among people living with HIV (PLWH) with or without comorbid non-communicable diseases (NCDs)., Methods: The Harambee study is a cluster randomised trial that tested the effectiveness of delivering integrated HIV and NCD care for PLWH. In this cross-sectional analysis, we examined baseline data from Harambee participants to investigate the relationship between household food insecurity and difficulty accessing care, using multivariable logistic regression models, controlling for sociodemographic factors and care satisfaction. We tested for effect measure modification by gender and household wealth and stratified analyses by NCD status., Results: Among 1039 participants, 11.1% reported difficulty accessing care, and 18.9% and 51.9% of participants had moderate and severe food insecurity, respectively. Among those with difficulty accessing care, 73.9% cited transportation issues as the major barrier. Difficulty accessing care was greater with higher levels of food insecurity: among participants with low, moderate and severe food insecurity, 5.9%, 9.7% and 14.4% reported difficulty accessing care, respectively. After adjusting for confounders, severe food insecurity was independently associated with difficulty accessing care (adjusted OR=2.5, 95% CI 1.4 to 4.4). There was no statistical evidence for effect measure modification by gender or wealth., Conclusions: We found that greater food insecurity was associated with greater difficulty accessing care among PLWH with or without NCDs in rural western Kenya. These findings suggest that addressing social determinants of health may be necessary when implementing integrated HIV and NCD care programmes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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27. Strategies to Improve Women's Leadership Preparation for Early Career Global Health Professionals: Suggestions from Two Working Groups.
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Harrison M, Tran DN, Pena A, Iyengar S, Ahmed Abubakar A, Hoernke K, John-Akinola YO, Kiplagat S, Marconi AM, Vaghaiwalla TM, Kalbarczyk A, and Weinberg JL
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- Anxiety Disorders, Female, Global Health, Humans, Self Concept, Career Mobility, Leadership, Women education, Women psychology
- Abstract
Background: Despite advances in gender equality, women still experience inequitable gaps in global health leadership, and barriers to women's advancement as leaders in global health have been well described in the literature. In 2021, the Johns Hopkins Center for Global Health conducted two virtual working groups for emerging women leaders to share challenges and suggest solutions to advance women's leadership in global health. In this paper, we present emerging themes from the working groups, provide a framework for the results, and discuss strategies for advancing women's leadership in global health., Objectives: The objective of this paper is to synthesize and share the themes of the two working group sessions to provide strategies for improving women's leadership training and opportunities in the field of global health., Methods: Approximately 182 women in the global health field participated in two virtual working group sessions hosted by the Johns Hopkins Center for Global Health using the Zoom platform. Participants were divided into virtual breakout rooms and discussed pre-assigned topics related to women's leadership in global health. The participants then returned to share their ideas in a plenary session. Notes from the breakout rooms and transcripts from the plenary session were analyzed through a participatory and iterative thematic analysis approach., Findings: We found that the working group participants identified two overarching themes that were critical for emerging women leaders to find success in global health leadership. First, the acquisition of individual essential skills is necessary to advance in their careers. Second, the institutional environments should be setup to encourage and enable women to enter and succeed in leadership roles. The participants also shared suggestions for improving women's leadership opportunities such as including the use of virtual technologies to increase training and networking opportunities, intersectionality in mentorship and sponsorship, combatting impostor syndrome, and the importance of work-life balance., Conclusions: Investing in women and their leadership potential has the promise to improve health and wealth at the individual, institutional, and community levels. This manuscript offers lessons and proposes solutions for increasing women's leadership through improving individual level essential skills and fostering environments in which women leaders can emerge and thrive., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)
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- 2022
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28. Integrated community-based HIV and non-communicable disease care within microfinance groups in Kenya: study protocol for the Harambee cluster randomised trial.
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Genberg BL, Wachira J, Steingrimsson JA, Pastakia S, Tran DNT, Said JA, Braitstein P, Hogan JW, Vedanthan R, Goodrich S, Kafu C, Wilson-Barthes M, and Galárraga O
- Subjects
- Cost-Benefit Analysis, Delivery of Health Care, Humans, Kenya, Randomized Controlled Trials as Topic, HIV Infections drug therapy, Noncommunicable Diseases therapy
- Abstract
Introduction: In Kenya, distance to health facilities, inefficient vertical care delivery and limited financial means are barriers to retention in HIV care. Furthermore, the increasing burden of non-communicable diseases (NCDs) among people living with HIV complicates chronic disease treatment and strains traditional care delivery models. Potential strategies for improving HIV/NCD treatment outcomes are differentiated care, community-based care and microfinance (MF)., Methods and Analysis: We will use a cluster randomised trial to evaluate integrated community-based (ICB) care incorporated into MF groups in medium and high HIV prevalence areas in western Kenya. We will conduct baseline assessments with n=900 HIV positive members of 40 existing MF groups. Group clusters will be randomised to receive either (1) ICB or (2) standard of care (SOC). The ICB intervention will include: (1) clinical care visits during MF group meetings inclusive of medical consultations, NCD management, distribution of antiretroviral therapy (ART) and NCD medications, and point-of-care laboratory testing; (2) peer support for ART adherence and (3) facility referrals as needed. MF groups randomised to SOC will receive regularly scheduled care at a health facility. Findings from the two trial arms will be compared with follow-up data from n=300 matched controls. The primary outcome will be VS at 18 months. Secondary outcomes will be retention in care, absolute mean change in systolic blood pressure and absolute mean change in HbA1c level at 18 months. We will use mediation analysis to evaluate mechanisms through which MF and ICB care impact outcomes and analyse incremental cost-effectiveness of the intervention in terms of cost per HIV suppressed person-time, cost per patient retained in care and cost per disability-adjusted life-year saved., Ethics and Dissemination: The Moi University Institutional Research and Ethics Committee approved this study (IREC#0003054). We will share data via the Brown University Digital Repository and disseminate findings via publication., Trial Registration Number: NCT04417127., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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29. Solving the problem of access to cardiovascular medicines: revolving fund pharmacy models in rural western Kenya.
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Tran DN, Manji I, Njuguna B, Kamano J, Laktabai J, Tonui E, Vedanthan R, and Pastakia S
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- Health Services Accessibility, Humans, Kenya, Financial Management, Pharmacies, Pharmacy
- Abstract
Availability of medicines for treatment of cardiovascular disease (CVD) is low in low-income and middle-income countries (LMIC). Supply chain models to improve the availability of quality CVD medicines in LMIC communities are urgently required. Our team established contextualised revolving fund pharmacies (RFPs) in rural western Kenya, whereby an initial stock of essential medicines was obtained through donations or purchase and then sold at a small mark-up price sufficient to replenish drug stock and ensure sustainability. In response to different contexts and levels of the public health system in Kenya (eg, primary versus tertiary), we developed and implemented three contextualised models of RFPs over the past decade, creating a network of 72 RFPs across western Kenya, that supplied 22 categories of CVD medicines and increased availability of essential CVD medications from <30% to 90% or higher. In one representative year, we were able to successfully supply 5 793 981 units of CVD and diabetes medicines to patients in western Kenya. The estimated programme running cost was US$6.5-25 per patient, serving as a useful benchmark for public governments to invest in medication supply chain systems in LMICs going forward. One important lesson that we have learnt from implementing three different RFP models over the past 10 years has been that each model has its own advantages and disadvantages, and we must continue to stay nimble and modify as needed to determine the optimal supply chain model while ensuring consistent access to essential CVD medications for patients living in these settings., Competing Interests: Competing interests: Sonak Pastakia serves as a consultant for Abbott and Becton Dickinson on work unrelated to the study being presented here. The other authors declare that they have no competing interests., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2020
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30. Ensuring Patient-Centered Access to Cardiovascular Disease Medicines in Low-Income and Middle-Income Countries Through Health-System Strengthening.
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Tran DN, Njuguna B, Mercer T, Manji I, Fischer L, Lieberman M, and Pastakia SD
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- Humans, Poverty, Socioeconomic Factors, Cardiovascular Agents therapeutic use, Cardiovascular Diseases economics, Cardiovascular Diseases epidemiology, Cardiovascular Diseases therapy, Developing Countries, Health Services Accessibility trends, Patient-Centered Care organization & administration
- Abstract
Cardiovascular disease (CVD) is the leading cause of global mortality and is expected to reach 23 million deaths by 2030. Eighty percent of CVD deaths occur in low-income and middle-income countries (LMICs). Although CVD prevention and treatment guidelines are available, translating these into practice is hampered in LMICs by inadequate health care systems that limit access to lifesaving medications. In this review article, we describe the deficiencies in the current LMIC supply chains that limit access to effective CVD medicines, and discuss existing solutions that are translatable to similar settings so as to address these deficiencies., (Copyright © 2016 Elsevier Inc. All rights reserved.)
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- 2017
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31. Targeted Therapies Compared to Dacarbazine for Treatment of BRAF(V600E) Metastatic Melanoma: A Cost-Effectiveness Analysis.
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Shih V, Ten Ham RM, Bui CT, Tran DN, Ting J, and Wilson L
- Abstract
Purpose. Two BRAF(V600E) targeted therapies, dabrafenib and vemurafenib, have received US approval for treatment of metastatic melanoma in BRAF(V600E) patients, a mutation that affects ~50% of patients. We evaluated the cost-effectiveness of BRAF inhibitors and traditional chemotherapy for treatment of metastatic melanoma. Methods. A Markov model was developed using a societal perspective. Transition probabilities were derived from two Phase III registration trials comparing each BRAF inhibitor against dacarbazine. Costs were obtained from literature, national databases, and Medicare fee schedules. Utilities were obtained from published literature. Deterministic and probabilistic sensitivity analyses were run to test the impact of uncertainties. Results. The incremental cost-effectiveness ratio of dabrafenib was $149,035/QALY compared to dacarbazine. Vemurafenib was dominated by dabrafenib. Probabilistic sensitivity analysis showed that, at a willingness-to-pay (WTP) threshold of ≤$100,000/QALY, dacarbazine was the optimal treatment in ~85% of simulations. At a WTP threshold of ≥$150,000/QALY, dabrafenib was the optimal treatment. Conclusion. Compared with dacarbazine, dabrafenib and vemurafenib were not cost-effective at a willingness-to-pay threshold of $100,000/QALY. Dabrafenib is more efficient compared to vemurafenib. With few treatment options, dabrafenib is an option for qualifying patients if the overall cost of dabrafenib is reduced to $30,000-$31,000 or a WTP threshold of ≥$150,000/QALY is considered. More comparative data is needed.
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- 2015
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32. IgG protease Mac/IdeS is not essential for phagocyte resistance or mouse virulence of M1T1 group A Streptococcus.
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Okumura CY, Anderson EL, Döhrmann S, Tran DN, Olson J, von Pawel-Rammingen U, and Nizet V
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- Animals, Bacterial Proteins genetics, Cell Line, Coculture Techniques, Disease Models, Animal, Gene Deletion, Humans, Male, Mice, Microbial Viability, Phagocytosis, Proteolysis, Streptococcal Infections microbiology, Streptococcal Infections pathology, Streptococcus pyogenes genetics, Virulence, Virulence Factors genetics, Bacterial Proteins metabolism, Immunoglobulin G metabolism, Phagocytes microbiology, Streptococcus pyogenes immunology, Streptococcus pyogenes pathogenicity, Virulence Factors metabolism
- Abstract
Unlabelled: The Mac/IdeS protein of group A Streptococcus (GAS) is a secreted cysteine protease with cleavage specificity for IgG and is highly expressed in the GAS serotype M1T1 clone, which is the serotype most frequently isolated from patients with life-threatening invasive infections. While studies of Mac/IdeS with recombinant protein have shown that the protein can potentially prevent opsonophagocytosis of GAS by neutrophils, the role of the protein in immune evasion as physiologically produced by the living organism has not been studied. Here we examined the contribution of Mac/IdeS to invasive GAS disease by generating a mutant lacking Mac/IdeS in the hyperinvasive M1T1 background. While Mac/IdeS was highly expressed and proteolytically active in the hyperinvasive strain, elimination of the bacterial protease did not significantly influence GAS phagocytic uptake, oxidative-burst induction, cathelicidin sensitivity, resistance to neutrophil or macrophage killing, or pathogenicity in pre- or postimmune mouse infectious challenges. We conclude that in the highly virulent M1T1 background, Mac/IdeS is not essential for either phagocyte resistance or virulence. Given the conservation of Mac/IdeS and homologues across GAS strains, it is possible that Mac/IdeS serves another important function in GAS ecology or contributes to virulence in other strain backgrounds., Importance: Group A Streptococcus (GAS) causes human infections ranging from strep throat to life-threatening conditions such as flesh-eating disease and toxic shock syndrome. Common disease-associated clones of GAS can cause both mild and severe infections because of a characteristic mutation and subsequent change in the expression of several genes that develops under host immune selection. One of these genes encodes Mac/IdeS, a protease that has been shown to cleave antibodies important to the immune defense system. In this study, we found that while Mac/IdeS is highly expressed in hypervirulent GAS, it does not significantly contribute to the ability of the bacteria to survive white blood cell killing or produce invasive infection in the mouse. These data underscore the importance of correlating studies on virulence factor function with physiologic expression levels and the complexity of streptococcal pathogenesis and contribute to our overall understanding of how GAS causes disease.
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- 2013
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33. Pharmacological inhibition of the ClpXP protease increases bacterial susceptibility to host cathelicidin antimicrobial peptides and cell envelope-active antibiotics.
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McGillivray SM, Tran DN, Ramadoss NS, Alumasa JN, Okumura CY, Sakoulas G, Vaughn MM, Zhang DX, Keiler KC, and Nizet V
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- Amino Acid Sequence, Bacillus anthracis drug effects, Bacillus anthracis genetics, Cell Membrane metabolism, Drug Resistance, Bacterial, Drug Synergism, Methicillin-Resistant Staphylococcus aureus drug effects, Molecular Sequence Data, Staphylococcus aureus drug effects, Staphylococcus aureus growth & development, Tetrazoles pharmacology, Cathelicidins, Anti-Bacterial Agents pharmacology, Antimicrobial Cationic Peptides pharmacology, Bacteria drug effects, Endopeptidase Clp antagonists & inhibitors, Escherichia coli Proteins antagonists & inhibitors, Protease Inhibitors pharmacology
- Abstract
The ClpXP protease is a critical bacterial intracellular protease that regulates protein turnover in many bacterial species. Here we identified a pharmacological inhibitor of the ClpXP protease, F2, and evaluated its action in Bacillus anthracis and Staphylococcus aureus. We found that F2 exhibited synergistic antimicrobial activity with cathelicidin antimicrobial peptides and antibiotics that target the cell well and/or cell membrane, such as penicillin and daptomycin, in B. anthracis and drug-resistant strains of S. aureus. ClpXP inhibition represents a novel therapeutic strategy to simultaneously sensitize pathogenic bacteria to host defenses and pharmaceutical antibiotics.
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- 2012
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34. Pharmacological properties of the marine natural product marinopyrrole A against methicillin-resistant Staphylococcus aureus.
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Haste NM, Hughes CC, Tran DN, Fenical W, Jensen PR, Nizet V, and Hensler ME
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- HeLa Cells, Humans, Microbial Sensitivity Tests, Molecular Structure, Pyrroles chemistry, Serum chemistry, Methicillin-Resistant Staphylococcus aureus drug effects, Pyrroles pharmacology
- Abstract
The ongoing spread of methicillin-resistant Staphylococcus aureus (MRSA) strains in hospital and community settings presents a great challenge to public health and illustrates the urgency of discovering new antibiotics. Marinopyrrole A is a member of a structurally novel class of compounds identified from a species of marine-derived streptomycetes with evidence of antistaphylococcal activity. We show that marinopyrrole A has potent concentration-dependent bactericidal activity against clinically relevant hospital- and community-acquired MRSA strains, a prolonged postantibiotic effect superior to that of the current first-line agents vancomycin and linezolid, and a favorable resistance profile. Marinopyrrole A showed limited toxicity to mammalian cell lines (at >20× MIC). However, its antibiotic activity against MRSA was effectively neutralized by 20% human serum. A variety of marinopyrrole analogs were isolated from culture or synthetically produced to try to overcome the inhibitory effect of serum. While many of these compounds retained potent bactericidal effect against MRSA, their activities were also inhibited by serum. Marinopyrrole A has significant affinity for plastic and may therefore have potential as a potent anti-MRSA agent in cutaneous, intracatheter, or antibiotic-lock applications.
- Published
- 2011
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