19 results on '"Huntley K"'
Search Results
2. Archaeopteryx feathers and bone chemistry fully revealed via synchrotron imaging
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Bergmann, U., Morton, R. W., Manning, P. L., Sellers, W. I., Farrar, S., Huntley, K. G., Wogelius, R. A., and Larson, P.
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- 2010
3. Experiences and needs of people with haematological cancers during the COVID-19 pandemic: A qualitative study.
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Zomerdijk N., Jongenelis M., Yuen E., Turner J., Huntley K., Smith A., McIntosh M., Short C.E., Zomerdijk N., Jongenelis M., Yuen E., Turner J., Huntley K., Smith A., McIntosh M., and Short C.E.
- Abstract
Objective: Haematological cancer patients are particularly vulnerable to the effects of COVID-19. In addition to being immunocompromised, pandemic-related travel restrictions have impacted access to treatments and overseas stem cell donations for patients requiring transplantation. Given this vulnerability, people with haematological cancers are at risk of experiencing heightened distress during the pandemic. This study aimed to explore haematological cancer patients' experiences and needs. Method(s): Twenty-four Australian haematological cancer patients completed semi-structured interviews exploring their concerns and worries during the pandemic, impact of pandemic on management of disease, access to information and support, lifestyle changes, and attitudes towards emerging models of healthcare during the pandemic. Interview transcripts were thematically analysed. Result(s): Four themes reflecting the experiences of haematological cancer patients during the pandemic were identified: 'Fears about contracting COVID-19' (behaviour changes to protect health, impact on daily routine and habits, annoyance at dismissive attitude of others toward COVID-19); 'Reduced sense of connection and support' (reduced social support and access to external support services); 'New challenges' (increased financial hardship, worsened health), and; 'Underlying system and communication issues' (access to trusted information, satisfaction/dissatisfaction with care, navigating telehealth). Participants expressed a need for improved access to support services and trusted information. Conclusion(s): The findings emphasise the additional challenges experienced by haematological cancer patients during the COVID-19 pandemic and their impact on daily life. Results point to the importance of validation of increased distress during periods of uncertainty; reinforcing recommendations about high-quality sources of information; and facilitating access to support services when face-to-face care is limit
- Published
- 2021
4. Prevalence and correlates of psychological distress, unmet supportive care needs, and fear of cancer recurrence among haematological cancer patients during the COVID-19 pandemic
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Zomerdijk, N, Jongenelis, M, Short, CE, Smith, A, Turner, J, Huntley, K, Zomerdijk, N, Jongenelis, M, Short, CE, Smith, A, Turner, J, and Huntley, K
- Abstract
BACKGROUND: The COVID-19 pandemic has had a disruptive effect on people with haematological cancers, who represent a high-risk population due to the nature of their disease and immunosuppressive treatments. We aimed to identify the psychological impacts of the COVID-19 pandemic on haematology patients and identify correlated factors to inform the development of appropriate supportive interventions. METHODS: Three hundred and ninety-four respondents volunteered their participation in response to a study advertisement distributed online through established haematology groups. Participants completed a self-report online survey exploring wellbeing, psychological distress, unmet supportive care needs, and fear of cancer recurrence. RESULTS: At least 1 in 3 respondents (35%) reported clinical levels of distress and nearly 1 in 3 (32%) identified at least one unmet need. Among respondents in remission (n = 134), clinical fear of cancer recurrence was reported by nearly all (95%). Unmet needs, pre-existing health conditions, younger age, financial concerns, and perceived risk of contracting COVID-19 were the dominant factors contributing to psychological distress during the pandemic. Psychological distress, lost income, perceived inadequate support from care team, perceived risk of contracting COVID-19, and being a woman were significantly associated with unmet needs. Psychological distress and concern about the impact of COVID-19 on cancer management were significantly associated with fear of cancer recurrence among respondents in remission. CONCLUSION: Results highlight the high psychological burden and unmet needs experienced by people with haematological cancers during the COVID-19 pandemic and indicate a need for innovative solutions to rapidly identify distress and unmet needs during, and beyond, pandemic times.
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- 2021
5. Experiences and needs of people with haematological cancers during the COVID-19 pandemic: A qualitative study
- Author
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Zomerdijk, N, Jongenelis, M, Yuen, E, Turner, J, Huntley, K, Smith, A, McIntosh, M, Short, CE, Zomerdijk, N, Jongenelis, M, Yuen, E, Turner, J, Huntley, K, Smith, A, McIntosh, M, and Short, CE
- Abstract
OBJECTIVE: Haematological cancer patients are particularly vulnerable to the effects of COVID-19. In addition to being immunocompromised, pandemic-related travel restrictions have impacted access to treatments and overseas stem cell donations for patients requiring transplantation. Given this vulnerability, people with haematological cancers are at risk of experiencing heightened distress during the pandemic. This study aimed to explore haematological cancer patients' experiences and needs. METHODS: Twenty-four Australian haematological cancer patients completed semi-structured interviews exploring their concerns and worries during the pandemic, impact of pandemic on management of disease, access to information and support, lifestyle changes, and attitudes towards emerging models of healthcare during the pandemic. Interview transcripts were thematically analysed. RESULTS: Four themes reflecting the experiences of haematological cancer patients during the pandemic were identified: 'Fears about contracting COVID-19' (behaviour changes to protect health, impact on daily routine and habits, annoyance at dismissive attitude of others toward COVID-19); 'Reduced sense of connection and support' (reduced social support and access to external support services); 'New challenges' (increased financial hardship, worsened health), and; 'Underlying system and communication issues' (access to trusted information, satisfaction/dissatisfaction with care, navigating telehealth). Participants expressed a need for improved access to support services and trusted information. CONCLUSIONS: The findings emphasise the additional challenges experienced by haematological cancer patients during the COVID-19 pandemic and their impact on daily life. Results point to the importance of validation of increased distress during periods of uncertainty; reinforcing recommendations about high-quality sources of information; and facilitating access to support services when face-to-face care is limited.
- Published
- 2021
6. Scoring for eye irritation tests
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Chambers, W.A., primary, Green, S., additional, Gupta, K.C., additional, Hill, R.N., additional, Huntley, K., additional, Hurley, P.M., additional, Lambert, L.A., additional, Lee, C.C., additional, Lee, J.K., additional, Liu, P.T., additional, Lowther, D.K., additional, Roberts, C.D., additional, Seabaugh, V.M., additional, Springer, J.A., additional, and Wilcox, N.L., additional
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- 1993
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7. DIETARY INTAKE, PHYSICAL ACTIVITY AND BODY MASS INDEX AMONG AFRICAN AMERICAN YOUTH.
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Harris Huntley, K. A., Weese, J., Crayton, E. F., Gropper, S., White, D., and Johnson, J.
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AFRICAN Americans - Abstract
An abstract of the article "Dietary intake, physical activity and body mass index among African American youth," by K.A. Harris Huntley and colleagues is presented.
- Published
- 2008
8. Extended-Release 7-Day Injectable Buprenorphine for Patients With Minimal to Mild Opioid Withdrawal.
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D'Onofrio G, Herring AA, Perrone J, Hawk K, Samuels EA, Cowan E, Anderson E, McCormack R, Huntley K, Owens P, Martel S, Schactman M, Lofwall MR, Walsh SL, Dziura J, and Fiellin DA
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- Adult, Female, Humans, Male, Middle Aged, Analgesics, Opioid administration & dosage, Analgesics, Opioid therapeutic use, Feasibility Studies, Narcotic Antagonists administration & dosage, Narcotic Antagonists therapeutic use, Opiate Substitution Treatment methods, Buprenorphine administration & dosage, Buprenorphine therapeutic use, Delayed-Action Preparations, Opioid-Related Disorders drug therapy, Substance Withdrawal Syndrome drug therapy
- Abstract
Importance: Buprenorphine is an effective yet underused treatment for opioid use disorder (OUD)., Objective: To evaluate the feasibility (acceptability, tolerability, and safety) of 7-day injectable extended-release buprenorphine in patients with minimal to mild opioid withdrawal., Design, Setting, and Participants: This nonrandomized trial comprising 4 emergency departments in the Northeast, mid-Atlantic, and Pacific geographic areas of the US included adults aged 18 years or older with moderate to severe OUD and Clinical Opiate Withdrawal Scale (COWS) scores less than 8 (minimal to mild), in which scores range from 0 to 7, with higher scores indicating increasing withdrawal. Exclusion criteria included methadone-positive urine, pregnancy, overdose, or required admission. Outcomes were assessed at baseline, daily for 7 days by telephone surveys, and in person at 7 days. Patient recruitment occurred between July 13, 2020, and May 25, 2023., Intervention: Injection of a 24-mg dose of a weekly extended-release formulation of buprenorphine (CAM2038) and referral for ongoing OUD care., Main Outcomes and Measures: Primary feasibility outcomes included the number of patients who (1) experienced a 5-point or greater increase in the COWS score or (2) transitioned to moderate or greater withdrawal (COWS score ≥13) within 4 hours of extended-release buprenorphine or (3) experienced precipitated withdrawal within 1 hour of extended-release buprenorphine. Secondary outcomes included injection pain, satisfaction, craving, use of nonprescribed opioids, adverse events, and engagement in OUD treatment., Results: A total of 100 adult patients were enrolled (mean [SD] age, 36.5 [8.7] years; 72% male). Among the patients, 10 (10.0% [95% CI, 4.9%-17.6%]) experienced a 5-point or greater increase in COWS and 7 (7.0% [95% CI, 2.9%-13.9%]) transitioned to moderate or greater withdrawal within 4 hours, and 2 (2.0% [95% CI, 0.2%-7.0%]) experienced precipitated withdrawal within 1 hour of extended-release buprenorphine. A total of 7 patients (7.0% [95% CI, 2.9%-13.9%]) experienced precipitated withdrawal within 4 hours of extended-release buprenorphine, which included 2 of 63 (3.2%) with a COWS score of 4 to 7 and 5 of 37 (13.5%) with a COWS score of 0 to 3. Site pain scores (based on a total pain score of 10, in which 0 indicated no pain and 10 was the worst possible pain) after injection were low immediately (median, 2.0; range, 0-10.0) and after 4 hours (median, 0; range, 0-10.0). On any given day among those who responded, between 29 (33%) and 31 (43%) patients reported no cravings and between 59 (78%) and 75 (85%) reported no use of opioids; 57 patients (60%) reported no days of opioid use. Improving privacy (62%) and not requiring daily medication (67%) were deemed extremely important. Seventy-three patients (73%) were engaged in OUD treatment on day 7. Five serious adverse events occurred that required hospitalization, of which 2 were associated with medication., Conclusions and Relevance: This nonrandomized trial of the feasibility of a 7-day buprenorphine injectable in patients with minimal to mild opioid withdrawal (COWS scores, 0-7) found the formulation to be acceptable, well tolerated, and safe in those with COWS scores of 4 to 7. This new medication formulation could substantially increase the number of patients with OUD receiving buprenorphine., Trial Registration: ClinicalTrials.gov Identifier: NCT04225598.
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- 2024
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9. Results of VOICE: a global survey of disease-specific knowledge and perspectives of real-world patients with CLL.
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Tam C, Pinilla-Ibarz J, Castillo CG, Fenili AC, Huntley K, Karakus V, Mattar M, Miroli MA, Moura C, Pavlovsky M, Piotrowski F, Šimkovič M, and Stilgenbauer S
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- Humans, United States, Outpatients, Duration of Therapy, Australia epidemiology, Leukemia, Lymphocytic, Chronic, B-Cell therapy, Leukemia, Lymphocytic, Chronic, B-Cell drug therapy, Physicians
- Abstract
The Virtual Opinions poll Independent Centered on CLL patients' Experience (VOICE) evaluated patients' knowledge about chronic lymphocytic leukemia (CLL), their perspectives on diagnosis and treatment, and their unmet needs. Clinicians and patient advocacy group representatives developed and distributed the survey from March through December 2022 in 12 countries, and 377 patients with ≥1 line of previous CLL treatment responded from Europe, Latin America, the United States, Australia, Egypt, and Turkey. A majority of them (90%; 336/374) relied on their physicians for information regarding CLL and treatment. If at high risk, respondents prefer oral medications to intravenous (78%; 232/296), fixed duration treatment over treatment until progression (69%; 185/270), outpatient over inpatient treatments (91%; 257/283). Over three-fourths of respondents (78%; 286/368) wanted to be involved in treatment decisions, but a minority actually participated (44%; 138/313). COVID-19 vaccinations were widely available (97%; 273/281), but one-fifth (19%; 63/331) were unaware that CLL increases vulnerability to infections. Most patients' physicians explained their treatment options (84%; 297/355), and 90% (271/301) understood their treatment. Notably, >10% would continue treatment normally if they experienced cardiac problems or arrhythmias, whereas 23% would consider stopping treatment if they developed skin cancer. Treatment-associated side effects affected 27% to 43% of patients. These results in a global patient population highlight gaps in patients' knowledge of risk groups, their susceptibility to infections including COVID, and the side effects of common treatments. Such knowledge can guide the appropriate targeting of patient education initiatives by clinicians, advocates, and policymakers., (© 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
- Published
- 2023
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10. Implementation Facilitation to Promote Emergency Department-Initiated Buprenorphine for Opioid Use Disorder.
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D'Onofrio G, Edelman EJ, Hawk KF, Chawarski MC, Pantalon MV, Owens PH, Martel SH, Rothman R, Saheed M, Schwartz RP, Cowan E, Richardson L, Salsitz E, Lyons MS, Freiermuth C, Wilder C, Whiteside L, Tsui JI, Klein JW, Coupet E, O'Connor PG, Matthews AG, Murphy SM, Huntley K, and Fiellin DA
- Subjects
- Humans, Male, Adult, Female, Narcotic Antagonists therapeutic use, Opiate Substitution Treatment methods, Naloxone therapeutic use, Emergency Service, Hospital, Buprenorphine therapeutic use, Opioid-Related Disorders drug therapy
- Abstract
Importance: Emergency department (ED)-initiated buprenorphine for the treatment of opioid use disorder (OUD) is underused., Objective: To evaluate whether provision of ED-initiated buprenorphine with referral for OUD increased after implementation facilitation (IF), an educational and implementation strategy., Design, Setting, and Participants: This multisite hybrid type 3 effectiveness-implementation nonrandomized trial compared grand rounds with IF, with pre-post 12-month baseline and IF evaluation periods, at 4 academic EDs. The study was conducted from April 1, 2017, to November 30, 2020. Participants were ED and community clinicians treating patients with OUD and observational cohorts of ED patients with untreated OUD. Data were analyzed from July 16, 2021, to July 14, 2022., Exposure: A 60-minute in-person grand rounds was compared with IF, a multicomponent facilitation strategy that engaged local champions, developed protocols, and provided learning collaboratives and performance feedback., Main Outcomes and Measures: The primary outcomes were the rate of patients in the observational cohorts who received ED-initiated buprenorphine with referral for OUD treatment (primary implementation outcome) and the rate of patients engaged in OUD treatment at 30 days after enrollment (effectiveness outcome). Additional implementation outcomes included the numbers of ED clinicians with an X-waiver to prescribe buprenorphine and ED visits with buprenorphine administered or prescribed and naloxone dispensed or prescribed., Results: A total of 394 patients were enrolled during the baseline evaluation period and 362 patients were enrolled during the IF evaluation period across all sites, for a total of 756 patients (540 [71.4%] male; mean [SD] age, 39.3 [11.7] years), with 223 Black patients (29.5%) and 394 White patients (52.1%). The cohort included 420 patients (55.6%) who were unemployed, and 431 patients (57.0%) reported unstable housing. Two patients (0.5%) received ED-initiated buprenorphine during the baseline period, compared with 53 patients (14.6%) during the IF evaluation period (P < .001). Forty patients (10.2%) were engaged with OUD treatment during the baseline period, compared with 59 patients (16.3%) during the IF evaluation period (P = .01). Patients in the IF evaluation period who received ED-initiated buprenorphine were more likely to be in treatment at 30 days (19 of 53 patients [35.8%]) than those who did not 40 of 309 patients (12.9%; P < .001). Additionally, there were increases in the numbers of ED clinicians with an X-waiver (from 11 to 196 clinicians) and ED visits with provision of buprenorphine (from 259 to 1256 visits) and naloxone (from 535 to 1091 visits)., Conclusions and Relevance: In this multicenter effectiveness-implementation nonrandomized trial, rates of ED-initiated buprenorphine and engagement in OUD treatment were higher in the IF period, especially among patients who received ED-initiated buprenorphine., Trial Registration: ClinicalTrials.gov Identifier: NCT03023930.
- Published
- 2023
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11. Factors associated with changes in healthy lifestyle behaviors among hematological cancer patients during the COVID-19 pandemic.
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Zomerdijk N, Jongenelis MI, Collins B, Turner J, Short CE, Smith A, and Huntley K
- Abstract
Background: There is a paucity of research examining the effects of the COVID-19 pandemic on the healthy lifestyle behaviors of hematological cancer patients. We examined changes in healthy lifestyle behaviors since the pandemic and identified factors associated with these changes among members of this high-risk population., Methods: Hematological cancer patients ( n = 394) completed a self-report online survey from July to August 2020. The survey assessed pandemic-related changes in exercise, alcohol consumption, and consumption of fruit, vegetables, and wholegrains. Information relating to several demographic, clinical, and psychological factors was also collected. Factors associated with changes in healthy lifestyle behaviors were analyzed using logistic regression., Results: Just 14% of patients surveyed reported exercising more during the pandemic (39% exercised less). Only a quarter (24%) improved their diet, while nearly half (45%) reported eating less fruit, vegetables, and wholegrains. Just over a quarter (28%) consumed less alcohol (17% consumed more alcohol). Fear of contracting COVID-19 and psychological distress were significantly associated with reduced exercise. Younger age was significantly associated with both increased alcohol consumption and increased exercise. Being a woman was significantly associated with unfavorable changes in diet and being married was significantly associated with decreased alcohol consumption., Conclusion: A substantial proportion of hematological cancer patients reported unfavorable changes in healthy lifestyle behaviors during the pandemic. Results highlight the importance of supporting healthy lifestyle practices among this particularly vulnerable group to ensure health is optimized while undergoing treatment and when in remission, particularly during crisis times like the COVID-19 pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zomerdijk, Jongenelis, Collins, Turner, Short, Smith and Huntley.)
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- 2023
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12. Prolonged SARS-CoV-2 infection following rituximab treatment: clinical course and response to therapeutic interventions correlated with quantitative viral cultures and cycle threshold values.
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Thornton CS, Huntley K, Berenger BM, Bristow M, Evans DH, Fonseca K, Franko A, Gillrie MR, Lin YC, Povitz M, Shafey M, Conly JM, and Tremblay A
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- COVID-19 prevention & control, COVID-19 Vaccines administration & dosage, Humans, Immunocompromised Host, Male, Middle Aged, Nasopharynx, Tomography, X-Ray Computed, Treatment Outcome, Viral Load, COVID-19 Drug Treatment, COVID-19 pathology, Rituximab pharmacology, SARS-CoV-2 drug effects, Virus Shedding drug effects
- Abstract
Background: Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is completed through reverse transcriptase-PCR (RT-PCR) from either oropharyngeal or nasopharyngeal swabs, critically important for diagnostics but also from an infection control lens. Recent studies have suggested that COVID-19 patients can demonstrate prolonged viral shedding with immunosuppression as a key risk factor., Case Presentation: We present a case of an immunocompromised patient with SARS-CoV-2 infection demonstrating prolonged infectious viral shedding for 189 days with virus cultivability and clinical relapse with an identical strain based on whole genome sequencing, requiring a multi-modal therapeutic approach. We correlated clinical parameters, PCR cycle thresholds and viral culture until eventual resolution., Conclusions: We successfully demonstrate resolution of viral shedding, administration of COVID-19 vaccination and maintenance of viral clearance. This case highlights implications in the immunosuppressed patient towards infection prevention and control that should consider those with prolonged viral shedding and may require ancillary testing to fully elucidate viral activity. Furthermore, this case raises several stimulating questions around complex COVID-19 patients around the role of steroids, effect of antiviral therapies in absence of B-cells, role for vaccination and the requirement of a multi-modal approach to eventually have successful clearance of the virus., (© 2022. The Author(s).)
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- 2022
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13. Advanced Placement Courses for Medical School: A Novel AMed Track to Reduce Financial Burden and Attract Nontraditional Students.
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Labiste CC, Huntley K, Bauckman KA, Fine L, and Rajput V
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Medical school admissions have become increasingly competitive, creating a pool of nontraditional applicants that seek postbaccalaureate training in biomedical sciences. Several postbaccalaureate and graduate programs developed curricula that, except for learning clinical skills, mirror the learning objectives of the foundational science curricula in medical schools. This education structure provides applicants with a competitive advantage when applying to medical schools. However, basic science curriculum assessments in medical schools have changed to pass/fail scoring systems. As a result, students that participate in preparatory postbaccalaureate and graduate programs cannot show their superior level of knowledge and may find some core foundational science subjects redundant during their pre-clerkship medical education. The aim of this article is to propose an innovative system for matriculation into medical school through the AdvancedMed (AMed) Track, a three-year accelerated medical curriculum in which graduate curricula adopt an advanced placement course called AMed courses. This system would mirror the structure of the high school Advanced Placement (AP) system; therefore, students would take AMed courses similar in rigor to medical school basic science courses. These courses include Anatomy, Histology, Physiology, Cellular Biology, Biochemistry, Genetics, Microbiology, Immunology, Biostatistics, and Epidemiology. All courses would require a scored national standardized test to receive medical school credit toward a three-year accelerated track curriculum. Nontraditional students could choose to study independently and take the AMed standardized examination for credit to enter the AMed Track. Medical schools have the incentive to start an AMed Track because its implementation could lessen the financial burden, reduce time spent in medical school, and increase the participation of nontraditional medical students., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Labiste et al.)
- Published
- 2021
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14. Surgical Management of Benign Tumors of the Proximal Fibula.
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Huntley K, Al-Hardan W, and Pretell-Mazzini J
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- Humans, Neoplasm Recurrence, Local, Bone Neoplasms diagnostic imaging, Fibula diagnostic imaging
- Abstract
Benign tumors of the proximal fibula are clinically notable, often resulting in pain, cosmetic defects, and potential neurovascular compromise. These symptomatic lesions warrant surgical consultation, but specific procedure selection remains a topic of ongoing discussion. The fibula is widely considered an expendable bone, which permits a greater variety of surgical options relative to other skeletal locations. As a result, some authors suggested en bloc resections without reconstruction as a viable first-line option to decrease tumor recurrence risk. However, wide resections may still result in diminished postoperative functionality compared with the standard intralesional and marginal approaches. Thus, surgical management remains a multifactorial decision, and often orthopaedic surgeons rely on past clinical experience or surgical preference within this unique tumor location. This detailed review will summarize the published literature and discuss the outcomes and indications of various surgical approaches for benign tumors of the proximal fibula. Emphasis will be placed on balancing tumor recurrence risk and postoperative functionality within the context of histologic diagnoses and surgical approaches., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)
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- 2021
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15. Advancing emergency department-initiated buprenorphine.
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Huntley K, Einstein E, Postma T, Thomas A, Ling S, and Compton W
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Opioids are the main driver of drug overdose deaths in the United States, and there has been a marked increase in opioid-related overdoses during the COVID-19 public health emergency. Many emergency departments (EDs) across the country are implementing ED-initiated buprenorphine programs, and this is a method to address and prevent opioid overdoses. Resources are available to overcome barriers and take action., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)
- Published
- 2021
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16. Racial and Ethnic Disparities in COVID-19 Outcomes: Social Determination of Health.
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Raine S, Liu A, Mintz J, Wahood W, Huntley K, and Haffizulla F
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- Betacoronavirus, COVID-19, Coronavirus Infections mortality, Cross-Sectional Studies, Ethnicity, Humans, Pandemics, Pneumonia, Viral mortality, Racial Groups, SARS-CoV-2, United States epidemiology, Coronavirus Infections ethnology, Pneumonia, Viral ethnology, Social Determinants of Health
- Abstract
As of 18 October 2020, over 39.5 million cases of coronavirus disease 2019 (COVID-19) and 1.1 million associated deaths have been reported worldwide. It is crucial to understand the effect of social determination of health on novel COVID-19 outcomes in order to establish health justice. There is an imperative need, for policy makers at all levels, to consider socioeconomic and racial and ethnic disparities in pandemic planning. Cross-sectional analysis from COVID Boston University's Center for Antiracist Research COVID Racial Data Tracker was performed to evaluate the racial and ethnic distribution of COVID-19 outcomes relative to representation in the United States. Representation quotients (RQs) were calculated to assess for disparity using state-level data from the American Community Survey (ACS). We found that on a national level, Hispanic/Latinx, American Indian/Alaskan Native, Native Hawaiian/Pacific Islanders, and Black people had RQs > 1, indicating that these groups are over-represented in COVID-19 incidence. Dramatic racial and ethnic variances in state-level incidence and mortality RQs were also observed. This study investigates pandemic disparities and examines some factors which inform the social determination of health. These findings are key for developing effective public policy and allocating resources to effectively decrease health disparities. Protective standards, stay-at-home orders, and essential worker guidelines must be tailored to address the social determination of health in order to mitigate health injustices, as identified by COVID-19 incidence and mortality RQs.
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- 2020
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17. Developing a clinical decision support for opioid use disorders: a NIDA center for the clinical trials network working group report.
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Bart GB, Saxon A, Fiellin DA, McNeely J, Muench JP, Shanahan CW, Huntley K, and Gore-Langton RE
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- Algorithms, Electronic Health Records organization & administration, Humans, Mass Screening, Opiate Substitution Treatment methods, United States, Decision Support Systems, Clinical organization & administration, Health Services Accessibility organization & administration, National Institute on Drug Abuse (U.S.) organization & administration, Opioid-Related Disorders diagnosis, Opioid-Related Disorders therapy, Primary Health Care organization & administration
- Abstract
There is an urgent need for strategies to address the US epidemic of prescription opioid, heroin and fentanyl-related overdoses, misuse, addiction, and diversion. Evidence-based treatment such as medications for opioid use disorder (MOUD) are available but lack numbers of providers offering these services to meet the demands. Availability of electronic health record (EHR) systems has greatly increased and led to innovative quality improvement initiatives but this has not yet been optimized to address the opioid epidemic or to treat opioid use disorder (OUD). This report from a clinical decision support (CDS) working group convened by the NIDA Center for the Clinical Trials Network aims to converge electronic technology in the EHR with the urgent need to improve screening, identification, and treatment of OUD in primary care settings through the development of a CDS algorithm that could be implemented as a tool in the EHR. This aim is consistent with federal, state and local government and private sector efforts to improve access and quality of MOUD treatment for OUD, existing clinical quality and HEDIS measures for OUD or drug and alcohol use disorders, and with a recent draft grade B recommendation from the US Preventative Services Task Force (USPSTF) for screening for illicit drug use in adults when appropriate diagnosis, treatment and care services can be offered or referred. Through a face-to-face expert panel meeting and multiple follow-up conference calls, the working group drafted CDS algorithms for clinical care felt to be essential for screening, diagnosis, and management of OUD in primary care. The CDS algorithm was reviewed by addiction specialists and primary care providers and revised based on their input. A clinical decision support tool for OUD screening, assessment, and treatment within primary care systems may help improve healthcare delivery to help address the current epidemic of opioid misuse and overdose that has outpaced the capacity of specialized treatment settings. A semi-structured outline of clinical decision support for OUD was developed to facilitate implementation within the EHR. Further work for adaptation at specific sites and for testing is needed.
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- 2020
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18. Implementation facilitation to promote emergency department-initiated buprenorphine for opioid use disorder: protocol for a hybrid type III effectiveness-implementation study (Project ED HEALTH).
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D'Onofrio G, Edelman EJ, Hawk KF, Pantalon MV, Chawarski MC, Owens PH, Martel SH, VanVeldhuisen P, Oden N, Murphy SM, Huntley K, O'Connor PG, and Fiellin DA
- Subjects
- Adult, Evidence-Based Medicine, Female, Focus Groups, Humans, Inservice Training, Male, Program Development, Program Evaluation, Research Design, United States, Buprenorphine therapeutic use, Emergency Medicine education, Emergency Service, Hospital organization & administration, Narcotic Antagonists therapeutic use, Opiate Substitution Treatment methods, Opioid-Related Disorders drug therapy
- Abstract
Background: Patients with opioid use disorder (OUD) frequently present to the emergency department (ED) after overdose, or seeking treatment for general medical conditions, their addiction, withdrawal symptoms, or complications of injection drug use, such as soft tissue infections. ED-initiated buprenorphine has been shown to be effective in increasing patient engagement in treatment compared with brief intervention with a facilitated referral or referral alone. However, adoption into practice has lagged behind need. To address this implementation challenge, we are evaluating the impact of implementation facilitation (IF) on the adoption of ED-initiated buprenorphine for OUD into practice., Methods: This protocol describes a study that is being conducted through the National Institute on Drug Abuse's Center for the Clinical Trials Network. A hybrid type III effectiveness-implementation study design is used to evaluate the effectiveness of a standard educational dissemination strategy versus IF on implementation (primary) and effectiveness (secondary) outcomes in four urban, academic EDs. Sites start with a standard 60-min "Grand Rounds" educational intervention describing the prevalence of ED patients with OUD, the evidence for opioid agonist treatment and for innovative interventions with ED-initiated buprenorphine; followed by a 1-year baseline evaluation period. Using a modified stepped wedge design, sites are randomly assigned to the IF intervention which is guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework to assess evidence, context, and facilitation-related factors impacting the adoption of ED-initiated buprenorphine. During the 6 months of IF through the 1-year IF evaluation period, external facilitators work with local stakeholders to tailor and refine a bundle of activities to meet the site's needs. The primary analyses compare the baseline evaluation period to the IF evaluation period (n = 120 patients with untreated OUD enrolled during each period) on (1) rates of provision of ED-initiated buprenorphine by ED providers with referral for ongoing medication (implementation outcome) and (2) rates of patient engagement in addiction treatment on the 30th day after the ED visit (effectiveness outcome). Finally, we will perform a cost-effectiveness analysis (CEA) to determine if the effectiveness benefits are worth the additional costs., Discussion: Results will generate novel information regarding the impact of IF as a strategy to promote ED-initiated buprenorphine., Trial Registration: ClinicalTrials.gov NCT03023930 first posted 1/10/2017, https://clinicaltrials.gov/ct2/show/NCT03023930?term=0069&rank=1.
- Published
- 2019
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19. Mutual exclusivity and exclusion: Converging evidence from two contrasting traditions.
- Author
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Huntley KR and Ghezzi PM
- Abstract
Mutual exclusivity and exclusion are two terms used by cognitive psychologists and behavior analysts, respectively, to identify essentially the same phenomenon. While cognitive psychologists view mutual exclusivity in terms of a hypothesis that individuals use intuitively while acquiring language, behavior analysts regard exclusion as a derived stimulus relation that bears upon the acquisition and elaboration of verbal behavior. Each research tradition, though at odds with respect to accounting for the phenomenon, employs similar procedures to answer comparable questions. Insofar as both cognitive and behavioral psychologists are studying the same phenomenon, the ground work is established for collaboration between them.
- Published
- 1993
- Full Text
- View/download PDF
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