32 results on '"Hong-nei Wong"'
Search Results
2. Impact of climate change on rheumatic diseases: A scoping review
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Tamiko R. Katsumoto, Liya Stolyar, Chathurika L. Dandeniya, Hong Nei Wong, Cristina M. Lanata, Titilola Falasinnu, and Thomas Bush
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Scoping review ,Climate change ,Global warming ,Pollution ,Malnutrition ,Rheumatology ,Public aspects of medicine ,RA1-1270 ,Meteorology. Climatology ,QC851-999 - Abstract
Introduction: Although the impacts of climate change on human health conditions are reasonably well documented, specific influences on rheumatic diseases remain incompletely characterized. The goal of this scoping review was to better understand how climate change is impacting rheumatic diseases, either directly or indirectly, as well as how climate change affects the geographical distribution of infectious diseases with arthritogenic manifestations, which will impact rheumatic disease care. Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). Results: 149 papers were identified regarding the impact of climate change related exposures on patients with rheumatic diseases. The most common climate-related exposure was air pollution, with other factors including excess heat or cold, precipitation, exposure to ultraviolet light, and malnutrition. The vast majority of studies identified associations of climate related factors with increased disease activity or incidence. 105 studies were identified that addressed the influence of climate change on the observed or projected changes in the geographical range of diseases with arthritogenic manifestations spread by arthropods or environmental vectors. The majority of studies focused on dengue, Lyme disease and chikungunya and found an increase in the geographical range with climate change. A grey literature search of rheumatology organization websites suggests that the field of rheumatology remains inadequately prepared for climate change impacts. Conclusions: The existing literature was summarized and gaps were highlighted that are deserving of further exploration such that rheumatologists can be better prepared to care for their patients, educate them on potential health harms, and advocate for policies to proactively address the climate crisis.
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- 2024
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3. 67 Teaching information fluency to digital native medical and physician assistant students
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Hong-Nei Wong, Henry Lee, and John Borghi
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- 2022
4. 136 Effectiveness of library instruction on medical students’ information literacy skills
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Hong-Nei Wong and Lily Ren
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- 2022
5. Patient-reported outcome measurement implementation in cancer survivors: a systematic review
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Surbhi Singhal, James Dickerson, Michael J. Glover, Mohana Roy, Michelle Chiu, Timothy Ellis-Caleo, Gavin Hui, Carla Tamayo, Nele Loecher, Hong-nei Wong, Lauren C. Heathcote, and Lidia Schapira
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Oncology ,Oncology (nursing) - Abstract
PURPOSE: Patient-reported outcome measurements (PROMs) are increasingly used for cancer patients receiving active treatment, but little is known about the implementation and usefulness of PROMs in cancer survivorship care. This systematic review evaluates how cancer survivors and healthcare providers (HCPs) perceive PROM implementation in survivorship care, and how PROM implementation impacts cancer survivors' health outcomes.METHODS: We systematically searched PubMed/MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Database of Systematic Reviews from database inception to February 2022 to identify randomized and nonrandomized studies of PROM implementation in cancer survivors.RESULTS: Based on prespecified eligibility criteria, we included 29 studies that reported on 26 unique PROMs. The studies were heterogeneous in study design, PROM instrument, patient demographics, and outcomes. Several studies found that cancer survivors and HCPs had favorable impressions of the utility of PROMs, and a few studies demonstrated that PROM implementation led to improvements in patient quality of life (QoL), with small to moderate effect sizes.CONCLUSIONS: We found implementation of PROMs in cancer survivorship care improved health outcomes for select patient populations. Future research is needed to assess the real-world utility of PROM integration into clinical workflows and the impact of PROMs on measurable health outcomes.IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors accepted PROMs. When successfully implemented, PROMs can improve health outcomes after completion of active treatment. We identify multiple avenues to strengthen PROM implementation to support cancer survivors.
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- 2022
6. Teaming in Interdisciplinary Chronic Pain Management Interventions in Primary Care: a Systematic Review of Randomized Controlled Trials
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Natalie B. Connell, Pallavi Prathivadi, Karl A. Lorenz, Sophia N. Zupanc, Sara J. Singer, Erin E. Krebs, Elizabeth M. Yano, Hong-nei Wong, and Karleen F. Giannitrapani
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Internal Medicine ,Systematic Review - Abstract
BACKGROUND: Current pain management recommendations emphasize leveraging interdisciplinary teams. We aimed to identify key features of interdisciplinary team structures and processes associated with improved pain outcomes for patients experiencing chronic pain in primary care settings. METHODS: We searched PubMed, EMBASE, and CINAHL for randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (e.g., BPI total pain, GCPS pain intensity, RMDQ pain-related disability), include primary care as an intervention setting, and demonstrate some evidence of teamwork or teaming; specifically, they needed to involve at least two clinicians interacting with each other and with patients in an ongoing process over at least two timepoints. We assessed study quality with the Cochrane Risk of Bias tool. We narratively synthesized intervention team structures and processes, comparing among interventions that reported a clinically meaningful improvement in patient-reported pain outcomes defined by the minimal clinically important difference (MCID). RESULTS: We included 13 total interventions in our review, of which eight reported a clinically meaningful improvement in at least one patient-reported pain outcome. No included studies had an overall high risk of bias. We identified the role of a care manager as a common structural feature of the interventions with some clinical effect on patient-reported pain. The team processes involving clinicians varied across interventions reporting clinically improved pain outcomes. However, when analyzing team processes involving patients, six of the interventions with some clinical effect on pain relied on pre-scheduled phone calls for continuous patient follow-up. DISCUSSION: Our review suggests that interdisciplinary interventions incorporating teamwork and teaming can improve patient-reported pain outcomes in comparison to usual care. Given the current evidence, future interventions might prioritize care managers and mechanisms for patient follow-up to help bridge the gap between clinical guidelines and the implementation of interdisciplinary, team-based chronic pain care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-021-07255-w.
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- 2022
7. Palliative Care Opportunities Among Adults With Congenital Heart Disease—A Systematic Review
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Shelly S. Lo, Amy Kloosterboer, Savithri Nageswaran, Thomas Carroll, James Powers, Jason Leong, Katherine Ast, Jonathan Ludmir, Krista L. Harrison, Rebecca Aslakson, Elizabeth Dzeng, Thomas W. LeBlanc, Hong-nei Wong, Christina Ullrich, Joseph Rotella, Erica C. Kaye, Rebecca A. Aslakson, Jill M. Steiner, Kelly McKenna, and Theresa Vickey
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Heart Defects, Congenital ,Advance care planning ,Resuscitation ,medicine.medical_specialty ,Palliative care ,Databases, Factual ,Heart disease ,Context (language use) ,CINAHL ,Hospital Anxiety and Depression Scale ,Advance Care Planning ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,General Nursing ,Terminal Care ,business.industry ,Palliative Care ,medicine.disease ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Family medicine ,Anxiety ,Neurology (clinical) ,medicine.symptom ,Advance Directives ,business - Abstract
Context Little is known about advance care planning (ACP) and palliative care needs among adults with congenital heart disease (ACHD). Objectives The objective of this study was to identify and synthesize studies concerning palliative care among ACHD patients. Methods We searched five electronic databases (PubMed, Embase, SCOPUS, Web of Science, and CINAHL) using the keywords palliative care and congenital heart disease. Inclusion criteria were adults (age > 18 years) with congenital heart disease and publications in English through March 3, 2019. Results Our search yielded 2872 studies, and after removal of duplicates, we screened 2319 abstracts and identified seven for inclusion. Study findings were grouped into three domains: ACP, symptomatology, and end-of-life care. Among the five cross-sectional studies, only 1%–28% of ACHD patients recalled participating in ACP discussions with their doctors but 69%–78% reported a strong interest and desire to participate in ACP. In one study, 46% (n = 67) of patients had elevated anxiety symptoms (Hospital Anxiety and Depression Scale [HADS-A] ≥ 8) and 11% (n = 15) had elevated depressive symptoms (HADS-A ≥ 8). ACHD patients who had a documented goals of care conversation before cardiac decompensation had a lower incidence of resuscitation and aggressive treatments at end of life (12% [n = 3] vs. 100% [n = 12], P Conclusion While few ACHD patients complete advance directives, our findings support that many ACHD patients recognize the value of initiating end-of-life and goals of care conversations early on in the course of illness. Future studies investigating communication and implementation strategies of ACP as well as the symptom experience of patients with ACHD are needed.
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- 2019
8. A Scoping Review of Palliative Care for Adults with Huntington's Disease: Current Practice and Future Directions
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Sara Martin, Hong-nei Wong, Thomas Carroll, and Maie El-Sourady
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Advance care planning ,Adult ,medicine.medical_specialty ,Terminal Care ,Palliative care ,business.industry ,Palliative Care ,Context (language use) ,General Medicine ,humanities ,Advance Care Planning ,Anesthesiology and Pain Medicine ,Hospice Care ,Huntington Disease ,medicine ,Anxiety ,Humans ,Apathy ,medicine.symptom ,Cognitive decline ,Psychiatry ,business ,Suicidal ideation ,End-of-life care ,General Nursing - Abstract
Context: Huntington's disease (HD) is a neurodegenerative disorder characterized by mid-life onset, cognitive decline, and behavioral disturbance. Objective: We conducted a review of the end-of-life (EOL) experience of HD patients and their families. Methods: We searched 5 electronic databases. Eligible studies were published in English and contained outcomes related to PC, end-of-life (EOL), advance directives (ADs), symptom management, or hospice use for HD adults. Results: We screened 1566 studies, assessed 244 studies, and included 27 studies. Symptom Prevalence: Decedent data showed greater likelihood of pneumonia, choking, nutritional deficiencies, and skin ulcers. HD patients in hospice experienced pain, anxiety, nausea, and dyspnea. Psychiatric symptoms included dysphoria, agitation, irritability, apathy, and anxiety. Psychosis is associated with worse cognition, function, and behavioral disturbance. Symptom Management: Electroconvulsive therapy (ECT) and venlafaxine improved depression. Suicidal ideation improved with talking, self-management, medication, and discussing EOL wishes. Tetrabenazine improved chorea. Experience as Illness Progressed: HD patients require home care within two years of diagnosis. Only one study reported use of palliative care services (4%). HD patients are admitted to the hospital late in disease course and are often discharged to long-term care facilities (LTCF). Advance Care Planning: Two studies created tools to navigate EOL decisions. Most HD patients had EOL wishes; only familiarity with HD predicted having EOL wishes. Few had ADs or discussed EOL wishes with their families. Clinicians drive EOL discussions. Views on physician-assisted death (PAD) and euthanasia varied widely. Conclusions: Research is needed to further assess the PC needs of HD patients and to provide care recommendations.
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- 2021
9. Teaming In Interdisciplinary Chronic Pain Management Interventions In Primary Care: A Systematic Review Protocol
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Hong-nei Wong, Sara J. Singer, Pallavi Prathivadi, Karleen F. Giannitrapani, Sophia Zupanc, Karl A. Lorenz, Natalie Connell, and Elizabeth M. Yano
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Protocol (science) ,medicine.medical_specialty ,business.industry ,Psychological intervention ,Chronic pain ,Medicine ,Primary care ,business ,medicine.disease ,Intensive care medicine - Abstract
BackgroundPatients with chronic cancer or non-cancer pain often struggle with physical, emotional, and psychological problems not easily addressed by a single clinician. Current pain management recommendations emphasize leveraging interdisciplinary teams. We aim to describe how we intend to identify key features of interdisciplinary team structures and processes associated with improved pain outcomes for patients experiencing chronic pain in primary care settings. Methods We will include randomized studies and systematic reviews of interventions involving teaming that address chronic or cancer-related pain. A systematic review of articles published in English and after 2009 in PubMed, EMBASE, CINAHL, and Cochrane Library will be conducted. The primary outcome will be a numeric, patient-reported pain score. Extracted data will include details about the team structures and processes used in the interdisciplinary interventions based in primary care. DiscussionThe intended systematic review will examine interventions that incorporate teamwork or teaming to manage chronic pain and will synthesize evidence as to which team structures and processes may help facilitate improved pain management, and thus improved pain outcomes. Results of this systematic review may help inform how to organize teams within primary care that will be most beneficial to chronic pain patients and highlight opportunities for future, high-quality randomized controlled trials exploring teaming models in primary care.Systematic review registration: PROSPERO #CRD42020191467
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- 2021
10. Distal Femur Replacement Versus Open Reduction and Internal Fixation for Treatment of Periprosthetic Distal Femur Fractures: A Systematic Review and Meta-Analysis
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Noelle L Van Rysselberghe, Malcolm R. DeBaun, Michael J. Gardner, Julius A. Bishop, Brett P. Salazar, L. Henry Goodnough, Harsh Wadhwa, and Hong-nei Wong
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Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Periprosthetic ,Rate ratio ,Fracture Fixation, Internal ,medicine ,Internal fixation ,Humans ,Orthopedics and Sports Medicine ,Femur ,Reduction (orthopedic surgery) ,Retrospective Studies ,business.industry ,General Medicine ,Surgery ,Open Fracture Reduction ,Treatment Outcome ,Sample size determination ,Meta-analysis ,Cohort ,Periprosthetic Fractures ,business ,Range of motion ,Femoral Fractures - Abstract
OBJECTIVE To compare complications and functional outcomes of treatment with primary distal femoral replacement (DFR) versus open reduction and internal fixation (ORIF). DATA SOURCES PubMed, Embase, and Cochrane databases were searched for English language studies up to May 19, 2020, identifying 913 studies. STUDY SELECTION Studies that assessed complications of periprosthetic distal femur fractures with primary DFR or ORIF were included. Studies with sample size ≤5, mean age
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- 2021
11. Sa1404: CHARACTERISTICS AND OUTCOMES OF ELDERLY HEPATOCELLULAR CARCINOMA PATIENTS FOLLOWING SURGICAL RESECTION: A META-ANALYSIS OF 44 STUDIES AND 9,778 PATIENTS
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Elizabeth M. Garcia, Eunice X. Tan, Sabrina X. Quek, Sanjna N. Nerurkar, Readon Teh, Margaret Teng, Andrew K. Tran, Michael H. Le, Ee Jin Yeo, Hong-nei Wong, Ramsey Cheung, and Daniel Huang
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Hepatology ,Gastroenterology - Published
- 2022
12. Protocol for a Systematic Review of the Effectiveness of Provider-targeted Interventions to Improve Opioid Prescribing in Primary Care
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Karleen F. Giannitrapani, Hong-nei Wong, Danielle Mazza, Louisa Picco, Natalie Connell, Pallavi Prathivadi, Karl A. Lorenz, and Christopher Barton
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Protocol (science) ,medicine.medical_specialty ,business.industry ,medicine ,Primary care ,Targeted interventions ,Intensive care medicine ,business ,Opioid prescribing - Abstract
Background: Improving primary care opioid prescribing is a public health priority in many western nations. Governments, policymakers and key stakeholders are intervening on multiple levels to address patient, prescriber and systems factors contributing to opioid over-prescription in primary care. Many opioid prescribing interventions specifically target primary care providers (PCPs); however, the overall effectiveness of these interventions is not known. Identifying effective components of PCP-targeted behaviour change interventions may help inform scalability and translation of prescribing interventions across countries and varying primary healthcare settings. The aim of this systematic review is to assess the effectiveness of provider-targeted interventions to improve opioid prescribing in primary care. This protocol reports the methods of the proposed narrative synthesis review that will be guided by the Theoretical Domains Framework (TDF). Methods: The study will follow Cochrane methods for conducting a narrative synthesis. Reporting is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocols. The review will conduct searches in PubMed, EMBASE, PsychInfo, CINAHL, and the Cochrane Library databases for studies published in the English language from 2010 onwards. Reference lists of accepted articles will be also screened for additional studies meeting inclusion. Any opioid prescribing behaviour will be measured as an outcome. Intervention components will be mapped to domains of the TDF. No geographic limits will be applied. All stages of screening and data extraction will involve a dual review with gold standard adjudication. The Cochrane Risk of Bias tool will be used to evaluate quality and risk. Discussion: This review is being conducted in strict adherence to Cochrane principles. The protocol was submitted for registration to Prospero prior to publication for transparency and to avoid duplication of research. Formal ethics approval is not required for this research. The findings of this review will inform the delivery and implementation of PCP targeted opioid prescribing interventions. Findings will be disseminated to a wide range of stakeholders involved in quality improvement, prescribing interventions, education and training; professional groups, policymakers, researchers and PCPs.Systematic review registration: Submitted to Prospero 22 December 2020; pending registration
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- 2021
13. A systematic review of communication about Complementary and Integrative Health (CIH) in global biomedical settings
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Hong-Nei Wong, Christopher J. Koenig, Carma L. Bylund, Evelyn Y. Ho, Easton Wollney, and Emily B. Peterson
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Complementary Therapies ,Integrative Medicine ,Future studies ,Operationalization ,International studies ,Operational definition ,030503 health policy & services ,Communication ,Applied psychology ,General Medicine ,03 medical and health sciences ,0302 clinical medicine ,Humans ,030212 general & internal medicine ,0305 other medical science ,Psychology ,Delivery of Health Care - Abstract
Objectives A systematic review to analyze communication rates of complementary and integrative health (CIH) and analyze how communication terms, such as “disclosure,” are measured and operationalized. Methods We searched seven databases for studies published between 2010 and 2018 with quantitative measurements of patients’ communication of CIH to a biomedical clinician. We analyzed communication terms used to describe patients reporting CIH usage. We also examined the conceptual and operational definitions of CIH provided and whether those terms were explicitly operationalized. We aggregated the percentage, rate, or ratio of CIH users that communicated about CIH with their clinicians by disease type and geographical region. Results 7882 studies were screened and 89 included in the review. Studies used a wide range of conceptual and operational definitions for CIH, as well as 23 different terms to report communication related to reporting CIH usage. Usage varied by disease type and geographical region. Conclusions Studies of CIH and CIH communication may measure different kinds of social and communicative phenomena, which makes comparison across international studies challenging. Practice Implications Future studies should employ standardized, replicable measures for defining CIH and for reporting CIH communication. Clinicians can incorporate questions about prior, current, and future CIH use during the medical visit.
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- 2021
14. Identification of BRCA1/2 founder mutations in Southern Chinese breast cancer patients using gene sequencing and high resolution DNA melting analysis.
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Ava Kwong, Enders Kai On Ng, Chris Lei Po Wong, Fian Bic Fai Law, Tommy Au, Hong Nei Wong, Allison W Kurian, Dee W West, James M Ford, and Edmond Siu Kwan Ma
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Medicine ,Science - Abstract
Ethnic variations in breast cancer epidemiology and genetics have necessitated investigation of the spectra of BRCA1 and BRCA2 mutations in different populations. Knowledge of BRCA mutations in Chinese populations is still largely unknown. We conducted a multi-center study to characterize the spectra of BRCA mutations in Chinese breast and ovarian cancer patients from Southern China.A total of 651 clinically high-risk breast and/or ovarian cancer patients were recruited from the Hong Kong Hereditary Breast Cancer Family Registry from 2007 to 2011. Comprehensive BRCA1 and BRCA2 mutation screening was performed using bi-directional sequencing of all coding exons of BRCA1 and BRCA2. Sequencing results were confirmed by in-house developed full high resolution DNA melting (HRM) analysis. Among the 451 probands analyzed, 69 (15.3%) deleterious BRCA mutations were identified, comprising 29 in BRCA1 and 40 in BRCA2. The four recurrent BRCA1 mutations (c.470_471delCT, c.3342_3345delAGAA, c.5406+1_5406+3delGTA and c.981_982delAT) accounted for 34.5% (10/29) of all BRCA1 mutations in this cohort. The four recurrent BRCA2 mutations (c.2808_2811delACAA, c.3109C>T, c.7436_7805del370 and c.9097_9098insA) accounted for 40% (16/40) of all BRCA2 mutations. Haplotype analysis was performed to confirm 1 BRCA1 and 3 BRCA2 mutations are putative founder mutations. Rapid HRM mutation screening for a panel of the founder mutations were developed and validated.In this study, our findings suggest that BRCA mutations account for a substantial proportion of hereditary breast/ovarian cancer in Southern Chinese population. Knowing the spectrum and frequency of the founder mutations in this population will assist in the development of a cost-effective rapid screening assay, which in turn facilitates genetic counseling and testing for the purpose of cancer risk assessment.
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- 2012
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15. Identifying Teaming in Chronic Pain Management Interventions in Primary Care: A Systematic Review
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Pallavi Prathivadi, Karleen F. Giannitrapani, Sophia Zupanc, Natalie Connell, Hong-nei Wong, and Karl A. Lorenz
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medicine.medical_specialty ,business.industry ,Psychological intervention ,medicine ,Chronic pain ,General Medicine ,Primary care ,Pain management ,Intensive care medicine ,business ,medicine.disease - Abstract
Background: Current pain management recommendations emphasize leveraging interdisciplinary care models, which rely on communication, coordination, and collaboration (i.e., teaming) among multiple p...
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- 2021
16. The Impact of Specialty Palliative Care in Pediatric Oncology: A Systematic Review
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Kristina Zalud, Meaghann S. Weaver, Justin N. Baker, Elizabeth Byers, Jacob Applegarth, Leila Hamzi DeWitt, Christina Ullrich, Brandon Shih, Sarah E. Stevens, Erica C. Kaye, Hong-nei Wong, and Joe Lukowski
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Advance care planning ,medicine.medical_specialty ,Palliative care ,Specialty ,Context (language use) ,CINAHL ,Article ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Neoplasms ,Intensive care ,Humans ,Medicine ,030212 general & internal medicine ,Child ,General Nursing ,Terminal Care ,business.industry ,Palliative Care ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Family medicine ,Hospice and Palliative Care Nursing ,Quality of Life ,Neurology (clinical) ,business ,Psychosocial - Abstract
Context Children with cancer and their families have complex needs related to symptoms, decision-making, care planning, and psychosocial impact extending across the illness trajectory, which for some includes end of life. Whether specialty pediatric palliative care (SPPC) is associated with improved outcomes for children with cancer and their families is unknown. Objective We conducted a systematic review following PRISMA guidelines to investigate outcomes associated with SPPC in pediatric oncology with a focus on intervention delivery, collaboration, and alignment with National Quality Forum domains. Methods We searched PubMed, Embase, Scopus, Web of Science, and CINAHL databases from inception until April 2020 and reviewed references manually. Eligible articles were published in English, involved pediatric patients aged 0-18 years with cancer, and contained original data regarding patient and family illness and end-of-life experiences, including symptom management, communication, decision-making, quality of life, satisfaction, and healthcare utilization. Results We screened 6682 article abstracts and 82 full-text articles; 32 studies met inclusion criteria, representing 15,635 unique children with cancer and 342 parents. Generally, children with cancer who received SPPC had improved symptom burden, pain control, and quality of life with decreased intensive procedures, increased completion of advance care planning and resuscitation status documentation, and fewer end-of-life intensive care stays with higher likelihood of dying at home. Family impact included satisfaction with SPPC and perception of improved communication. Conclusion SPPC may improve illness experiences for children with cancer and their families. Multisite studies utilizing comparative effectiveness approaches and validated metrics may support further advancement of the field.
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- 2021
17. Interventions Incorporating Interdisciplinary Teaming to Improve Chronic Pain Management in Primary Care: A Systematic Review
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Karleen F. Giannitrapani, Natalie Connell, Pallavi Prathivadi, Sophia Zupanc, Hong-nei Wong, and Karl A. Lorenz
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medicine.medical_specialty ,Teamwork ,business.industry ,media_common.quotation_subject ,education ,Psychological intervention ,Chronic pain ,CINAHL ,Primary care ,Cochrane Library ,medicine.disease ,Anesthesiology and Pain Medicine ,Neurology ,Intervention (counseling) ,Family medicine ,Medicine ,Neurology (clinical) ,business ,Veterans Affairs ,media_common - Abstract
Current chronic pain management recommendations emphasize leveraging interdisciplinary care models, which rely on communication, coordination, and collaboration among multiple providers. We aimed to identify key features of interdisciplinary teamwork and teaming processes that facilitate improved pain outcomes for patients experiencing chronic pain in primary care settings. We searched PubMed, EMBASE, CINAHL, and the Cochrane Library for English language, randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (i.e. BPI total pain), include primary care as an intervention setting, and involve interactions between at least two providers and the patient over time. We assessed study quality with the Cochrane Risk of Bias tool. We qualitatively synthesized findings on intervention characteristics related to teamwork and teaming processes and patient pain outcomes. PROSPERO Registration: CRD42020191467. We included 13 randomized studies with 14 total interventions in our review, of which 7 reported one or more significantly improved pain outcome compared to controls over 6 to 12 months of observation. Most studies involved multiple primary care practices in the USA or Canada. Five studies were evaluated either within the Indianapolis Veterans Affairs Medical Center (VAMC) or the Portland VAMC. Other studies took place in primary care centers in Spain, Finland, the UK, and the Netherlands. Interventions with positive pain outcomes often described regularly scheduled patient contact, but there were few identified similarities about the communication, coordination, and collaboration processes among clinical intervention members. Care management and patient follow-up schedules were identified as key characteristics of teamwork or teaming in the interventions associated with improved pain outcomes. Despite widespread emphasis on interdisciplinary teams for pain management, high quality evidence about relevant team structures and teamwork and teaming processes remains limited. Care management and patient follow-up characterized primary care-based interventions involving teaming associated with improved pain outcomes.
- Published
- 2021
18. End-of-Life Care, Palliative Care Consultation, and Palliative Care Referral in the Emergency Department: A Systematic Review
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Jennifer G. Wilson, Erica Chimelski, Diana P. English, Savithri Nageswaran, Rebecca Aslakson, Corita R. Grudzen, Elizabeth Dzeng, Erica C. Kaye, Thomas Carroll, Christina Ullrich, James Powers, Joseph Rotella, Krista L. Harrison, Thomas W. LeBlanc, Theresa Vickey, Shelly S. Lo, Clark G. Owyang, Rebecca A. Aslakson, Hong-nei Wong, Kelly McKenna, and Katherine Ast
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medicine.medical_specialty ,Palliative care ,Referral ,Psychological intervention ,Context (language use) ,CINAHL ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Medicine ,Humans ,030212 general & internal medicine ,Referral and Consultation ,General Nursing ,Aged ,Randomized Controlled Trials as Topic ,Terminal Care ,business.industry ,Palliative Care ,Emergency department ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Family medicine ,Quality of Life ,Neurology (clinical) ,business ,Emergency Service, Hospital ,End-of-life care - Abstract
There is growing interest in providing palliative care (PC) in the emergency department (ED), but relatively little is known about the efficacy of ED-based PC interventions. A 2016 systematic review on this topic found no evidence that ED-based PC interventions affect patient outcomes or health care utilization, but new research has emerged since the publication of that review.This systematic review provides a concise summary of current literature addressing the impact of ED-based PC interventions on patient-reported or family reported outcomes, health care utilization, and survival.We searched PubMed, Embase, Web of Science, Scopus, and the Cumulative Index to Nursing and Allied Health Literature from inception until September 1, 2018 and reviewed references. Eligible articles evaluated the effects of PC interventions in the ED on patient-reported or family reported outcomes, health care utilization, or survival.We screened 3091 abstracts and 98 full-text articles with 13 articles selected for final inclusion. Two articles reported the results of a single randomized controlled trial, whereas the remaining 11 studies were descriptive or quasi-experimental cohort studies. More than half of the included articles were published after the previous systematic review on this topic. Populations studied included older adults, patients with advanced malignancy, and ED patients screening positive for unmet PC needs. Most interventions involved referral to hospice or PC or PC provided directly in the ED. Compared with usual care, ED-PC interventions improved quality of life, although this improvement was not observed when comparing ED-PC to inpatient PC. ED-PC interventions expedited PC consultation; most studies reported a concomitant reduction in hospital length of stay and increase in hospice utilization, but some data were conflicting. Short-term mortality rates were high across all studies, but ED-PC interventions did not decrease survival time compared with usual care.Existing data support that PC in the ED is feasible, may improve quality of life, and does not appear to affect survival.
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- 2019
19. Palliative Care for Adults with Cystic Fibrosis: A Systematic Review
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Meghan Marmor, Elika Rad, Rebecca A. Aslakson, Alicia A. Mirza, Hong-nei Wong, and Andrea Jonas
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medicine.medical_specialty ,Palliative care ,business.industry ,medicine ,Intensive care medicine ,medicine.disease ,business ,Cystic fibrosis - Published
- 2019
20. Efficacy and toxicity of particle radiotherapy in WHO grade II and grade III meningiomas: a systematic review
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Antonio Meola, Adela Wu, Steven D. Chang, Hong-Nei Wong, and Michael C. Jin
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Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Cost-Benefit Analysis ,Population ,030218 nuclear medicine & medical imaging ,Meningioma ,03 medical and health sciences ,Necrosis ,0302 clinical medicine ,Seizures ,Internal medicine ,Cations ,Meningeal Neoplasms ,Proton Therapy ,Medicine ,Humans ,Adverse effect ,education ,Radiation Injuries ,Retrospective Studies ,education.field_of_study ,Photons ,Particle therapy ,business.industry ,Brain ,Retrospective cohort study ,Alopecia ,General Medicine ,medicine.disease ,Prognosis ,Combined Modality Therapy ,Carbon ,Radiation therapy ,Toxicity ,Surgery ,Radiotherapy, Adjuvant ,Neurology (clinical) ,Cranial Irradiation ,business ,Adjuvant ,030217 neurology & neurosurgery ,Craniotomy ,Follow-Up Studies - Abstract
OBJECTIVEAdjuvant radiotherapy has become a common addition to the management of high-grade meningiomas, as immediate treatment with radiation following resection has been associated with significantly improved outcomes. Recent investigations into particle therapy have expanded into the management of high-risk meningiomas. Here, the authors systematically review studies on the efficacy and utility of particle-based radiotherapy in the management of high-grade meningioma.METHODSA literature search was developed by first defining the population, intervention, comparison, outcomes, and study design (PICOS). A search strategy was designed for each of three electronic databases: PubMed, Embase, and Scopus. Data extraction was conducted in accordance with the PRISMA guidelines. Outcomes of interest included local disease control, overall survival, and toxicity, which were compared with historical data on photon-based therapies.RESULTSEleven retrospective studies including 240 patients with atypical (WHO grade II) and anaplastic (WHO grade III) meningioma undergoing particle radiation therapy were identified. Five of the 11 studies included in this systematic review focused specifically on WHO grade II and III meningiomas; the others also included WHO grade I meningioma. Across all of the studies, the median follow-up ranged from 6 to 145 months. Local control rates for high-grade meningiomas ranged from 46.7% to 86% by the last follow-up or at 5 years. Overall survival rates ranged from 0% to 100% with better prognoses for atypical than for malignant meningiomas. Radiation necrosis was the most common adverse effect of treatment, occurring in 3.9% of specified cases.CONCLUSIONSDespite the lack of randomized prospective trials, this review of existing retrospective studies suggests that particle therapy, whether an adjuvant or a stand-alone treatment, confers survival benefit with a relatively low risk for severe treatment-derived toxicity compared to standard photon-based therapy. However, additional controlled studies are needed.
- Published
- 2019
21. Patient-Reported Outcomes for Cancer Patients Receiving Checkpoint Inhibitors: Opportunities for Palliative Care-A Systematic Review
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Krista L. Harrison, Christina Ullrich, Katherine Ast, Rebecca Aslakson, Evan T. Hall, James Dickerson, James Powers, Susan Wong, Surbhi Singhal, Erica C. Kaye, Hong-nei Wong, Victoria Powell, Elizabeth Dzeng, Thomas W. LeBlanc, Theresa Vickey, Joseph Rotella, Savithri Nageswaran, Erica Frechman, Rebecca Goett, Ashwin A. Kotwal, Kelly McKenna, Rebecca A. Aslakson, Lidia Schapira, Shelly S. Lo, Thomas Carroll, and Brooke Peterson Gabster
- Subjects
Oncology ,medicine.medical_specialty ,Palliative care ,Ipilimumab ,Context (language use) ,Pembrolizumab ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Antineoplastic Agents, Immunological ,Randomized controlled trial ,law ,Atezolizumab ,Internal medicine ,Neoplasms ,medicine ,Humans ,030212 general & internal medicine ,Patient Reported Outcome Measures ,General Nursing ,business.industry ,Palliative Care ,humanities ,Clinical trial ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Quality of Life ,Neurology (clinical) ,Nivolumab ,business ,medicine.drug - Abstract
Context Immune checkpoint inhibitors (ICIs) are increasingly used to treat a variety of cancers, but comparatively little is known about patient-reported outcomes (PROs) and health-related quality of life (HRQoL) among patients receiving these novel therapies. Objectives We performed a systematic review to examine PROs and HRQoL among cancer patients receiving ICIs as compared to other anticancer therapies. Methods We systematically searched PubMed, CINAHL, Embase, Web of Science, and Scopus, using search terms representing ICIs, PROs, and HRQoL on August 10, 2018. Eligible articles were required to involve cancer patients treated with ICIs and to report PROs and/or HRQoL data. Results We screened 1453 references and included 15 publications representing 15 randomized controlled trials in our analysis. Studies included several cancer types (melanoma, lung cancer, genitourinary cancer, and head/neck cancer), used four different ICIs (nivolumab, pembrolizumab, atezolizumab, and ipilimumab), and compared ICIs to a wide range of therapies (chemotherapy, targeted therapies, other immunotherapy strategies, and placebo). Studies used a total of seven different PROs to measure HRQOL, most commonly the European Organisation for the Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30) (n = 12, 80%). PRO data were reported in a variety of formats and at a variety of time points throughout treatment, which made direct comparison challenging. Some trials (n = 11, 73%) reported PROs on specific symptoms. In general, patients receiving ICIs had similar-to-improved HRQoL and experiences when compared to other therapies. Conclusion Despite the broad clinical trials experience of ICI therapies across cancer types, relatively few randomized studies reported PROs and patient HRQoL data. Available data suggest that ICIs are well tolerated in terms of HRQoL compared to other anticancer therapies although the conclusions are limited by the heterogeneity of trial designs and outcomes. Currently used instruments may fail to capture important symptomatology unique to ICIs, underscoring a need for PROs designed specifically for ICIs.
- Published
- 2019
22. Opportunities for Palliative Care in Patients with Burn Injury—A Systematic Review (GP718)
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Allyson Cook, Jessica Langston, Joshua Jaramillo, Kristin Edwards, Hong-Nei Wong, and Rebecca Aslakson
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Anesthesiology and Pain Medicine ,Neurology (clinical) ,General Nursing - Published
- 2020
23. Opportunities for Palliative Care in Patients with Burn Injury—A Systematic Review (FR407C)
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Allyson Cook, Jessica Langston, Joshua Jaramillo, Kristin Edwards, Hong-Nei Wong, and Rebecca Aslakson
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Anesthesiology and Pain Medicine ,Neurology (clinical) ,General Nursing - Published
- 2020
24. Palliative Care in the Emergency Department: An Updated Systematic Review (S726)
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Jennifer C. H. Wilson, Hong-nei Wong, Erica Chimelski, Clark G. Owyang, Diana English, and Rebecca A. Aslakson
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Anesthesiology and Pain Medicine ,Palliative care ,business.industry ,medicine ,Neurology (clinical) ,Medical emergency ,Emergency department ,medicine.disease ,business ,General Nursing - Published
- 2020
25. Opportunities to Improve Utilization of Palliative Care Among Adults With Cystic Fibrosis: A Systematic Review
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Katherine Ast, James Powers, Elika Rad, Meghan Marmor, Hong-nei Wong, Alicia A. Mirza, Kelly McKenna, Savithri Nageswaran, Thomas W. LeBlanc, Joseph Rotella, Shelly S. Lo, Thomas Carroll, Theresa Vickey, Rebecca A. Aslakson, Andrea Jonas, Rebecca Aslakson, Christina Ullrich, Erica C. Kaye, Krista L. Harrison, and Elizabeth Dzeng
- Subjects
Adult ,Advance care planning ,medicine.medical_specialty ,Palliative care ,Cystic Fibrosis ,Context (language use) ,CINAHL ,law.invention ,Advance Care Planning ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,law ,Humans ,Medicine ,030212 general & internal medicine ,General Nursing ,Depression (differential diagnoses) ,Terminal Care ,business.industry ,Palliative Care ,Intensive care unit ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Emergency medicine ,Anxiety ,Neurology (clinical) ,medicine.symptom ,Advance Directives ,business - Abstract
Context Individuals with cystic fibrosis (CF) frequently survive into adulthood, and many have multifaceted symptoms that impair quality of life. Objective We conducted a systematic review to investigate opportunities to improve utilization of palliative care among adults with CF. Methods We searched PubMed, Embase, Scopus, Web of Science, and CINAHL databases from inception until September 27, 2018, and reviewed references manually. Eligible articles were published in English, involved adults aged 18 years and older with CF, and contained original data regarding patient outcomes related to presence of advance care planning (ACP), symptom experience, and preferred and/or received end-of-life (EOL) care. Results We screened 652 article abstracts and 32 full-text articles; 12 studies met inclusion criteria. All studies were published between 2000 and 2018. Pertinent findings include that although 43% to 65% of adults with CF had contemplated completing ACP, the majority only completed ACP during their terminal hospital admission. Patients also reported high prevalence of untreated symptoms, with adequate symptom control reported in 45% among those with dyspnea, 22% among those with pain, and 51% among those with anxiety and/or depression. Prevalence of in-hospital death ranged from 62% to 100%, with a third dying in the intensive care unit. The majority received antibiotics and preventative treatments during their terminal hospitalization. Finally, treatment from a palliative care specialist was associated with a higher prevalence of patient completion of advanced directives, decreased likelihood of death in intensive care unit, and decreased use of mechanical ventilation at EOL. Conclusion Adults with CF often have untreated symptoms, and many opportunities exist for palliative care specialists to improve ACP completion and quality of EOL care.
- Published
- 2019
26. Prevalence of Bisexual Behaviors Among Men Who Have Sex With Men (MSM) in China and Associations Between Condom Use in MSM and Heterosexual Behaviors
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Xiaoyou Su, Yun Zhang, Joseph Lau, Ning Wang, Hong Nei Wong, Feng Cheng, Manhong Jia, Hi Yi Tsui, and Ming Wang
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Adult ,Male ,Microbiology (medical) ,Sexually transmitted disease ,China ,medicine.medical_specialty ,Adolescent ,Sexual Behavior ,Voluntary counseling and testing ,Population ,Dermatology ,Men who have sex with men ,law.invention ,Condoms ,Interviews as Topic ,Acquired immunodeficiency syndrome (AIDS) ,Condom ,law ,Prevalence ,medicine ,Humans ,Homosexuality, Male ,Heterosexuality ,education ,Aged ,Gynecology ,education.field_of_study ,Marital Status ,business.industry ,Public Health, Environmental and Occupational Health ,virus diseases ,Middle Aged ,medicine.disease ,Sexual Partners ,Infectious Diseases ,Multivariate Analysis ,Bisexuality ,Marital status ,Female ,business ,Demography - Abstract
This study investigated the prevalence of bisexual behaviors and marital status among Chinese men who have sex with men (MSM) and the associations between MSMs condom use and their heterosexual behaviors. Eight hundred ninety-six adult males in Yunnan Province China who reported to ever have engaged in MSM behaviors were interviewed. Data were acquired through the China-UK HIV/AIDS Prevention and Care Project from 2003 to 2006. Of all respondents one-third had ever been married 59% had ever engaged in bisexual behaviors and 31% had done so in the past 6 months. High prevalence of inconsistent condom use was reported in heterosexual behaviors (71.9%) as well as with those who had engaged in MSM sexual behaviors in the past 6 months (30.8% with commercial sex workers and 54.7% with noncommercial sex partners) in the past 6 months. Those who did not use condoms with MSM partners were also more likely than others to not use condoms with their female sex partners (FSP). Those who had voluntary counseling and testing services were more likely than others to have used a condom in the last episode of sex with their FSP (multivariate odds ratio = 1.66). The clustering of unprotected sexual behaviors with male and FSP among bisexual MSM is revealed. The bridging effects of the risk for human immunodeficiency virus transmission from the MSM population to the female population are evident. (authors)
- Published
- 2008
27. Outbreaks of Short-Incubation Ocular and Respiratory Illness Following Exposure to Indoor Swimming Pools
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James C. Kile, Neely Kazerouni, Michael J. Beach, Benjamin C. Blount, Anna Bowen, Alicia M. Fry, Connie Austin, Charles Otto, and Hong-Nei Wong
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Adult ,Male ,trihalomethanes ,Adolescent ,Eye Diseases ,Health, Toxicology and Mutagenesis ,Disease Outbreaks ,Toxicology ,Environmental Medicine ,Cohort Studies ,Indoor air quality ,Swimming Pools ,Risk Factors ,Medicine ,Humans ,chloramines ,Child ,Incubation ,Respiratory illness ,indoor air pollution ,business.industry ,Research ,Public Health, Environmental and Occupational Health ,Outbreak ,cyanuric acid ,Environmental exposure ,Environmental Exposure ,Middle Aged ,Respiration Disorders ,Key factors ,Child, Preschool ,Water chemistry ,Female ,Water quality ,business ,Water Microbiology ,Water Pollutants, Chemical - Abstract
Swimming is a popular activity and sport among people of all ages. Outbreaks of illness caused by infectious organisms associated with swimming pool use are reported with regularity (Yoder et al. 2004). Proper pool maintenance, especially appropriate water disinfection procedures, and monitoring of pool water quality are key factors in the prevention of infectious diseases associated with use of swimming pools (Nemery et al. 2002). However, although chlorine kills many potential pathogens, it can also react with human wastes such as perspiration, urine, skin particles, and lotion in pool water to form chloramines and trihalomethanes. Chloramines may remain in the pool water or volatilize into the air, where they create the pungent smell and acutely irritating properties of air above swimming pools (Aggazzotti et al. 1990; Goyder 2000; Hery et al. 1995). Chloramines have been suspected as a cause of occupational asthma and pneumonitis among lifeguards (Massin et al. 1998; Nemery et al. 2002; Thickett et al. 2002). Also, an outbreak associated with a swimming pool and attributed to chloramine exposure led to cough or ocular symptoms in > 70% of pool patrons interviewed (Goyder 2000). Chloramine levels in pool water depend on chlorine and nitrogen concentrations, pool pH, temperature, and water circulation patterns (Hery et al. 1995; Massin et al. 1998; Nemery et al. 2002). However, chloramine levels in the air above swimming pools are also influenced by ventilation and the pool water chemistry (Hery et al. 1995; Massin et al. 1998). Indoor pools are likely to be less well ventilated than outdoor pools, so the risks associated with chloramine exposure are likely to differ between indoor and outdoor swimming pools. We investigated two outbreaks of acute ocular and respiratory symptoms associated with exposure to indoor swimming pools. In January 2004, the Illinois Department of Public Health was notified of two outbreaks of acute ocular and respiratory symptoms associated with indoor swimming pool exposure among patrons of two hotels located in noncontiguous central Illinois counties. We investigated these outbreaks during January 2004 to describe illness syndromes, determine risk factors for illness, and develop recommendations to prevent future incidents.
- Published
- 2006
28. Age-prevalence of Otarine Herpesvirus-1, a tumor-associated virus, and possibility of its sexual transmission in California sea lions
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Rebecca S. Duerr, Denise J. Greig, Gately L. Ross, Hong Nei Wong, Frances M. D. Gulland, Linda J. Lowenstine, Sharon R. Melin, Regina K. Vittore, Robert L. DeLong, Judith A. St Leger, Elizabeth L. Buckles, and Jeffrey L Stott
- Subjects
Sexually transmitted disease ,Male ,Sexual transmission ,Urogenital System ,Viremia ,Biology ,medicine.disease_cause ,Microbiology ,Virus ,Herpesviridae ,California ,law.invention ,Age Distribution ,law ,medicine ,Prevalence ,Juvenile ,Animals ,Polymerase chain reaction ,General Veterinary ,General Medicine ,Herpesviridae Infections ,Sexually Transmitted Diseases, Viral ,medicine.disease ,Sea Lions ,Real-time polymerase chain reaction ,Immunology ,Leukocytes, Mononuclear ,Pharynx ,Female - Abstract
Otarine Herpesvirus-1 (OtHV-1) is a gammaherpesvirus routinely detected in urogenital tumor tissues of adult sea lions dying during rehabilitation, To investigate the epidemiology of this virus and guide the development of a mathematical model of its role in the multifactorial etiology of cancer in California sea lions, polymerase chain reaction (PCR) amplification of an OtHV-1 specific fragment of the DNA polymerase gene was used to look for evidence of OtHV-1 infection in urogenital and pharyngeal swabs and peripheral blood mononuclear cells (PBMC) of sea lions of different ages. Samples were also examined from pregnant females and their late term in utero or aborted fetuses to investigate potential for vertical transmission. Prevalence of infection in 72 adult females was 22%, whereas it was 46% in 52 adult males, and was significantly lower in 120 juvenile animals (6%). OtHV-1 DNA was most often detected in the lower reproductive tract of the adult animals, especially the males, and rarely in the pharynx or urogenital tract of juvenile animals. These data suggest sexual transmission may an important route of transmission. Additional studies are required to confirm this mode of transmission. Additionally, the virus was detected in a single prematurely born pup, suggesting the possibility of perinatal transmission. No indication of a PBMC associated viremia was evident in adults using standard PCR or in juveniles using standard and real time PCR.
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- 2006
29. Identification of BRCA1/2 Founder Mutations in Southern Chinese Breast Cancer Patients Using Gene Sequencing and High Resolution DNA Melting Analysis.
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Kwong, Ava, Kai On Ng, Enders, Lei Po Wong, Chris, Fai Law, Fian Bic, Au, Tommy, Hong Nei Wong, Kurian, Allison W., West, Dee W., Ford, James M., Siu Kwan Ma, Edmond, and Toland, Amanda Ewart
- Subjects
GENETIC mutation ,BREAST cancer research ,OVARIAN cancer ,EXONS (Genetics) ,GENETIC counseling - Abstract
Background: Ethnic variations in breast cancer epidemiology and genetics have necessitated investigation of the spectra of BRCA1 and BRCA2 mutations in different populations. Knowledge of BRCA mutations in Chinese populations is still largely unknown. We conducted a multi-center study to characterize the spectra of BRCA mutations in Chinese breast and ovarian cancer patients from Southern China. Methodology/Principal Findings: A total of 651 clinically high-risk breast and/or ovarian cancer patients were recruited from the Hong Kong Hereditary Breast Cancer Family Registry from 2007 to 2011. Comprehensive BRCA1 and BRCA2 mutation screening was performed using bi-directional sequencing of all coding exons of BRCA1 and BRCA2. Sequencing results were confirmed by in-house developed full high resolution DNA melting (HRM) analysis. Among the 451 probands analyzed, 69 (15.3%) deleterious BRCA mutations were identified, comprising 29 in BRCA1 and 40 in BRCA2. The four recurrent BRCA1 mutations (c.470_471delCT, c.3342_3345delAGAA, c.5406+1_5406+3delGTA and c.981_982delAT) accounted for 34.5% (10/29) of all BRCA1 mutations in this cohort. The four recurrent BRCA2 mutations (c.2808_2811delACAA, c.3109C>T, c.7436_7805del370 and c.9097_9098insA) accounted for 40% (16/40) of all BRCA2 mutations. Haplotype analysis was performed to confirm 1 BRCA1 and 3 BRCA2 mutations are putative founder mutations. Rapid HRM mutation screening for a panel of the founder mutations were developed and validated. Conclusion: In this study, our findings suggest that BRCA mutations account for a substantial proportion of hereditary breast/ovarian cancer in Southern Chinese population. Knowing the spectrum and frequency of the founder mutations in this population will assist in the development of a cost-effective rapid screening assay, which in turn facilitates genetic counseling and testing for the purpose of cancer risk assessment. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
30. Prevalence of Bisexual Behaviors Among Men Who Have Sex With Men (MSM) in China and Associations Between Condom Use in MSM and Heterosexual Behaviors.
- Author
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Lau, Joseph T. F., Ming Wang, Hong Nei Wong, Hi Yi Tsui, Manhong Jia, Feng Cheng, Yun Zhang, Xiaoyou Su, and Ning Wang
- Published
- 2008
- Full Text
- View/download PDF
31. Outbreaks of Short-Incubation Ocular and Respiratory Illness Following Exposure to Indoor Swimming Pools.
- Author
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Bowen, Anna B., Kile, James C., Otto, Charles, Kazerouni, Neely, Austin, Connie, Blount, Benjamin C., Hong-Nei Wong, Beach, Michael J., and Fry, Alicia M.
- Subjects
CHLORINATION ,SWIMMING pools ,HOSPITALITY industry ,RESPIRATORY diseases ,VENTILATION ,PATHOGENIC microorganisms ,CHLORAMINES ,EYE diseases - Abstract
OBJECTIVES: Chlorination destroys pathogens in swimming pool water, but by-products of chlorination can cause human illness. We investigated outbreaks of ocular and respiratory symptoms associated with chlorinated indoor swimming pools at two hotels. MEASUREMENTS: We interviewed registered guests and companions who stayed at hotels X and Y within 2 days of outbreak onset. We performed bivariate and stratified analyses, calculated relative risks (RR), and conducted environmental investigations of indoor pool areas. RESULTS: Of 77 guests at hotel X, 47 (61%) completed questionnaires. Among persons exposed to the indoor pool area, 22 (71%) of 31 developed ocular symptoms [RR = 24; 95% confidence interval (CI), 1.5-370], and 14 (45%) developed respiratory symptoms (RR = 6.8; 95% CI, 1.0-47) with a median duration of 10 hr (0.25-24 hr). We interviewed 30 (39%) of 77 registered persons and 59 unregistered companions at hotel Y. Among persons exposed to the indoor pool area, 41 (59%) of 69 developed ocular symptoms (RR = 24; 95% CI, 1.5-370), and 28 (41%) developed respiratory symptoms (RR = 17; 95% CI, 1.1-260) with a median duration of 2.5 hr (2 min-14 days). Four persons sought medical care. During the outbreak, the hotel X's ventilation system malfunctioned. Appropriate water and air samples were not available for laboratory analysis. CONCLUSIONS AND RELEVANCE TO PROFESSIONAL PRACTICE: Indoor pool areas were associated with illness in these outbreaks. A large proportion of bathers were affected; symptoms were consistent with chloramine exposure and were sometimes severe. Improved staff training, pool maintenance, and pool area ventilation could prevent future outbreaks. [ABSTRACT FROM AUTHOR]
- Published
- 2007
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32. Identifying Teaming in Chronic Pain Management Interventions in Primary Care: A Systematic Review.
- Author
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Giannitrapani, Karleen F., Connell, Natalie, Prathivadi, Pallavi, Zupanc, Sophia, Hong-Nei Wong, and Lorenz, Karl
- Abstract
Background: Current pain management recommendations emphasize leveraging interdisciplinary care models, which rely on communication, coordination, and collaboration (i.e., teaming) among multiple providers. We aimed to identify key features of interdisciplinary teaming structures and processes that facilitate improved pain outcomes for patients experiencing chronic pain in primary care settings. Methods: We searched PubMed, EMBASE, CINAHL, and the Cochrane Library for randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (i.e., BPI total pain), include primary care as an intervention setting, and demonstrate sufficient evidence of teaming (i.e., ongoing collaboration, coordination, or communication processes among providers and with patients). We assessed study quality with the Cochrane Risk of Bias tool. We qualitatively synthesized intervention characteristics related to teaming processes and categorized findings by positive or negative patient-reported pain outcomes. Results: We included 13 randomized studies with 14 total interventions in our review, of which 7 reported one or more significantly improved pain outcome compared to controls over 6 to 12 months of observation. No included studies had a high risk of bias. Interventions with positive pain outcomes often described regularly scheduled patient contact, but there were few identified similarities about the communication, coordination, and collaboration processes among intervention providers. Care management and patient follow-up schedules were identified as key characteristics of teaming in the interventions associated with improved pain outcomes. Discussion: Despite widespread emphasis on interdisciplinary teams for pain management, high quality evidence about relevant teaming structures and processes remains limited. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
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