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Item Decision Fatigue in Hospital Settings: A Scoping Review(Wiley, 2024-11-11) Perry , Kelsey; Jones , Sarah; Stumpff, Julia C.; Kruer, Rachel; Czosnowski, Lauren; Kashiwagi, Deanne; Kara, AreebaBACKGROUND: ‘Decision Fatigue’ (DF) describes the impaired ability to make decisions because of repeated acts of decision-making. We conducted a scoping review to describe DF in inpatient settings. METHODS: To be included, studies should have explored a clinical decision, included a mechanism to account for the order of decision making, published in English in or after the year 2000. Six data bases were searched. Retrieved citations were screened and retained studies were reviewed against inclusion criteria. References of included studies were manually searched, and forward citation searches were conducted to capture relevant sources. RESULTS: The search retrieved 12,781 citations of which 41 were retained following screening. Following review, sixteen studies met inclusion criteria. Half were conference abstracts and no studies examined hospitalists. Emergency medicine and intensive care settings were the most frequently studied clinical environments (n=13, 81%). All studies were observational. The most frequently examined decisions were about resource utilization (n=8, 50%), however only half of these examined downstream clinical outcomes. Decision quality against prespecified standards was examined in four (25%) studies. Work environment and patient attributes were often described but not consistently accounted for in analyses. Clinician attributes were described in four (25%) investigations. Findings were inconsistent: both supporting and refuting DF’s role in the outcome studied. CONCLUSIONS: The role of clinician, patient and work environment attributes in mediating DF is understudied. Similarly, the contexts surrounding the decision under study require further explication and when assessing resource use and decision quality, adjudication should be made against prespecified standards.Item Impact of positive cytology in uterine serous carcinoma: A reassessment(Elsevier, 2021-07-12) Corey, Logan; Fucinari, Juliana; Elshaikh, Mohamed; Schultz, Daniel; Musallam, Rami; Zaiem, Feras; Daaboul, Fayez; Fehmi, Omar; Dyson, Greg; Ruterbusch, Julie; Morris, Robert; Cote, Michelle L.; Ali-Fehmi, Rouba; Bandyopadhyay, Sudeshna; Medicine, School of MedicineObjectives: The aim of this study was to evaluate the prognostic value of peritoneal cytology status among other clinicopathological parameters in uterine serous carcinoma (USC). Methods: A retrospective study of 148 patients diagnosed with uterine serous carcinoma from 1997 to 2016 at two academic medical centers in the Detroit metropolitan area was done. A central gynecologic pathologist reviewed all available slides and confirmed the histologic diagnosis of each case of USC. We assessed the prognostic impact of various clinicopathological parameters on overall survival (OS) and endometrial cancer-specific survival (ECSS). Those parameters included race, body mass index (BMI), stage at diagnosis, tumor size, lymphovascular invasion (LVSI), peritoneal cytology status, receipt of adjuvant treatment, and comorbidity count using the Charlson Comorbidity Index (CCI). We used Cox proportional hazards models and 95% confidence intervals for statistical analysis. Results: Positive peritoneal cytology had a statistically significant effect on OS (HR: 2.09, 95% CI: [1.19, 3.68]) and on ECSS (HR: 2.02, 95% CI: [1.06 - 3.82]). LVSI had a statistically significant effect on both OS (HR: 2.27, 95% CI: [1.14, 4.53]) and ECSS (HR: 3.45, 95% CI: [1.49, 7.99]). Black or African American (AA) race was also found to have a significant effect on both OS (HR: 1.92, 95% CI: [1.07, 3.47]) and ECSS (HR: 2.01, 95% CI: [1.02, 3.98]). Other factors including BMI and tumor size > 1 cm did not show a statistically significant impact on OS or ECSS. Conclusions: Peritoneal washings with positive cytology and LVSI are important prognostic tools that may have a significant impact on overall survival in USC and can be used as independent negative prognosticators to help guide adjuvant treatment.Item Uptake of Co-testing with HPV and Cytology for Cervical Screening: A population-based evaluation in the United States(Elsevier, 2021) Cuzick, Jack; Du, Ruofei; Adcock, Rachael; Kinney, Walter; Joste, Nancy; McDonald, Ruth M.; English, Kevin; Torres, Salina M.; Saslow, Debbie; Wheeler, Cosette M.; New Mexico HPV Pap Registry Steering Committee; Medicine, School of MedicineObjectives: Human papillomavirus (HPV) testing for cervical screening has been shown to increase the yield of precancerous disease and reduce the incidence of cervical cancer more than cytology alone. Here we document the state-wide uptake of co-testing with HPV and cytology in women aged 30-64 years as recommended by national and international bodies. Methods: Registry-based study of all screening cytology and HPV tests in New Mexico from 2008 to 2019 among women aged 21-64 years, with a focus on cytology negative tests to distinguish co-testing from reflex HPV testing to triage equivocal or mildly abnormal cytology. Results: A total of 1,704,055 cervical screening tests from 681,440 women aged 21-64 years in the state of New Mexico were identified. The proportion of screening tests which were co-tests rose from 5.6% in 2008 to 84.3% in 2019 among women aged 30-64 years with a marked change from the near exclusive use of the Hybrid Capture II HPV test, (a signal amplified test method) to the use of target amplified HPV tests. The largest increases were seen between 2013 and 2015, reflecting the introduction and adoption of new clinical guidelines. Increases in co-testing were also seen in younger women. Conclusions: Co-testing is now well established in women aged 30-64 years, but smaller increases have also been seen at younger ages, although this is not currently recommended. The impact of co-testing on cervical disease outcomes and number of colposcopies and biopsies in routine population settings remain important, especially in young women.Item Post-intensive care screening: French translation and validation of the Healthy Aging Brain Care-Monitor, hybrid version(Springer Nature, 2022-04-02) Horlait, Geoffrey; Beaudart, Charlotte; Bougard, Laurine; Bornheim, Stephen; Colson, Camille; Misset, Benoit; Bruyère, Olivier; Boustani, Malaz; Rousseau, Anne‑Françoise; Medicine, School of MedicineBackground: The Healthy Aging Brain Care-Monitor (HABC-M) questionnaires (self-reported version and caregiver version) have been validated for post-intensive care syndrome (PICS) detection in patients surviving a stay in the intensive care unit (ICU). Their authors have also developed a hybrid version (HABC-M-HV) suited to the daily needs of their post-ICU follow-up clinic. The objectives of the present cross-sectional observational study were to translate the HABC-M-HV questionnaire into French (HABC-M-HV-F) according to international guidelines and to test its measurement properties. Methods: The HABC-M-HV was translated according to international guidelines. The measurement performances of the questionnaire were tested using internal consistency, test-retest reliability, Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) calculation, floor and ceiling effect measurement and construct validity. Results: The validation study included 51 ICU survivors (27.5% women, 63 [55-71] years old). The questionnaire was administered by phone. The internal consistency was very good (Cronbach's alpha coefficient 0.79). The intra- and inter-examinator reliabilities were excellent (Intraclass Coefficient Correlation = 0.99 and 0.97, respectively). The SEM was 0.62 and the SDC was 1.72. No floor or ceiling effects were observed. The convergent validity was almost entirely confirmed with 71.4% of our hypothesis confirmed. Conclusion: The HABC-M-HV-F has been shown to be a valid and reliable tool for PICS screening and follow-up in French-speaking ICU survivors. A remote administration by phone was feasible.Item Continuity of care and receipt of aggressive end of life care among women dying of ovarian cancer(Elsevier, 2021) Mullins, Megan A.; Ruterbusch, Julie J.; Clarke, Philippa; Uppal, Shitanshu; Cote, Michele L.; Wallner, Lauren P.; Medicine, School of MedicineObjective: To evaluate the association between post-diagnosis continuity of care and receipt of aggressive end of life care among women dying of ovarian cancer. Methods: This retrospective claims analysis included 6680 Medicare beneficiaries over age 66 with ovarian cancer who survived at least one year after diagnosis, had at least 4 outpatient evaluation and management visits and died between 2000 and 2016. We calculated the Bice-Boxerman Continuity of Care Index (COC) for each woman, and split COC into tertiles (high, medium, low). We compared late or no hospice use, >1 emergency department (ED) visit, intensive care unit (ICU) admission, >1 hospitalization, terminal hospitalization, chemotherapy, and invasive and/or life extending procedures among women with high or medium vs. low COC using multivariable adjusted logistic regression. Results: In this sample, 49.8% of women received aggressive care in the last month of life. Compared to women with low COC, women with high COC had 66% higher odds of chemotherapy (adjusted OR 1.66 CI 1.23-2.24) in the last two weeks of life. Women with high COC also had 16% greater odds of not enrolling in hospice compared to women with low COC (adjusted OR 1.16 CI 1.01-1.33). COC was not associated with late enrollment in hospice, hospital utilization, or aggressive procedures. Conclusions: COC at the end of life is complicated and may pose unique challenges in providing quality end of life care. Future work exploring the specific facets of continuity associated with quality end of life care is needed.Item Molecular characterization and clinical outcome of B-cell precursor acute lymphoblastic leukemia with IG-MYC rearrangement(Ferrata-Storti Foundation, 2023-03-01) Bomken, Simon; Enshaei, Amir; Schwalbe, Edward C.; Mikulasova, Aneta; Dai, Yunfeng; Zaka, Masood; Fung, Kent T. M.; Bashton, Matthew; Lim, Huezin; Jones, Lisa; Karataraki, Nefeli; Winterman, Emily; Ashby, Cody; Attarbaschi, Andishe; Bertrand, Yves; Bradtke, Jutta; Buldini, Barbara; Burke, G. A. Amos; Cazzaniga, Giovanni; Gohring, Gudrun; De Groot-Kruseman, Hesta A.; Haferlach, Claudia; Lo Nigro, Luca; Parihar, Mayur; Plesa, Adriana; Seaford, Emma; Sonneveld, Edwin; Strehl, Sabine; Van der Velden, Vincent H. J.; Rand, Vikki; Hunger, Stephen P.; Harrison, Christine J.; Bacon, Chris M.; Van Delft, Frederik W.; Loh, Mignon L.; Moppett, John; Vormoor, Josef; Walker, Brian A.; Moorman, Anthony V.; Russell, Lisa J.; Medicine, School of MedicineRarely, immunophenotypically immature B-cell precursor acute lymphoblastic leukemia (BCP-ALL) carries an immunoglobulin- MYC rearrangement (IG-MYC-r). This can result in diagnostic confusion with Burkitt lymphoma/leukemia and use of individualized treatment schedules of unproven efficacy. Here we compare the molecular characteristics of these conditions and investigate historic clinical outcome data. We identified 90 cases registered in a national BCP-ALL clinical trial/registry. When present, diagnostic material underwent cytogenetic, exome, methylome and transcriptome analyses. The outcomes analyzed were 3-year event-free survival and overall survival. IG-MYC-r was identified in diverse cytogenetic backgrounds, co-existing with either established BCP-ALL-specific abnormalities (high hyperdiploidy, n=3; KMT2A-rearrangement, n=6; iAMP21, n=1; BCR-ABL1, n=1); BCL2/BCL6-rearrangements (n=15); or, most commonly, as the only defining feature (n=64). Within this final group, precursor-like V(D)J breakpoints predominated (8/9) and KRAS mutations were common (5/11). DNA methylation identified a cluster of V(D)J-rearranged cases, clearly distinct from Burkitt leukemia/lymphoma. Children with IG-MYC-r within that subgroup had a 3-year event-free survival of 47% and overall survival of 60%, representing a high-risk BCP-ALL. To develop effective management strategies this group of patients must be allowed access to contemporary, minimal residual disease-adapted, prospective clinical trial protocols.Item Healthy Peribiliary Glands are Necessary for Successful Liver Transplantation(Wolters Kluwer, 2022) Francis, Heather; Kundu, Debjyoti; Baiocchi, Leonardo; Medicine, School of MedicineItem Utilizing Artificial Intelligence to Enhance Health Equity Among Patients with Heart Failure(Elsevier, 2022) Johnson, Amber E.; Brewer, LaPrincess C.; Echols, Melvin R.; Mazimba, Sula; Shah, Rashmee U.; Breathett, Khadijah; Medicine, School of MedicinePatients with heart failure (HF) are heterogeneous with various intrapersonal and interpersonal characteristics contributing to clinical outcomes. Bias, structural racism, and social determinants of health have been implicated in unequal treatment of patients with HF. Through several methodologies, artificial intelligence (AI) can provide models in HF prediction, prognostication, and provision of care, which may help prevent unequal outcomes. This review highlights AI as a strategy to address racial inequalities in HF; discusses key AI definitions within a health equity context; describes the current uses of AI in HF, strengths and harms in using AI; and offers recommendations for future directions.Item Abnormal liver tests are not sufficient for diagnosis of hepatic graft‐versus‐host disease in critically ill patients(Wolters Kluwer, 2022) Yang, Alexander H.; Han, Mai Ai Thanda; Samala, Niharika; Rizvi, Bisharah S.; Marchalik, Rachel; Etzion, Ohad; Wright, Elizabeth C.; Patel, Ruchi; Khan, Vinshi; Kapuria, Devika; Venkat, Vikramaditya Samala; Kleiner, David E.; Koh, Christopher; Kanakry, Jennifer A.; Kanakry, Christopher G.; Pavletic, Steven; Williams, Kirsten M.; Heller, Theo; Medicine, School of MedicineHepatic graft-versus-host disease (HGVHD) contributes significantly to morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Clinical findings and liver biomarkers are neither sensitive nor specific. The relationship between clinical and histologic diagnoses of HGVHD was assessed premortem and at autopsy. Medical records from patients who underwent HSCT at the National Institutes of Health (NIH) Clinical Center between 2000 and 2012 and expired with autopsy were reviewed, and laboratory tests within 45 days of death were divided into 15-day periods. Clinical diagnosis of HGVHD was based on Keystone Criteria or NIH Consensus Criteria, histologic diagnosis based on bile duct injury without significant inflammation, and exclusion of other potential etiologies. We included 37 patients, 17 of whom had a cholestatic pattern of liver injury and two had a mixed pattern. Fifteen were clinically diagnosed with HGVHD, two showed HGVHD on autopsy, and 13 had histologic evidence of other processes but no HGVHD. Biopsy or clinical diagnosis of GVHD of other organs during life did not correlate with HGVHD on autopsy. The diagnostic accuracy of the current criteria was poor (κ = -0.20). A logistic regression model accounting for dynamic changes included peak bilirubin 15 days before death, and an increase from period -30 (days 30 to 16 before death) to period -15 (15 days before death) showed an area under the receiver operating characteristic curve of 0.77. Infection was the immediate cause of death in 68% of patients. In conclusion, liver biomarkers at baseline and GVHD elsewhere are poor predictors of HGVHD on autopsy, and current clinical diagnostic criteria have unsatisfactory performance. Peak bilirubin and cholestatic injury predicted HGVHD on autopsy. A predictive model was developed accounting for changes over time. Further validation is needed.Item Systems Pharmacology Modeling Identifies a Novel Treatment Strategy for Bortezomib-Induced Neuropathic Pain(Frontiers Media, 2022-01-19) Bloomingdale, Peter; Meregalli, Cristina; Pollard, Kevin; Canta, Annalisa; Chiorazzi, Alessia; Fumagalli, Giulia; Monza, Laura; Pozzi, Eleonora; Alberti, Paola; Ballarini, Elisa; Oggioni, Norberto; Carlson, Louise; Liu, Wensheng; Ghandili, Mehrnoosh; Ignatowski, Tracey A.; Lee, Kelvin P.; Moore, Michael J.; Cavaletti, Guido; Mager, Donald E.; Medicine, School of MedicineChemotherapy-induced peripheral neurotoxicity is a common dose-limiting side effect of several cancer chemotherapeutic agents, and no effective therapies exist. Here we constructed a systems pharmacology model of intracellular signaling in peripheral neurons to identify novel drug targets for preventing peripheral neuropathy associated with proteasome inhibitors. Model predictions suggested the combinatorial inhibition of TNFα, NMDA receptors, and reactive oxygen species should prevent proteasome inhibitor-induced neuronal apoptosis. Dexanabinol, an inhibitor of all three targets, partially restored bortezomib-induced reduction of proximal action potential amplitude and distal nerve conduction velocity in vitro and prevented bortezomib-induced mechanical allodynia and thermal hyperalgesia in rats, including a partial recovery of intraepidermal nerve fiber density. Dexanabinol failed to restore bortezomib-induced decreases in electrophysiological endpoints in rats, and it did not compromise bortezomib anti-cancer effects in U266 multiple myeloma cells and a murine xenograft model. Owing to its favorable safety profile in humans and preclinical efficacy, dexanabinol might represent a treatment option for bortezomib-induced neuropathic pain.