首页 > 最新文献

Lancet Regional Health-Americas最新文献

英文 中文
Venous thromboembolism prevention program implementation in a community oncology practice: a cohort study 在社区肿瘤诊所实施静脉血栓栓塞预防计划:一项队列研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-29 DOI: 10.1016/j.lana.2024.100866
Steven Ades , Yonatan Resnick , Jacob Barker , Karlyn Martin , Ryan Thomas , Karen Libby , John Winters , Chris Holmes

Background

While national guidelines recommend Venous Thromboembolism (VTE) risk assessment in cancer outpatients and consideration of pharmacologic prophylaxis in high-risk patients, prophylaxis rates are low in community oncology practices. A successful model for guideline implementation (the Vermont Model, VM) is validated in an academic tertiary oncology setting. We undertook an implementation study to determine the success of this model in a multi-site community oncology practice. The study objectives were to: 1) adapt the VM to the community practice setting; 2) implement the adapted VM into practice; and 3) evaluate clinical and implementation outcomes.

Methods

The study was carried out in three phases: (1) Pre-implementation, a multidisciplinary team addressed the need to adapt the VM to the local context including electronic medical record (EMR) optimisation and clinician education; (2) implementation of the strategies adapted to the local context, informed by VM and adapted based on stakeholder feedback; (3) prospective evaluation of clinical and implementation outcomes at six months after implementation.

Findings

Following creation of a comprehensive initiation roadmap for the adaptation of VM program to the community practice, 302 cancer outpatients initiating new treatment met inclusion criteria over a 6 month implementation period. VTE risk education was provided to 100% of patients, and 98% (296) of patients received a VTE risk assessment. Of 52 patients (18%) who scored as high risk based on a modified Khorana (Protecht) score, 14 (27%) initiated prophylaxis. Barriers to program adaptation included EMR optimization challenges and practice-level responsibility assignment, time constraints, concern about potential drug interactions, and financial & insurance issues.

Interpretation

Implementation of a multidisciplinary VTE prevention model in the community-based oncology setting successfully increased VTE education and risk assessment rates. AC prophylaxis rates were modestly increased, highlighting the need to understand and address barriers to anticoagulant prophylaxis prescribing in this setting.

Funding

Northern New England Clinical Oncology Society Research Funding Program.

背景虽然国家指南建议对癌症门诊患者进行静脉血栓栓塞症(VTE)风险评估,并考虑对高危患者进行药物预防,但社区肿瘤诊所的预防率却很低。一个成功的指南实施模式(佛蒙特模式,VM)在一个三级肿瘤学术机构中得到了验证。我们开展了一项实施研究,以确定该模式在多点社区肿瘤实践中的成功率。研究目标是方法该研究分三个阶段进行:(1)实施前,由一个多学科团队处理根据当地情况调整 VM 的需求,包括电子病历 (EMR) 优化和临床医生教育;(2)实施根据当地情况调整的策略,这些策略由 VM 提供信息,并根据利益相关者的反馈进行调整;(3)实施后六个月对临床和实施结果进行前瞻性评估。研究结果在制定了将 VM 计划应用于社区实践的全面启动路线图后,302 名接受新治疗的癌症门诊患者在 6 个月的实施期间符合了纳入标准。100%的患者接受了VTE风险教育,98%(296人)的患者接受了VTE风险评估。在根据改良霍拉纳(Protecht)评分被评为高风险的 52 名患者(18%)中,有 14 名(27%)开始了预防治疗。项目适应性的障碍包括 EMR 优化挑战和实践层面的责任分配、时间限制、对潜在药物相互作用的担忧以及财务和保险问题。抗凝血药物预防率略有提高,这表明有必要了解并解决在这种情况下开具抗凝血药物预防处方的障碍。
{"title":"Venous thromboembolism prevention program implementation in a community oncology practice: a cohort study","authors":"Steven Ades ,&nbsp;Yonatan Resnick ,&nbsp;Jacob Barker ,&nbsp;Karlyn Martin ,&nbsp;Ryan Thomas ,&nbsp;Karen Libby ,&nbsp;John Winters ,&nbsp;Chris Holmes","doi":"10.1016/j.lana.2024.100866","DOIUrl":"10.1016/j.lana.2024.100866","url":null,"abstract":"<div><h3>Background</h3><p>While national guidelines recommend Venous Thromboembolism (VTE) risk assessment in cancer outpatients and consideration of pharmacologic prophylaxis in high-risk patients, prophylaxis rates are low in community oncology practices. A successful model for guideline implementation (the Vermont Model, VM) is validated in an academic tertiary oncology setting. We undertook an implementation study to determine the success of this model in a multi-site community oncology practice. The study objectives were to: 1) adapt the VM to the community practice setting; 2) implement the adapted VM into practice; and 3) evaluate clinical and implementation outcomes.</p></div><div><h3>Methods</h3><p>The study was carried out in three phases: (1) Pre-implementation, a multidisciplinary team addressed the need to adapt the VM to the local context including electronic medical record (EMR) optimisation and clinician education; (2) implementation of the strategies adapted to the local context, informed by VM and adapted based on stakeholder feedback; (3) prospective evaluation of clinical and implementation outcomes at six months after implementation.</p></div><div><h3>Findings</h3><p>Following creation of a comprehensive initiation roadmap for the adaptation of VM program to the community practice, 302 cancer outpatients initiating new treatment met inclusion criteria over a 6 month implementation period. VTE risk education was provided to 100% of patients, and 98% (296) of patients received a VTE risk assessment. Of 52 patients (18%) who scored as high risk based on a modified Khorana (Protecht) score, 14 (27%) initiated prophylaxis. Barriers to program adaptation included EMR optimization challenges and practice-level responsibility assignment, time constraints, concern about potential drug interactions, and financial &amp; insurance issues.</p></div><div><h3>Interpretation</h3><p>Implementation of a multidisciplinary VTE prevention model in the community-based oncology setting successfully increased VTE education and risk assessment rates. AC prophylaxis rates were modestly increased, highlighting the need to understand and address barriers to anticoagulant prophylaxis prescribing in this setting.</p></div><div><h3>Funding</h3><p>Northern New England Clinical Oncology Society Research Funding Program.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100866"},"PeriodicalIF":7.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001935/pdfft?md5=d3206742b6cc98a6f5792bb988967117&pid=1-s2.0-S2667193X24001935-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sports betting scandals highlight knowledge gaps for gambling harm 体育博彩丑闻凸显对赌博危害的认识差距
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-28 DOI: 10.1016/j.lana.2024.100879
Luke Clark , Michael J.A. Wohl
{"title":"Sports betting scandals highlight knowledge gaps for gambling harm","authors":"Luke Clark ,&nbsp;Michael J.A. Wohl","doi":"10.1016/j.lana.2024.100879","DOIUrl":"10.1016/j.lana.2024.100879","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100879"},"PeriodicalIF":7.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002060/pdfft?md5=afb0db3ce57b9e84558578892c19efb4&pid=1-s2.0-S2667193X24002060-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A surveillance study of cancer incidence and mortality among young adults in Costa Rica 哥斯达黎加青壮年癌症发病率和死亡率监测研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-27 DOI: 10.1016/j.lana.2024.100872
Rachel Slimovitch , Jaimie Z. Shing , Romain Fantin , Juan C. Vanegas , Carolina Porras , Rolando Herrero , Meredith S. Shiels , Mónica S. Sierra , Erica S. Stephens , Allan Hildesheim , Aimée R. Kreimer , Alejandro Calderón , Loretto J. Carvajal

Background

There has been an increase in certain cancers among young adults (YA) aged 20–39, particularly in Latin America. This is the first study to examine cancer incidence and mortality in YA in Costa Rica, focusing on sex-specific patterns.

Methods

Invasive cancer cases (excluding non-melanoma skin cancer) in YA from 2006 to 2015 were obtained from the Costa Rican National Registry of Tumors. Utilising SEER∗Stat software, age-standardized incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Trends and annual percent changes (APCs) in IRs were estimated using the Joinpoint regression analysis program. Cancer deaths from 2000 to 2021 were obtained from the Costa Rican National Institute of Statistics and Census. Age-standardised mortality rates were calculated using STATA®17.

Findings

YA comprised 10.7% of all invasive cancer cases diagnosed from 2006 to 2015. The age-standardized incidence rate (ASIR) of invasive cancer in YA was 50.9/100,000 person-years. The ASIR was twofold higher for females compared to males (IRR = 2.03, 95% CI:1.94, 2.13). This difference increased with age, peaking in the 35–39-year age group (IRR = 2.84, 95% CI:2.62, 3.10). Thyroid, breast, and cervical cancer were the most common in females. Testicular cancer was the most common in males. Leading causes of cancer-related deaths included cervical and breast cancer in females and stomach and brain/nervous system cancer in males.

Interpretation

The study highlights sex-specific patterns in cancer incidence and mortality among YA in Costa Rica to increase understanding and improve cancer outcomes in this age group.

Funding

This study was funded by the Intramural Research Program of the National Cancer Institute.

背景20-39岁的年轻人(YA)中某些癌症的发病率有所上升,尤其是在拉丁美洲。这是第一项研究哥斯达黎加青年癌症发病率和死亡率的研究,重点关注性别特异性模式。方法从哥斯达黎加国家肿瘤登记处获得 2006 年至 2015 年青年中的侵袭性癌症病例(不包括非黑色素瘤皮肤癌)。利用 SEER∗Stat 软件计算了年龄标准化发病率 (IR) 和发病率比 (IRR)。使用Joinpoint回归分析程序估算了IRs的趋势和年度百分比变化(APCs)。2000 年至 2021 年的癌症死亡人数来自哥斯达黎加国家统计和普查局。使用 STATA®17 计算了年龄标准化死亡率。研究结果在 2006 年至 2015 年诊断出的所有侵袭性癌症病例中,YA 占 10.7%。亚裔浸润性癌症的年龄标准化发病率(ASIR)为 50.9/100,000人年。女性的年龄标准化发病率是男性的两倍(IRR = 2.03,95% CI:1.94,2.13)。这一差异随着年龄的增长而增加,在 35-39 岁年龄组达到峰值(IRR = 2.84,95% CI:2.62, 3.10)。甲状腺癌、乳腺癌和宫颈癌在女性中最为常见。男性最常见的是睾丸癌。与癌症相关的主要死亡原因包括女性的宫颈癌和乳腺癌,以及男性的胃癌和脑/神经系统癌症。这项研究强调了哥斯达黎加亚裔癌症发病率和死亡率的性别特异性模式,以增进对这一年龄组癌症的了解并改善其治疗效果。
{"title":"A surveillance study of cancer incidence and mortality among young adults in Costa Rica","authors":"Rachel Slimovitch ,&nbsp;Jaimie Z. Shing ,&nbsp;Romain Fantin ,&nbsp;Juan C. Vanegas ,&nbsp;Carolina Porras ,&nbsp;Rolando Herrero ,&nbsp;Meredith S. Shiels ,&nbsp;Mónica S. Sierra ,&nbsp;Erica S. Stephens ,&nbsp;Allan Hildesheim ,&nbsp;Aimée R. Kreimer ,&nbsp;Alejandro Calderón ,&nbsp;Loretto J. Carvajal","doi":"10.1016/j.lana.2024.100872","DOIUrl":"10.1016/j.lana.2024.100872","url":null,"abstract":"<div><h3>Background</h3><p>There has been an increase in certain cancers among young adults (YA) aged 20–39, particularly in Latin America. This is the first study to examine cancer incidence and mortality in YA in Costa Rica, focusing on sex-specific patterns.</p></div><div><h3>Methods</h3><p>Invasive cancer cases (excluding non-melanoma skin cancer) in YA from 2006 to 2015 were obtained from the Costa Rican National Registry of Tumors. Utilising SEER∗Stat software, age-standardized incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Trends and annual percent changes (APCs) in IRs were estimated using the Joinpoint regression analysis program. Cancer deaths from 2000 to 2021 were obtained from the Costa Rican National Institute of Statistics and Census. Age-standardised mortality rates were calculated using STATA®17.</p></div><div><h3>Findings</h3><p>YA comprised 10.7% of all invasive cancer cases diagnosed from 2006 to 2015. The age-standardized incidence rate (ASIR) of invasive cancer in YA was 50.9/100,000 person-years. The ASIR was twofold higher for females compared to males (IRR = 2.03, 95% CI:1.94, 2.13). This difference increased with age, peaking in the 35–39-year age group (IRR = 2.84, 95% CI:2.62, 3.10). Thyroid, breast, and cervical cancer were the most common in females. Testicular cancer was the most common in males. Leading causes of cancer-related deaths included cervical and breast cancer in females and stomach and brain/nervous system cancer in males.</p></div><div><h3>Interpretation</h3><p>The study highlights sex-specific patterns in cancer incidence and mortality among YA in Costa Rica to increase understanding and improve cancer outcomes in this age group.</p></div><div><h3>Funding</h3><p>This study was funded by the <span>Intramural Research Program</span> of the <span>National Cancer Institute</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100872"},"PeriodicalIF":7.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001996/pdfft?md5=50ebab2883e4bb97bd74a7ae5c524134&pid=1-s2.0-S2667193X24001996-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sociohistorical justice: a corrective framework to mend the modern harms of medical history 社会历史正义:弥补医学史现代危害的矫正框架
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-24 DOI: 10.1016/j.lana.2024.100874
Carmen Black , Shavonne Temple , Amber Acquaye , Christopher Fields , Abigail Konopasky
{"title":"Sociohistorical justice: a corrective framework to mend the modern harms of medical history","authors":"Carmen Black ,&nbsp;Shavonne Temple ,&nbsp;Amber Acquaye ,&nbsp;Christopher Fields ,&nbsp;Abigail Konopasky","doi":"10.1016/j.lana.2024.100874","DOIUrl":"10.1016/j.lana.2024.100874","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100874"},"PeriodicalIF":7.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002011/pdfft?md5=050c9283fc3a018904d27e6e485396c9&pid=1-s2.0-S2667193X24002011-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Our environment, our health, our challenge: perspectives from a Southern Brazil tragedy 我们的环境、我们的健康、我们的挑战:巴西南部悲剧的视角
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-24 DOI: 10.1016/j.lana.2024.100878
Rafael Dall’Alba , Marco André Germanò , Carine B. Ferreira Nied , Paula Emília Adamy , Cristianne Famer Rocha
{"title":"Our environment, our health, our challenge: perspectives from a Southern Brazil tragedy","authors":"Rafael Dall’Alba ,&nbsp;Marco André Germanò ,&nbsp;Carine B. Ferreira Nied ,&nbsp;Paula Emília Adamy ,&nbsp;Cristianne Famer Rocha","doi":"10.1016/j.lana.2024.100878","DOIUrl":"10.1016/j.lana.2024.100878","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100878"},"PeriodicalIF":7.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002059/pdfft?md5=aaad5d3cc59cfc1ab2061e5e34f58b0c&pid=1-s2.0-S2667193X24002059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A scoping review of end-of-life discussions and palliative care: implications for neurological intensive care among Latinos in the U.S. 临终讨论和姑息治疗的范围界定综述:对美国拉美裔神经重症监护的影响。
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-24 DOI: 10.1016/j.lana.2024.100873
Monica M. Diaz , Lesley A. Guareña , Bettsie Garcia , Christoper A. Alarcon-Ruiz , Stella M. Seal , Clio Rubinos , Dulce M. Cruz-Oliver , J. Ricardo Carhuapoma

Goals of care (Goals-of-care) discussions and palliative care (PC) are crucial to providing comprehensive healthcare, particularly for acute neurological conditions requiring admission to a neurological intensive care unit. We identified gaps in the literature and describe insight for future research on end-of-life discussions and PC for U.S. Latinos with acute neurological conditions. We searched 10 databases including peer-reviewed abstracts and manuscripts of hospitalized U.S. Latinos with acute neurological and non-neurological conditions. We included 44 of 3231 publications and identified various themes: PC utilization, pre-established advanced directives in Goals-of-care discussions, Goals-of-care discussion outcomes, tracheostomy or percutaneous gastrostomy tube placement rates among hospitalized Latinos. Our review highlights that Latinos appear to have lower palliative care utilization compared with non-Latino Whites and may be less likely to have pre-established advanced directives, more likely to have gastrostomy or tracheostomy placement and less likely to have do-not-resuscitate status.

护理目标(Goals-of-care)讨论和姑息治疗(PC)对于提供全面的医疗保健服务至关重要,尤其是对于需要入住神经重症监护病房的急性神经系统疾病患者。我们发现了文献中的空白,并阐述了对患有急性神经系统疾病的美国拉美裔患者进行临终关怀讨论和姑息治疗的未来研究前景。我们检索了 10 个数据库,包括同行评议的摘要和手稿,内容涉及患有急性神经病和非神经病的住院美国拉美裔患者。我们收录了 3231 篇出版物中的 44 篇,并确定了多个主题:在住院的拉美裔患者中,PC 的使用率、护理目标讨论中预先确定的预嘱、护理目标讨论的结果、气管造口术或经皮胃造瘘管置入率。我们的综述强调,与非拉美裔白人相比,拉美裔人的姑息关怀利用率似乎较低,而且可能不太可能预先建立预先指示,更有可能置入胃造瘘管或气管造瘘管,也不太可能具有 "拒绝复苏 "状态。
{"title":"A scoping review of end-of-life discussions and palliative care: implications for neurological intensive care among Latinos in the U.S.","authors":"Monica M. Diaz ,&nbsp;Lesley A. Guareña ,&nbsp;Bettsie Garcia ,&nbsp;Christoper A. Alarcon-Ruiz ,&nbsp;Stella M. Seal ,&nbsp;Clio Rubinos ,&nbsp;Dulce M. Cruz-Oliver ,&nbsp;J. Ricardo Carhuapoma","doi":"10.1016/j.lana.2024.100873","DOIUrl":"10.1016/j.lana.2024.100873","url":null,"abstract":"<div><p>Goals of care (Goals-of-care) discussions and palliative care (PC) are crucial to providing comprehensive healthcare, particularly for acute neurological conditions requiring admission to a neurological intensive care unit. We identified gaps in the literature and describe insight for future research on end-of-life discussions and PC for U.S. Latinos with acute neurological conditions. We searched 10 databases including peer-reviewed abstracts and manuscripts of hospitalized U.S. Latinos with acute neurological and non-neurological conditions. We included 44 of 3231 publications and identified various themes: PC utilization, pre-established advanced directives in Goals-of-care discussions, Goals-of-care discussion outcomes, tracheostomy or percutaneous gastrostomy tube placement rates among hospitalized Latinos. Our review highlights that Latinos appear to have lower palliative care utilization compared with non-Latino Whites and may be less likely to have pre-established advanced directives, more likely to have gastrostomy or tracheostomy placement and less likely to have do-not-resuscitate status.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100873"},"PeriodicalIF":7.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X2400200X/pdfft?md5=08f8d85c1d015dccfb682f58937c86f1&pid=1-s2.0-S2667193X2400200X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Structural racism: a fundamental cause of drug overdose disparities 结构性种族主义:吸毒过量差异的根本原因
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-23 DOI: 10.1016/j.lana.2024.100875
David T. Zhu
{"title":"Structural racism: a fundamental cause of drug overdose disparities","authors":"David T. Zhu","doi":"10.1016/j.lana.2024.100875","DOIUrl":"10.1016/j.lana.2024.100875","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100875"},"PeriodicalIF":7.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002023/pdfft?md5=21ebbf1f957e17fe8522cb33fe12e16b&pid=1-s2.0-S2667193X24002023-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
AI-guided identification of risk variants for adrenocortical tumours in TP53 p.R337H carrier children: a genetic association study 人工智能指导下的 TP53 p.R337H 携带者儿童肾上腺皮质肿瘤风险变异识别:一项遗传关联研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-23 DOI: 10.1016/j.lana.2024.100863
Bonald C. Figueiredo , Florent Dupont , Geoffrey Portelli , Tatiana E.J. Costa , Gislaine Custódio , Mariana M. Paraizo , Heloisa Komechen , Hadrien Gascuel , Maxime Bottau , Elodie Callea , Ana Paula Percicote , Leila G. Telles , Mehdi Jendoubi , Enzo Lalli

Background

Adrenocortical tumours (ACT) in children are part of the Li-Fraumeni cancer spectrum and are frequently associated with a germline TP53 pathogenic variant. TP53 p.R337H is highly prevalent in the south and southeast of Brazil and predisposes to ACT with low penetrance. Thus, we aimed to investigate whether genetic variants exist which are associated with an increased risk of developing ACT in TP53 p.R337H carrier children.

Methods

A genetic association study was conducted in trios of children (14 girls, 7 boys) from southern Brazil carriers of TP53 p.R337H with (n = 18) or without (n = 3) ACT and their parents, one of whom also carries this pathogenic variant (discovery cohort). Results were confirmed in a validation cohort of TP53 p.R337H carriers with (n = 90; 68 girls, 22 boys) or without ACT (n = 302; 165 women, 137 men).

Findings

We analysed genomic data from whole exome sequencing of blood DNA from the trios. Using deep learning algorithms, according to a model where the affected child inherits from the non-carrier parent variant(s) increasing the risk of developing ACT, we found a significantly enriched representation of non-coding variants in genes involved in the cyclic AMP (cAMP) pathway known to be involved in adrenocortical tumorigenesis. One among those variants (rs2278986 in the SCARB1 gene) was confirmed to be significantly enriched in the validation cohort of TP53 p.R337H carriers with ACT compared to carriers without ACT (OR 1.858; 95% CI 1.146, 3.042, p = 0.01).

Interpretation

Profiling of the variant rs2278986 is a candidate for future confirmation and possible use as a tool for ACT risk stratification in TP53 p.R337H carriers.

Funding

Centre National de la Recherche Scientifique (CNRS), Behring Foundation, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

背景儿童肾上腺皮质肿瘤(ACT)是Li-Fraumeni癌症谱的一部分,经常与种系TP53致病变体有关。TP53 p.R337H在巴西南部和东南部的发病率很高,易导致低渗透性肾上腺皮质肿瘤。因此,我们旨在研究是否存在与 TP53 p.R337H 携带者儿童 ACT 患病风险增加相关的遗传变异。方法:我们对巴西南部 TP53 p.R337H 携带者(14 名女孩,7 名男孩)中患有(18 人)或未患有(3 人)ACT 的三组儿童及其父母(其中一人也携带该致病变异体)(发现队列)进行了遗传关联研究。我们分析了三人血液 DNA 全外显子测序的基因组数据。利用深度学习算法,根据受影响儿童从非携带者父母处继承变体以增加患 ACT 风险的模型,我们发现在参与肾上腺皮质肿瘤发生的环磷酸腺苷(cAMP)通路的基因中,非编码变体的代表性显著增强。其中一个变异(SCARB1 基因中的 rs2278986)被证实在患有 ACT 的 TP53 p.R337H 携带者的验证队列中比没有 ACT 的携带者明显富集(OR 1.858; 95% CI 1.146, 3.042, p = 0.01)。解释对变异体rs2278986的分析是未来确认的候选对象,并有可能用作对TP53 p.R337H携带者进行ACT风险分层的工具。
{"title":"AI-guided identification of risk variants for adrenocortical tumours in TP53 p.R337H carrier children: a genetic association study","authors":"Bonald C. Figueiredo ,&nbsp;Florent Dupont ,&nbsp;Geoffrey Portelli ,&nbsp;Tatiana E.J. Costa ,&nbsp;Gislaine Custódio ,&nbsp;Mariana M. Paraizo ,&nbsp;Heloisa Komechen ,&nbsp;Hadrien Gascuel ,&nbsp;Maxime Bottau ,&nbsp;Elodie Callea ,&nbsp;Ana Paula Percicote ,&nbsp;Leila G. Telles ,&nbsp;Mehdi Jendoubi ,&nbsp;Enzo Lalli","doi":"10.1016/j.lana.2024.100863","DOIUrl":"10.1016/j.lana.2024.100863","url":null,"abstract":"<div><h3>Background</h3><p>Adrenocortical tumours (ACT) in children are part of the Li-Fraumeni cancer spectrum and are frequently associated with a germline <em>TP53</em> pathogenic variant. <em>TP53</em> p.R337H is highly prevalent in the south and southeast of Brazil and predisposes to ACT with low penetrance. Thus, we aimed to investigate whether genetic variants exist which are associated with an increased risk of developing ACT in <em>TP53</em> p.R337H carrier children.</p></div><div><h3>Methods</h3><p>A genetic association study was conducted in trios of children (14 girls, 7 boys) from southern Brazil carriers of <em>TP53</em> p.R337H with (<em>n</em> = 18) or without (<em>n</em> = 3) ACT and their parents, one of whom also carries this pathogenic variant (discovery cohort). Results were confirmed in a validation cohort of <em>TP53</em> p.R337H carriers with (<em>n</em> = 90; 68 girls, 22 boys) or without ACT (<em>n</em> = 302; 165 women, 137 men).</p></div><div><h3>Findings</h3><p>We analysed genomic data from whole exome sequencing of blood DNA from the trios. Using deep learning algorithms, according to a model where the affected child inherits from the non-carrier parent variant(s) increasing the risk of developing ACT, we found a significantly enriched representation of non-coding variants in genes involved in the cyclic AMP (cAMP) pathway known to be involved in adrenocortical tumorigenesis. One among those variants (rs2278986 in the <em>SCARB1</em> gene) was confirmed to be significantly enriched in the validation cohort of <em>TP53</em> p.R337H carriers with ACT compared to carriers without ACT (OR 1.858; 95% CI 1.146, 3.042, p = 0.01).</p></div><div><h3>Interpretation</h3><p>Profiling of the variant rs2278986 is a candidate for future confirmation and possible use as a tool for ACT risk stratification in <em>TP53</em> p.R337H carriers.</p></div><div><h3>Funding</h3><p><span>Centre National de la Recherche Scientifique</span> (CNRS), <span>Behring Foundation</span>, <span>Conselho Nacional de Desenvolvimento Científico e Tecnológico</span> (CNPq).</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100863"},"PeriodicalIF":7.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X2400190X/pdfft?md5=a1febed3f3ea3fb3dd7ea58e92302897&pid=1-s2.0-S2667193X2400190X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Expanding reach, enhancing capacity: embracing the role of primary care in lung cancer screening and smoking cessation in the United States 扩大覆盖面,提高能力:在美国发挥初级保健在肺癌筛查和戒烟中的作用
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-21 DOI: 10.1016/j.lana.2024.100870
Elochukwu Ezenwankwo , Duong Thuy Nguyen , Idorenyin Ubon Akpabio , Jan M. Eberth
{"title":"Expanding reach, enhancing capacity: embracing the role of primary care in lung cancer screening and smoking cessation in the United States","authors":"Elochukwu Ezenwankwo ,&nbsp;Duong Thuy Nguyen ,&nbsp;Idorenyin Ubon Akpabio ,&nbsp;Jan M. Eberth","doi":"10.1016/j.lana.2024.100870","DOIUrl":"10.1016/j.lana.2024.100870","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100870"},"PeriodicalIF":7.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001972/pdfft?md5=952021c25dcb44a245e42313714dc66f&pid=1-s2.0-S2667193X24001972-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142020413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort study 哥伦比亚外科成果研究对围术期死亡率(全球外科 Lancet 委员会的一项主要指标)的见解--一项前瞻性队列研究
IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-20 DOI: 10.1016/j.lana.2024.100862
Carlos J. Pérez Rivera , Nicolás Lozano-Suárez , Alejandro Velandia-Sánchez , Maria Paula Vargas-Cuellar , Luisa Fernanda Rojas-Serrano , Camilo A. Polanía-Sandoval , Daniela Lara-Espinosa , Laura García-Zambrano , Maria Paz Bohórquez-Tarazona , Silvia Valentina Agudelo-Mendoza , Paulo A. Cabrera-Rivera , Leonardo Briceno-Ayala

Background

Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia.

Methods

A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions.

Findings

3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively.

Interpretation

The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care.

Funding

This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

背景手术护理在医疗保健中具有重要意义,尤其是在中低收入国家,因为在手术后最初 30 天内死亡的 420 万人中,至少有 50%发生在这些国家。柳叶刀全球外科委员会提出了加强外科护理的六项指标。哥伦比亚利用二手数据进行了研究。然而,降低围手术期死亡率的策略尚未实施。本研究旨在利用哥伦比亚的原始数据描述第四项指标--围手术期死亡率(POMR)。方法 在哥伦比亚的 54 家中心(医院)开展了一项多中心前瞻性队列研究。每个中心在 2022 年 5 月 5 日至 2023 年 1 月 1 日之间选择了一个为期 7 天的招募期。纳入标准包括在手术室接受外科手术的 18 岁以上患者。研究结果3807名患者的中位年龄为48岁(IQR为32-64),80.3%的患者被归类为ASA I级或II级,27%的手术复杂程度较低。主要手术为骨科(19.2%)和妇产科(17.7%)。根据克拉维恩-丁多评分法,术后并发症分为主要并发症(11.7%,10.68-12.76)和任何并发症(31.6%,30.09-33.07)。POMR为1.9%(1.48-2.37),择期手术和急诊手术死亡率分别为0.7%(0.40-1.23)和3%(2.3-3.89)。本研究是公共卫生领域的重大进展,为国家决策者提高手术护理质量提供了有价值的见解。本文由罗萨里奥大学(Universidad del Rosario)和Fundación Cardioinfantil-Instituto de Cardiología基金资助,基金号为CTO-057-2021,项目编号为IV-FGV017。
{"title":"Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort study","authors":"Carlos J. Pérez Rivera ,&nbsp;Nicolás Lozano-Suárez ,&nbsp;Alejandro Velandia-Sánchez ,&nbsp;Maria Paula Vargas-Cuellar ,&nbsp;Luisa Fernanda Rojas-Serrano ,&nbsp;Camilo A. Polanía-Sandoval ,&nbsp;Daniela Lara-Espinosa ,&nbsp;Laura García-Zambrano ,&nbsp;Maria Paz Bohórquez-Tarazona ,&nbsp;Silvia Valentina Agudelo-Mendoza ,&nbsp;Paulo A. Cabrera-Rivera ,&nbsp;Leonardo Briceno-Ayala","doi":"10.1016/j.lana.2024.100862","DOIUrl":"10.1016/j.lana.2024.100862","url":null,"abstract":"<div><h3>Background</h3><p>Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia.</p></div><div><h3>Methods</h3><p>A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions.</p></div><div><h3>Findings</h3><p>3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively.</p></div><div><h3>Interpretation</h3><p>The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care.</p></div><div><h3>Funding</h3><p>This work was supported by <span>Universidad del Rosario</span> and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100862"},"PeriodicalIF":7.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001893/pdfft?md5=e610997e5ae9fb05500259165df6e8b9&pid=1-s2.0-S2667193X24001893-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Lancet Regional Health-Americas
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1