Jacobs Institute of Women's Health
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Cryoablation and Intratumoral Immunotherapy for Breast Cancer: A Future Path to Cost-Effective De-Escalation for Larger Tumors, Lymph Nodes and Metastatic Disease.
No full textCryoablation is a promising, cost-effective option to de-escalate surgical breast cancer morbidity, but presently is only suggested for breast cancers \u3c 1.5 cm, in select candidates. Breast cancer cryoablation is not a reliably covered procedure by insurance and is mainly guided by ultrasound (US), using a single cryoprobe. Yet, cryoablation is an accepted treatment option for various malignancies, including those of the kidney, liver and lung, utilizing a predominantly CT-guided, multi-probe approach using crucial cytotoxic isotherms for thorough tumor coverage. Cryoablation thus continues to find new clinical utility and is rapidly advancing on multiple fronts, similar to immunotherapy. Clinical concerns of expanding cryoablation to breast tumors \u3e 1.5 cm is more related to the greater risk of metastatic spread to local lymph nodes and beyond. Combined adjuvant treatment, such as radiation and/or chemotherapy, are currently used for regional and systemic breast cancer control, but have significant associated morbidities. US/CT-guided multi-probe large-volume breast cryoablation is presented as a thorough local control option for select patients. Intratumoral chemotherapy by direct tumor injection has been shown to be safe and is currently being tested with immunotherapy drugs and exhibits much lower morbidity. Cryoablation combined with intratumoral immunotherapy is presented to show robust systemic immune response and the potential to provide additional protection from regional and/or metastatic disease spread while de-escalating the morbidities from current adjuvant treatments for larger breast cancers. While further clinical trials are needed, it is essential to pursue safe and effective breast cancer treatments that offer the potential for cost-efficiency and therapeutic de-escalation across a wide spectrum of breast cancer cases
Efficacy of communication interventions for promoting blood donation in low- and middle-income countries: A systematic review
No full textBACKGROUND AND OBJECTIVES: In low- and middle-income countries (LMICs), information on the efficacy of communication interventions promoting blood donation is very scarce. The present review aimed to identify specific communication interventions and their efficacy for increasing blood donation in LMICs. MATERIALS AND METHODS: The databases searched were PubMed, Scopus, PsycINFO, Web of Science, CINAHL, ProQuest, AJOL and CAB Abstracts. Grey literature sources included the websites of African Society of Blood Transfusion, International Society of Blood Transfusion and World Health Organization. The outcomes of interest were donation attempt or actual blood donations. RESULTS: A total of 16 studies including nine randomized controlled trials (RCTs) were included in the review. The communication interventions included social media and mass media, such as radio and television, as platforms for promoting blood donation, and newspaper articles or advertisements as an incentive for donor recruitment. Mobile text messages were used either alone or in combination with phone calls, and other interventions such as meetings and brochures. Only three of the 16 studies specifically targeted behavioural science theories, and none of the 16 studies used any implementation science framework. For some communication interventions, there was evidence of statistically significant increases in donations, but the quality of the studies was weak. CONCLUSION: The efficacy of communication interventions for promoting blood donations in LMICs remains limited due to few rigorous studies. More rigorous, theory-based studies on the use of communication interventions to increase blood donation in LMICs, especially in sub-Saharan Africa where no prior RCT were identified, are needed
Feasibility and Applicability of Implementing the Framework for Comprehensive Understanding of Structural Stigma in Mental Healthcare Systems: A Case Example of Nepal
No full textINTRODUCTION: Mental health-related structural stigma is a multifaceted issue that significantly impacts access to quality mental healthcare, particularly in low-resource settings like Nepal. Therefore, there is a clear need to understand the complexities and identify gaps for targeted interventions through evaluations of various dimensions of structural stigma within healthcare systems. This study aimed to assess the feasibility and applicability of a mental health-related structural stigma measurement framework through its implementation in Nepal\u27s healthcare system. METHODS: A mixed-methods approach was employed, involving data mapping, key informant interviews and rating exercises with diverse stakeholders, including policymakers, health workers and people with lived experience (PWLEs). A visual analogue scale or Red/Amber/Green (RAG) rating scale was used to rate each indicator within the framework for the level of structural stigma based on the mapped information and their experiences. Data collection was carried out from May to June 2024. RESULTS: Twenty key informants were interviewed for this exercise. Most indicators within the framework were endorsed as yellow, followed by red by participants referring to mid to high levels of structural stigma within the healthcare system. The findings also revealed that the stakeholders perceived the framework as acceptable and applicable for measuring mental health-related structural stigma in the healthcare system. However, challenges were noted regarding the clarity of some indicators, limitations of the three-coloured visual analogue rating and the need for comparator conditions. CONCLUSION: The study underscores the measurement framework\u27s value as a tool for identifying and addressing structural stigma in a mental healthcare system in a low-resource setting. Stakeholder engagement and contextual adaptation are crucial for its successful implementation. The insights gained can inform structural reforms and improve mental health service delivery, ultimately promoting greater equity and access for PWLEs. PATIENT PUBLIC CONTRIBUTION: This framework being assessed in this study (FOCUS-MHS) was developed through extensive consultation with People with Lived Experiences (PWLEs) in Nepal and globally with the Global Mental Health Peer Network along with other stakeholders. Identification of documents, policies and studies, along with qualitative information mapped within the indicators, was informed by PWLEs involved in local study sites and by policymakers and health administrators. The reflections of the study participants-PWLEs, health administrators and policymakers, have guided further refinement of the framework for future use
A Hospital Resource for Nurses Navigating Doctoral Education and Beyond
No full textAdvancing nursing practice to improve care and system outcomes requires doctoral-prepared nurses to conduct programs of research and translate science to practice. The authors describe a Doctoral support group (DSG) at one hospital designed to support nurses considering and navigating doctoral education while continuing as hospital employees. Strategies from 18 years\u27 experience are provided for others to develop and sustain a DSG as part of an environment to support and retain nurses with doctoral degrees
Evaluation and management of pediatric refractory constipation: Recommendations from the NASPGHAN neurogastroenterology and motility committee
No full textRefractory constipation (RC) in pediatric patients should be recognized as a distinct condition with long-term impacts on patient and family quality of life. RC requires a more targeted diagnostic evaluation and complex management strategy that may involve management by pediatric neurogastroenterology and motility specialists and multidisciplinary teams including surgeons. Currently, there is a lack of a clear definition, evaluation, and management strategies for RC. This is the first North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition position paper to address pediatric RC regarding its definition, evaluation, and management
Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis
No full textSTUDY OBJECTIVES: Inflammatory and immune mechanisms are considered in restless legs syndrome (RLS) pathophysiology with several autoimmune diseases associated with RLS. There is a paucity of studies examining RLS prevalence in myasthenia gravis (MG), an autoimmune neuromuscular disease. This study investigated RLS prevalence and association with patient-reported measures in a large registry of participants with MG using a validated RLS diagnostic questionnaire. METHODS: The Myasthenia Gravis Foundation of America MG Patient Registry is used on a semiannual basis to survey participants with MG. Patients aged ≥ 18 years, living in the United States, and answering yes to physician diagnosed MG were invited by email to enroll in an RLS-customized web-based survey. Collection of data included demographics, disease variables, patient-reported measures with a simple depression scale, MG-quality of life-15 revised, MG-activities of daily living instruments, and 13-item short-form Cambridge-Hopkins diagnostic questionnaire for RLS. Multivariable logistic regression models explored the association between RLS and MG variables of interest. RESULTS: A total of 630 eligible participants with MG (age: 62.8 ± 13.2; 54.9% female; 91.6% White) completed the survey. The overall prevalence of RLS was 14.8%. The prevalence of clinically significant RLS was 8.4%. The odds of having RLS were increased with higher (worse) MG-activities of daily living, MG-quality of life-15 revised, and depression scores. History of thymic tumor with thymectomy and continuous positive airway pressure therapy were also independent predictors of RLS. CONCLUSIONS: RLS is common in patients with MG and is associated with worse functional status, quality of life, and depression. The thymus could play a key role in an autoimmune process associating MG with RLS. CITATION: AlGaeed M, McPherson T, Lee I, et al. Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis. J Clin Sleep Med. 2025;21(2):269-276
Agnostic identification of plasma biomarkers for postpartum hemorrhage risk
No full textBACKGROUND: Postpartum hemorrhage is difficult to predict, is associated with significant maternal morbidity, and is the leading cause of maternal mortality worldwide. The identification of maternal biomarkers that can predict increased postpartum hemorrhage risk would enhance clinical care and may uncover mechanisms that lead to postpartum hemorrhage. OBJECTIVE: This retrospective case-control study employed agnostic proteomic profiling of maternal plasma samples to identify differentially abundant proteins in controls and postpartum hemorrhage cases. STUDY DESIGN: Maternal plasma samples were procured from a cohort of \u3e60,000 participants in a single institution\u27s perinatal repository. Postpartum hemorrhage was defined as a decrease in hematocrit of ≥10% or receipt of transfusion within 24 hours after delivery. Postpartum hemorrhage cases (n=30) were matched by maternal age and delivery mode (vaginal or cesarean) with controls (n=56). Mass spectrometry was used to identify differentially abundant proteins using integrated peptide peak areas. Statistically significant differences between groups were defined as P\u3c.05 after controlling for multiple comparisons. RESULTS: By study design, cases and controls did not differ in race, ethnicity, gestational age at delivery, blood type, or predelivery platelet count. Cases had slightly but significantly lower predelivery and postdelivery hematocrit and hemoglobin. Mass spectrometry detected 1140 proteins, including 77 proteins for which relative abundance differed significantly between cases and controls (fold change \u3e1.15, P\u3c.05). Of these differentially abundant plasma proteins, most had likely liver or placental origins. Gene ontology term analysis mapped to protein clusters involved in responses to wound healing, stress response, and host immune defense. Significantly differentially abundant proteins with the highest fold change (prostaglandin D2 synthase, periostin, and several serine protease inhibitors) did not correlate with predelivery hematocrit or hemoglobin but identified postpartum hemorrhage cases with logistic regression modeling revealing good-to-excellent area under the operator receiver characteristic curves (0.802-0.874). Incorporating predelivery hemoglobin with these candidate proteins further improved the identification of postpartum hemorrhage cases. CONCLUSION: Agnostic analysis of maternal plasma samples identified differentially abundant proteins in controls and postpartum hemorrhage cases. Several of these proteins are known to participate in biologically plausible pathways for postpartum hemorrhage risk and have potential value for predicting postpartum hemorrhage. These findings identify candidate protein biomarkers for future validation and mechanistic studies
Just a Chicken in the Weeds
No full texthttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1011/thumbnail.jp