Jacobs Institute of Women's Health
George Washington University: Health Sciences Research Commons (HSRC)Not a member yet
51297 research outputs found
Sort by
Multispecialty comparison of point-of-care-ultrasound use, training, and barriers: a national survey of VA medical centers
No full textBACKGROUND: As more specialties have begun to use Point-of-Care Ultrasound (POCUS) in patient care, hospitals and healthcare systems have been investing increasing resources in POCUS infrastructure (training, equipment, and administration). Since each specialty uses different POCUS applications, healthcare systems seek to identify commonalities and differences between specialties to make thoughtful investments in POCUS infrastructure to support each specialty\u27s use of POCUS while minimizing redundancies. Historically, past studies have focused on POCUS use in individual specialties, primarily emergency medicine and critical care, but comparative studies of different specialties are needed to guide investment in POCUS infrastructure and bolster POCUS implementation across healthcare systems. We conducted a cross-sectional survey of all Veterans Affairs (VA) medical centers in the United States and compared data from 5 different specialties on current usage, training needs, and barriers to POCUS implementation. RESULTS: Data were collected from facility chiefs of staff (n = 130; 100% response rate) and chiefs of emergency medicine (n = 101; 92% response rate), critical care (n = 93; 83% response rate), hospital medicine (n = 105; 90% response rate), anesthesiology (n = 96; 77% response rate), and surgery (n = 104; 95% response rate). All specialties surveyed reported current POCUS use (surgery 54%, hospital medicine 64%, anesthesiology 83%, emergency medicine 90%, and critical care 93%) but more importantly, a greater desire for training was seen. Procedural POCUS applications were most often used by all specialties, despite decreased procedural POCUS use since 2015 for all specialties except critical care. Diagnostic POCUS use generally increased from 2015 to 2020, although use of specific POCUS applications varied significantly between specialties. Barriers limiting POCUS use included lack of training (53-80%), access to ultrasound equipment (25-57%), and POCUS infrastructure (36-65%). CONCLUSIONS: From 2015 to 2020, POCUS use increased significantly in emergency medicine, critical care, internal medicine, anesthesiology, and surgery, although use of specific applications varied significantly between specialties. Lack of training and POCUS infrastructure were common barriers to POCUS use across specialties. Desire for training exceeded current use for several POCUS applications. These findings can guide implementation and standardization of POCUS use in hospitals and healthcare systems
Alcohol intake and pancreatic cancer risk: An analysis from 30 prospective studies across Asia, Australia, Europe, and North America
No full textBACKGROUND: Alcohol is a known carcinogen, yet the evidence for an association with pancreatic cancer risk is considered as limited or inconclusive by international expert panels. We examined the association between alcohol intake and pancreatic cancer risk in a large consortium of prospective studies. METHODS AND FINDINGS: Population-based individual-level data was pooled from 30 cohorts across four continents, including Asia, Australia, Europe, and North America. A total of 2,494,432 participants without cancer at baseline (62% women, 84% European ancestries, 70% alcohol drinkers [alcohol intake ≥ 0.1 g/day], 47% never smokers) were recruited between 1980 and 2013 at the median age of 57 years and 10,067 incident pancreatic cancer cases were recorded. In age- and sex-stratified Cox proportional hazards models adjusted for smoking history, diabetes status, body mass index, height, education, race and ethnicity, and physical activity, pancreatic cancer hazard ratios (HR) and 95% confidence intervals (CI) were estimated for categories of alcohol intake and in continuous for a 10 g/day increase. Potential heterogeneity by sex, smoking status, geographic regions, and type of alcoholic beverage was investigated. Alcohol intake was positively associated with pancreatic cancer risk, with HR30-to-\u3c60 g/day and HR≥60 g/day equal to 1.12 (95% CI [1.03,1.21]) and 1.32 (95% CI [1.18,1.47]), respectively, compared to intake of 0.1 to \u3c5 g/day. A 10 g/day increment of alcohol intake was associated with a 3% increased pancreatic cancer risk overall (HR: 1.03; 95% CI [1.02,1.04]; pvalue \u3c 0.001) and among never smokers (HR: 1.03; 95% CI [1.01,1.06]; pvalue = 0.006), with no evidence of heterogeneity by sex (pheterogeneity = 0.274) or smoking status (pheterogeneity = 0.624). Associations were consistent in Europe-Australia (HR10 g/day = 1.03, 95% CI [1.00,1.05]; pvalue = 0.042) and North America (HR10 g/day = 1.03, 95% CI [1.02,1.05]; pvalue \u3c 0.001), while no association was observed in cohorts from Asia (HR10 g/day = 1.00, 95% CI [0.96,1.03]; pvalue = 0.800; pheterogeneity = 0.003). Positive associations with pancreatic cancer risk were found for alcohol intake from beer (HR10 g/day = 1.02, 95% CI [1.00,1.04]; pvalue = 0.015) and spirits/liquor (HR10 g/day = 1.04, 95% CI [1.03,1.06]; pvalue \u3c 0.001), but not wine (HR10 g/day = 1.00, 95% CI [0.98,1.03]; pvalue = 0.827). The differential associations across geographic regions and types of alcoholic beverages might reflect differences in drinking habits and deserve more investigations. CONCLUSIONS: Findings from this large-scale pooled analysis support a modest positive association between alcohol intake and pancreatic cancer risk, irrespective of sex and smoking status. Associations were particularly evident for baseline alcohol intake of at least 15 g/day in women and 30 g/day in men
Evaluating Tranexamic Acid Dosing Strategies for Postpartum Hemorrhage: A Population Pharmacokinetic Approach in Pregnant Individuals
No full textTranexamic acid (TXA) is used for the treatment and occasionally prevention of postpartum hemorrhage (PPH); however, questions still remain regarding dosing regimen optimization. This study evaluated TXA pharmacokinetic (PK) data from four clinical trials (NCT: 04274335, 03287336, 00872469, and 02797119) conducted in pregnant participants receiving intravenous, intramuscular, or oral TXA to prevent or treat PPH. The goal of this analysis was to comprehensively characterize TXA PK in a large, heterogeneous population of pregnant individuals to (1) assess the need for weight-based dosing and (2) compare exposure target attainment for alternative routes of administration. A population PK analysis was performed using nonlinear mixed-effects modeling in Pumas, and a stepwise approach was implemented to select the structural model and identify significant covariates. A total of 211 pregnant participants who received between 0.35 and 4 g of TXA intravenously, orally, or intramuscularly offered 1303 TXA plasma concentrations for model development. A two-compartment model with first-order elimination and first-order absorption for both intramuscular and oral administration best described the disposition of TXA. Actual body weight was the only statistically significant covariate identified, but inclusion into the model did not explain a substantial amount of the observed variability. Simulations of virtual pregnant individuals indicated minimal differences in TXA exposure between fixed and weight-based dosing regimens, supporting the use of fixed dosing. Intramuscular TXA was additionally found to be a viable alternative to intravenous administration, achieving similar target exposure metrics
CRISPR/Cas genome editing, functional genomics, and diagnostics for parasitic helminths
No full textFunctional genomics using CRISPR (Clustered Regulatory Interspaced Short Palindromic Repeats)/Cas (CRISPR-associated endonuclease)-based approaches has revolutionized biomedical sciences. Gene editing is also widespread in parasitology generally and its use is increasing in studies on helminths including flatworm and roundworm parasites. Here, we survey the progress, specifically with experimental CRISPR-facilitated functional genomics to investigate helminth biology and pathogenesis, and also with the burgeoning use of CRISPR-based methods to assist in diagnosis of helminth infections. We also provide an historical timeline of the introduction and uses of CRISPR in helminth species to date
Burden of Pain and Use of Analgesics in Patients With Chronic Hand Eczema-Findings From the Danish Skin Cohort
No full textBACKGROUND: Skin pain is a common symptom in patients with chronic hand eczema (CHE); however, its association with increased analgesic use has not been thoroughly investigated. OBJECTIVES: To examine analgesic use (paracetamol, nonsteroidal anti-inflammatory drugs [NSAIDs], opioids and gabapentin/pregabalin) among patients with CHE compared to a control group. METHODS: Data were obtained from the Danish Skin Cohort and the Danish national registries. Patients with dermatologist-verified CHE were systematically interviewed, including questions on skin and joint pain experienced within the past 7 days. RESULTS: The study included 1032 patients with CHE and 11 166 controls. We observed an overall higher utilisation of analgesics among patients with CHE compared to the control group. The highest utilisation of analgesics was observed for paracetamol (35.3% vs. 25.7%) followed by NSAIDs (21.5% vs. 15.3%). When stratified by disease severity, patients with moderate-to-very-severe CHE consistently used more analgesics compared to those with mild CHE. CONCLUSION: This study highlights the significant burden of pain in patients with CHE, as evidenced by their higher utilisation of analgesics compared to the general population in Denmark
Microglial IKKβ Alters Central and Peripheral Immune Activity at Distinct Time Points After Spinal Cord Injury
No full textAfter high-level spinal cord injury (SCI), persistently reactive microglia drive widespread plasticity throughout the neuraxis. Plasticity in the thoracolumbar cord, a region corresponding to the spinal sympathetic reflex (SSR) circuit, contributes to the development of sympathetic dysfunction and associated immune disorders. The transcription factor NF-κB is activated after SCI, promoting a pro-inflammatory loop by driving the expression of inflammatory mediators which further activate NF-κB signaling. We hypothesize that microglial NF-κB signaling via IKKβ modulates microglial activity, impacting central and peripheral immune activity related to the SSR circuit post-SCI. We assessed the effect of deleting canonical IKKβ in CNS-resident microglia, its impact on microglial activation, polarization, central transcriptional activity, and peripheral immune activity at 1- and 4-week post-SCI (wpi). Transcriptomic analyses reveal microglial IKKβ influences immune-related pathways in the thoracolumbar cord at 1 wpi. We show that inhibition of microglial NF-κB signaling via deletion of the activator IKKβ mitigates injury-induced increases in proinflammatory M1 microglia in the thoracolumbar cord at 4 wpi and increases the quantity of splenocytes at 1 wpi. This study advances our understanding of how microglial IKKβ signaling shapes the neuroimmune response and a peripheral immune organ after SCI
Mortality of uveal melanoma in children and adolescents from 2004 to 2020
No full textPURPOSE: To analyze epidemiological factors, tumor characteristics, and mortality rates in a cohort of pediatric patients with uveal melanoma (UM) from the National Cancer Database (NCDB). METHODS: In this retrospective cohort study, patients ≤20 years of age in the NCDB diagnosed with UM were included. Patients were identified using ICD-10 and ICD-O-3 codes. Main outcome measures were demographics, clinical features, and overall survival. Mortality was assessed using Kaplan-Meier survival analysis and Cox logistic regression. Significance was defined as P \u3c 0.05. RESULTS: Of 129 patients (68 females) included, mean age at diagnosis was 15.9 years. Most patients were White (91.5%), followed by Black (3.1%), and other races (5.4%). Tumors were primarily in the choroid (75.2%), followed by ciliary body (13.2%) or iris (7.0%). Kaplan Meier overall survival at 5-,10-, and 15-years was 93.6%, 80.3%, and 63.4%, respectively. Survival was worse with more advanced tumor T category (10-year survival 73.8% for cT1, 82.6% for cT2, 0% for cT4 [P = 0.022]) and American Joint Committee on Cancer stage (15-year survival 61.9% for stage I vs 45.5% for stage III [P \u3c 0.001]). Cox logistic regression analysis identified older age at presentation (OR = 1.618, P = 0.036) and non-White race (OR = 21.39, P = 0.045) as significant predictors of mortality. CONCLUSIONS: In our study cohort, older age, non-White race, and advanced tumor stage at diagnosis were associated with increased mortality in children and adolescents with UM. Adolescents have a similar prognosis to adults, whereas children have more favorable outcomes
Perspectives of Health Care Providers in Rural Côte d\u27Ivoire on the Influence of Traditional Beliefs on the Management of Rheumatic Heart Disease: A Qualitative Study
No full textINTRODUCTION: This article explores the positions of rural Côte d\u27Ivoire health care practitioners on the role of traditional beliefs in treating Rheumatic Heart Disease (RHD), a disease in which cardiovascular mortality is still high worldwide. Health care decisions in this region are hugely influenced by traditional African medicine (TAM). METHODS: A qualitative study was created using semi-structured interviews and focus groups with 24 health care experts. The themes and their significance were found using inductive thematic analysis. RESULTS: The integration of contemporary and TAM, community engagement and collaboration, improving patient education and awareness, consideration of cultural beliefs and practices in care delivery, and tackling delayed care and diagnosis are highlighted as the five main areas for development. DISCUSSION: The studies reveal possibilities for improving RHD control in rural Côte d\u27Ivoire. They emphasize the need for legislative action and cultural competency training to overcome challenges like cultural beliefs and budgetary constraints
