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Ethics Consultation Requests After Implementation of an Electronic Health Record Order

JCO Oncol Pract. 2022 Jun 24:OP2200174. doi: 10.1200/OP.22.00174. Online ahead of print.

ABSTRACT

PURPOSE: As the role of clinical ethics consultation in health care advances, there are calls to standardize the process of consultation. The Ethics Committee at Memorial Sloan Kettering Cancer Center (MSK) hypothesized that the process of requesting an ethics consultation could be improved by instituting an electronic health record (EHR) order for consultation requests. This report summarizes the impact of adopting an EHR order for ethics consultation requests at MSK.

METHODS: This retrospective review of all clinical ethics consultations requested at a tertiary cancer center from May 2017 to February 2020 spans 17 months before and after implementation of an electronic order for consultation requests. Summary statistics are presented using Pearson chi-square analyses with a significance level of 0.05.

RESULTS: There was a significant increase in the total number of consultation requests placed after implementation of the EHR order (n = 165, 0.08% of total patients) compared with before (n = 108, 0.05% of total patients; P = .007). The number of consults requested by providers from inpatient (P = .02) and outpatient (P = .04) settings significantly increased. The proportion of consults placed by medical versus nonmedical providers remained unchanged (P = .32).

CONCLUSION: In this large single-institution retrospective study, implementation of an EHR order for ethics consultation requests was associated with a significant increase in the number of consultation requests. Implementation of an electronic order may decrease barriers to ethics consultation in diverse practice settings. Further longitudinal, multicenter studies are needed to assess strategies to improve access to clinical ethics consultation for oncology patients.

PMID:35749678 | DOI:10.1200/OP.22.00174

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Photobiomodulation Effectiveness in Treating Androgenetic Alopecia

Photobiomodul Photomed Laser Surg. 2022 Jun;40(6):387-394. doi: 10.1089/photob.2022.0011.

ABSTRACT

Background: Androgenetic alopecia (AGA) is a genetically determined condition, which leads to progressive hair loss (HL) of the vertex, affects hair follicles, and promotes partial or total HL. It may be related to important psychological and social distress. Objective: The aim of the study was to evaluate the effects of photobiomodulation (PBM) in patients with AGA. Methods: Twenty-five men 20-54 years of age participated in this study. The irradiations were punctual, in contact mode, with 1 cm between each point covering the entire affected area. A red low-level laser (λ = 660 nm) (Recover®, MMOptics, São Carlos, Brazil) was used with 100 mW, 30 sec, and 3 J per point, twice a week on alternate days for 10 weeks. Evaluations were made by photographic records from the same area before any intervention (T1), after 5 weeks (T2), after 10 weeks (T3). Two blinded evaluators using the ImageJ® software assessed the hair density. Results: The hair density evaluation showed a significant increase in hair count between T1 and T2 (p = 0.0004) and between T1 and T3 (p = 0.0285), however between T2 and T3 no statistical difference was found (p > 0.05). Conclusions: PBM provides a stimulus for hair density in 5 weeks. After this period, we observed that after five extra sessions, it does not increase hair density in the treated region. This study showed that the PBM is effective and promoted safe results with a reduced number of sessions for the AGA treatment.

PMID:35749704 | DOI:10.1089/photob.2022.0011

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Defining Essential Childhood Cancer Medicines to Inform Prioritization and Access: Results From an International, Cross-Sectional Survey

JCO Glob Oncol. 2022 Jun;8:e2200034. doi: 10.1200/GO.22.00034.

ABSTRACT

PURPOSE: Access to essential cancer medicines is a major determinant of childhood cancer outcomes globally. The degree to which pediatric oncologists deem medicines listed on WHO’s Model List of Essential Medicines for Children (EMLc) essential is unknown, as is the extent to which such medicines are accessible on the front lines of clinical care.

METHODS: An electronic survey developed was distributed through the International Society of Pediatric Oncology mailing list to members from 87 countries. Respondents were asked to select 10 cancer medicines that would provide the greatest benefit to patients in their context; subsequent questions explored medicine availability and cost. Descriptive and bivariate statistics compared access to medicines between low- and lower-middle-income countries (LMICs), upper-middle-income countries (UMICs), and high-income countries (HICs).

RESULTS: Among 159 respondents from 44 countries, 43 (27%) were from LMICs, 79 (50%) from UMICs, and 37 (23%) from HICs. The top five medicines were methotrexate (75%), vincristine (74%), doxorubicin (74%), cyclophosphamide (69%), and cytarabine (65%). Of the priority medicines identified, 87% (27 of 31) are represented on the 2021 EMLc and 77% (24 of 31) were common to the lists generated by LMIC, UMIC, and HIC respondents. The proportion of respondents indicating universal availability for each of the top medicines ranged from 9% to 46% for LMIC, 25% to 89% for UMIC, and 67% to 100% for HIC. Risk of catastrophic expenditure was more common in LMIC (8%-20%), compared with UMIC (0%-28%) and HIC (0%).

CONCLUSION: Most medicines that oncologists deem essential for childhood cancer treatment are currently included on the EMLc. Barriers remain in access to these medicines, characterized by gaps in availability and risks of catastrophic expenditure for families that are most pronounced in low-income settings but evident across all income contexts.

PMID:35749676 | DOI:10.1200/GO.22.00034

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First report of Diplodia mutila causing wood necrosis in European hazelnut in Chile

Plant Dis. 2022 Jun 24. doi: 10.1094/PDIS-04-22-0869-PDN. Online ahead of print.

ABSTRACT

In Chile, the planted area of European hazelnut (Corylus avellana L.) reaches around 30,000 hectares, mainly concentrated in the central and southern area of the country where climate and soil provide a natural environment well suited to growing this species. Only a few diseases affect this nut tree in Chile. During the spring seasons in 2018 and 2020, European hazelnut plants (6 to 20% of incidence) exhibited wood necrosis and vascular discoloration of branches, with reduced growth, cankers and wilt branches, in orchards located in San Clemente and Curicó, Maule Region, Bulnes and El Carmen, Ñuble Region, Chile (36°45′-36°54′ S; 71°03′-72°26′ W). Symptomatic tissues were surface disinfected using a ~1% commercial sodium hypochlorite solution. Disinfected tissues were cut longitudinally, placed onto potato dextrose agar (PDA, Difco) plates, and incubated at 25 °C in the dark for 48 hours. Fungal hyphal tips were taken and placed on PDA medium. A fungal species was consistently isolated from these lignified tissues. The mycelium was initially translucent (turning white in appearance), while the mature mycelium was aerial, varying in color from pale to dark gray (Munsell color code: colony edge mycelium 6Y-6 4 / 5G and colony center mycelium B6-PB 7 / 5PB). The production of pycnidia and conidia was induced using pine needles in water agar medium and incubated in the dark for 10 days. Hyaline unicellular conidia of 25 ± 1.1 µm (range 23.9 to 26.1 µm) long and 11 ± 0.5 µm (Range 10.5 to 11.5 µm) wide (n = 50) were obtained from black pycnidia. Based on the cultural and morphological characteristics observed, the pathogen was identified as a possible species of the family Botryosphaeriaceae (20 isolates). Molecular techniques were used to identify the species of pathogen, and three isolates (F154, F199, and F167) were analyzed by using Multilocus sequence typing to confirm the identity of the pathogen. Genes ITS (internal transcribed spacer region), tef-1 (translation elongation factor 1-alpha) and β-tub (β-tubulin) were amplified using endpoint PCR, with primers ITS1/ITS4 (White et al., 1990), EF1-728F/EF1-986R (Carbone & Kohn, 1999) and Bt2a/Bt2b (Glass & Donaldson, 1995), respectively. The segments were sequenced using the same primers, deposited in Gen Bank, and the accession numbers for each isolate were OM993582, OM993583, ON003481 for ITS, ON054936, ON054938, ON054937 for tef1 and ON054939, ON054941, ON054940 for β-tub, respectively. A phylogenetic tree was constructed using the maximum likelihood statistical method with the Tamura-Nei model based on a concatenated dataset of ITS region, tef1 and β-tubulin gene using Mega-X, and the three Chilean isolates (F154, F199, and F167) formed a single clade with the reference isolates of Diplodia mutila (Fr.) Mont. BLAST algorithm analyses indicated 100% identity to D. mutila for ITS (accession NR_144906), for tef-1 (accession MK573559), and for β-tubulin (accession MG952719). The pathogenicity of the three isolates was validated through Koch’s postulates. For this purpose, a trial was established in 6-year-old European hazelnut plants cv. Tonda Di Giffoni. Ten healthy branches were individually inoculated using actively growing mycelial discs from each isolate, while a disc of PDA without fungus was used as a control. Holes of 5-mm diameter were inoculated, making sure the mycelium was in contact with the wood. Finally, the wounds were sealed with plastic film to prevent external contamination and improve humidity conditions. After 120 days, each branch was cut longitudinal-sectioned to verify the presence of wood necrosis which arose between 3.0 to 16.2 mm of length around the point of inoculation. No necrosis was observed in the control. To confirm pathogenicity, infected tissues were cut into small pieces with sterile knives and scalpels, and surface disinfected with a 1% sodium hypochlorite solution for 1 min. The disinfected tissues were placed on PDA medium and incubated at 25°C in the dark until fungal growth was observed. Hyphal tips were taken from the mycelia developed from the pieces of wood, and placed on PDA medium in order to obtain pure isolates. The pathogenicity of the D. mutila isolates F154 and F199 was observed in 100% of the inoculated branches, while isolate F167 showed symptoms in 85% of the branches. The reisolated strains showed similar mycelial growth and microscopic fungal structures to those observed in the isolates used for inoculation. This is the first report of D. mutila affecting European hazelnut in Chile. This fungus has been recently reported affecting hazelnut in Oregon, USA (Wiman et al., 2019), causing similar symptoms to those observed in our study. In addition, D. mutila has been reported infecting walnut in Chile (Diaz et al. 2018) and native forest trees, specifically Araucaria araucana in Chile (Besoain et al., 2017). The presence of D. mutila in commercial hazelnut orchards in Chile highlights the need for epidemiological studies in order to understand the characteristics and impact of this pathogen and, based on this, develop adequate phytosanitary programs for its control.

PMID:35749665 | DOI:10.1094/PDIS-04-22-0869-PDN

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Resynthesis of Transmasculine Voices to Assess Gender Perception as a Function of Testosterone Therapy

J Speech Lang Hear Res. 2022 Jun 24:1-16. doi: 10.1044/2022_JSLHR-21-00482. Online ahead of print.

ABSTRACT

PURPOSE: The goal of this study was to use speech resynthesis to investigate the effects of changes to individual acoustic features on speech-based gender perception of transmasculine voice samples following the onset of hormone replacement therapy (HRT) with exogenous testosterone. We hypothesized that mean fundamental frequency (f o) would have the largest effect on gender perception of any single acoustic feature.

METHOD: Mean f o, f o contour, and formant frequencies were calculated for three pairs of transmasculine speech samples before and after HRT onset. Sixteen speech samples with unique combinations of these acoustic features from each pair of speech samples were resynthesized. Twenty young adult listeners evaluated each synthesized speech sample for gender perception and synthetic quality. Two analyses of variance were used to investigate the effects of acoustic features on gender perception and synthetic quality.

RESULTS: Of the three acoustic features, mean f o was the only single feature that had a statistically significant effect on gender perception. Differences between the speech samples before and after HRT onset that were not captured by changes in f o and formant frequencies also had a statistically significant effect on gender perception.

CONCLUSION: In these transmasculine voice samples, mean f o was the most important acoustic feature for voice masculinization as a result of HRT; future investigations in a larger number of transmasculine speakers and on the effects of behavioral therapy-based changes in concert with HRT is warranted.

PMID:35749662 | DOI:10.1044/2022_JSLHR-21-00482

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Implication of Cerebral Small-Vessel Disease on Perihematomal Edema Progress in Patients With Hypertensive Intracerebral Hemorrhage

J Magn Reson Imaging. 2022 Jun 24. doi: 10.1002/jmri.28240. Online ahead of print.

ABSTRACT

BACKGROUND: Perihematomal edema (PHE) is an important determinant of outcome in spontaneous intracerebral hemorrhage (ICH) due to cerebral small vessel disease (CSVD). However, it is not known to date whether the severity of CSVD is associated with the extent of PHE progression in the acute phase.

PURPOSE: To investigate the association between the magnetic resonance imaging (MRI) marker of severe chronic-ischemia cerebral small vessel changes (sciSVC) and PHE growth or hematoma absorption among ICH patients with hypertension.

STUDY TYPE: Retrospective.

POPULATION: Three hundred and sixty-eight consecutive hypertensive ICH patients without surgical treatment.

FIELD STRENGTH/SEQUENCE: 3 T; spin-echo echo-planar imaging-diffusion-weighted imaging (DWI); T2-weighted, fluid-attenuated inversion recovery (FLAIR), T2*-weighted gradient-recalled echo and T1-weighted.

ASSESSMENT: The hematoma and PHE volumes at 24 hours and 5 days after symptom onset were measured in 121 patients with spontaneous ICH who had been administered standard medical treatment. Patients were grouped into two categories: those with sciSVC and those without. The imaging marker of sciSVC was defined as white matter hyperintensities (WMHs) Fazekas 2-3 combined cavitating lacunes.

STATISTICAL TESTS: Univariable analyses, χ2 test, Mann-Whitney U test, and multiple linear regression.

RESULTS: The presence of sciSVC (multiple lacunes and confluent WMH) had a significant negative influence on PHE progress (Beta = -5.3 mL, 95% CI = -10.3 mL to -0.3 mL), and hematoma absorption (Beta = -3.2 mL, 95% CI = -5.9 mL to -0.4 mL) compared to that observed in the absence of sciSVC, as determined by multivariate linear regression analysis.

DATA CONCLUSIONS: The presence of sciSVC (multiple lacunes and confluent WMH) negatively influenced hematoma absorption and PHE progress in ICH patients.

LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 3.

PMID:35749634 | DOI:10.1002/jmri.28240

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The problem of the risk of development of infection of surgical obstetric wound after cesarian section in women of the Kirov region

Klin Lab Diagn. 2022 Jun 20;67(6):374-379. doi: 10.51620/0869-2084-2022-67-6-374-379.

ABSTRACT

Over the past decade, the frequency of abdominal delivery in Russia has increased to an average of 25 %. The widespread use of abdominal delivery has not been without an increase in the incidence of complications. Among them is an infectious complication of a surgical obstetric wound (ICD O86.1) on the anterior abdominal wall after a caesarean section, which in some regions reaches 43 %. The development of complications is facilitated by various clinical and laboratory risk factors, the analysis of which in women of the Kirov region is the subject of this article. The analysis of clinical and laboratory risk factors was carried out on the basis of the data presented in the case histories of women hospitalized in the gynecological departments of the city of Kirov. Statistical data processing was carried out on a personal computer using the R-4.0.2 statistical program and Excel spreadsheets. When assessing the relevance of the problem for the Kirov region, it was found that the frequency of caesarean section over the past 10 years from 2011 to 2021 increased from 27,0 % to 34,0 %. The incidence of infectious complications in the Kirov region can be presented as follows: infection of the surgical obstetric wound (ICD O86.1) on the anterior abdominal wall after caesarean section – 27,0 %; peritonitis after caesarean section – 0,94 %-1,01 %; diffuse sepsis – 0,93 %-0,97 %. An important role, according to reports, in the addition of an infection of a surgical obstetric wound after cesarean section is played by the general morbidity and obstetric history in women with abdominal delivery, a detailed statistical analysis of which is presented in the materials of the article. The results of the study substantiated the problem of the development of an infection of a surgical obstetric wound after a caesarean section for the healthcare of the Kirov region, comparable to that for the healthcare of the entire Russian Federation. The analysis of clinical and laboratory risk factors showed the feasibility of using a comprehensive analysis of infection of a surgical wound after cesarean section at an early stage of its development to quickly resolve complications, reduce the duration of hospitalization of women after cesarean section, and subsequently preserve the reproductive function of a woman.

PMID:35749604 | DOI:10.51620/0869-2084-2022-67-6-374-379

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Health-related quality of life outcomes after neoadjuvant chemoradiotherapy for rectal cancer in NRG Oncology/NSABP R-04

Cancer. 2022 Jun 24. doi: 10.1002/cncr.34341. Online ahead of print.

ABSTRACT

BACKGROUND: There has been limited evaluation of health-related quality of life (HRQOL) in rectal cancer patients receiving neoadjuvant chemoradiotherapy. HRQOL outcomes in the National Surgical Adjuvant Breast and Bowel Project R-04 trial are examined in this article.

METHODS: Between 2004 and 2010, R-04 patients were invited to enroll in the HRQOL substudy, with questionnaires administered before randomization, after completion of chemoradiotherapy, and 1-year after surgery. HRQOL measures included: Functional Assessment of Cancer Therapy for colorectal cancer (FACT-C); Short Form-36v.2 Vitality scale; a treatment-specific symptom scale; and the FACT neurotoxicity scale. A 5-year postsurgery assessment was added to the protocol in 2012. Mixed-effects models examined neoadjuvant therapy treatment effects in the 1-year sample and models that explored associations of host factors and treatment impact on 5-year HRQOL.

RESULTS: A total of 1373 patients completed baseline HRQOL and at least one additional assessment. The average age was 58 years (range, 23-85 years), male (68%), and 59% Stage II. There were no statistically significant differences in HRQOL outcomes by treatment arm, but HRQOL worsened from baseline to postneoadjuvant chemoradiotherapy, with statistically significant effect sizes changes ranging from 0.6 (Vitality) to 0.9 (FACT-C Trial Outcome Index). Neurotoxicity was greater in the oxaliplatin-treated groups. Obese/overweight patients had statistically significantly worse FACT-C Trial Outcome Index scores than did underweight/normal weight groups. At 5 years, younger patients and those with normal baseline weight had statistically significantly better physical function scores and older patients had better mental health outcomes.

CONCLUSIONS: HRQOL did not differ across the four R-04 treatment arms; however, host factors explained significant variation in posttreatment HRQOL.

CLINICALTRIALS: gov: NCT00058474 (https://ClinicalTrials.gov/ct2/show/NCT00058474).

LAY SUMMARY: This article reports on the health-related quality of life (HRQOL) outcomes of patients treated with four different chemotherapy regimens combined with radiation in rectal cancer patients before definitive surgical treatment. There were no significant differences in HRQOL by treatment regimen, but all patients experienced decreased vitality (energy) and physical functioning. By 1 year after treatment, most patients had returned to pretreatment vitality and physical functioning, with the exception of increased neurotoxicity. In a subsample of patients assessed at 5 years after surgery, physical function was better in those who at pretreatment were younger, normal weight, and had better performance status. Mental function was better in those who at pretreatment were older and had better performance status.

PMID:35749631 | DOI:10.1002/cncr.34341

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MaxHiC: A robust background correction model to identify biologically relevant chromatin interactions in Hi-C and capture Hi-C experiments

PLoS Comput Biol. 2022 Jun 24;18(6):e1010241. doi: 10.1371/journal.pcbi.1010241. Online ahead of print.

ABSTRACT

Hi-C is a genome-wide chromosome conformation capture technology that detects interactions between pairs of genomic regions and exploits higher order chromatin structures. Conceptually Hi-C data counts interaction frequencies between every position in the genome and every other position. Biologically functional interactions are expected to occur more frequently than transient background and artefactual interactions. To identify biologically relevant interactions, several background models that take biases such as distance, GC content and mappability into account have been proposed. Here we introduce MaxHiC, a background correction tool that deals with these complex biases and robustly identifies statistically significant interactions in both Hi-C and capture Hi-C experiments. MaxHiC uses a negative binomial distribution model and a maximum likelihood technique to correct biases in both Hi-C and capture Hi-C libraries. We systematically benchmark MaxHiC against major Hi-C background correction tools including Hi-C significant interaction callers (SIC) and Hi-C loop callers using published Hi-C, capture Hi-C, and Micro-C datasets. Our results demonstrate that 1) Interacting regions identified by MaxHiC have significantly greater levels of overlap with known regulatory features (e.g. active chromatin histone marks, CTCF binding sites, DNase sensitivity) and also disease-associated genome-wide association SNPs than those identified by currently existing models, 2) the pairs of interacting regions are more likely to be linked by eQTL pairs and 3) more likely to link known regulatory features including known functional enhancer-promoter pairs validated by CRISPRi than any of the existing methods. We also demonstrate that interactions between different genomic region types have distinct distance distributions only revealed by MaxHiC. MaxHiC is publicly available as a python package for the analysis of Hi-C, capture Hi-C and Micro-C data.

PMID:35749574 | DOI:10.1371/journal.pcbi.1010241

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Fear of childbirth and mental health among lesbian, bisexual, transgender and queer people: a cross-sectional study

J Psychosom Obstet Gynaecol. 2022 Jun 24:1-6. doi: 10.1080/0167482X.2022.2089555. Online ahead of print.

ABSTRACT

Background: Most studies of fear of childbirth (FOC) are conducted on heterosexual cisgender pregnant populations of birth-giving parents. Among lesbian and bisexual women, as well as transgender and queer people (LBTQ), minority stress can add an extra layer to FOC. Gender binary and cisnormative assumptions leave it to the patient to educate and navigate healthcare providers, which can increase mental health problems.Objective: The aim of this study is to compare FOC and mental illness among expecting birth-giving parents and their partners in an LBTQ population.Materials and methods: This cross-sectional study recruited 80 self-identified pregnant LBTQ persons and their 54 non-pregnant partners at a LBTQ specialized antenatal clinic in a large Swedish city of over one million inhabitants. The survey included socio-demographic characteristics, sexual and gender orientation, obstetric history, previous mental health, previous trauma exposure and measures of FOC and mental health.Results: Levels of FOC were significantly higher for the pregnant participants (median W-DEQ 67.5) than for partners (median W-DEQ 60.0). The proportion of severe FOC was higher for pregnant participants (20.3%) than for partners (9.4%), although this difference was not statistically significant. Mental illness was significantly associated with FOC.Conclusion: The results add valuable information to our understanding of the specific needs of pregnant LBTQ people and their partners and may help us to develop healthcare in the future.

PMID:35749572 | DOI:10.1080/0167482X.2022.2089555