Publications by authors named "Albert Wu"

463 Publications

Patient Safety in the Eyes of Aspiring Healthcare Professionals: A Systematic Review of Their Attitudes.

Int J Environ Res Public Health 2021 Jul 15;18(14). Epub 2021 Jul 15.

Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy.

A culture of safety is important for the delivery of safe, high-quality care, as well as for healthcare providers' wellbeing. This systematic review aimed to describe and synthesize the literature on patient safety attitudes of the next generation of healthcare workers (health professional students, new graduates, newly registered health professionals, resident trainees) and assess potential differences in this population related to years of study, specialties, and gender. We screened four electronic databases up to 20 February 2020 and additional sources, including weekly e-mailed search alerts up to 18 October 2020. Two independent reviewers conducted the search, study selection, quality rating, data extraction, and formal narrative synthesis, involving a third reviewer in case of dissent. We retrieved 6606 records, assessed 188 full-texts, and included 31 studies. Across articles, healthcare students and young professionals showed overwhelmingly positive patient safety attitudes in some areas (e.g., teamwork climate, error inevitability) but more negative perceptions in other domains (e.g., safety climate, disclosure responsibility). Women tend to report more positive attitudes. To improve safety culture in medical settings, health professions educators and institutions should ensure education and training on patient safety.
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http://dx.doi.org/10.3390/ijerph18147524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306767PMC
July 2021

Gender Authorship Trends in the Ophthalmic Plastic and Reconstructive Surgery Literature.

Ophthalmic Plast Reconstr Surg 2021 Jul 21. Epub 2021 Jul 21.

Wills Eye Hospital, Philadelphia, Pennsylvania, U.S.A. Faculty of Medicine, McGill University, Montreal, Quebec, Canada Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, U.S.A.

Purpose: Despite increasing numbers of women oculoplastic surgeons, they remain underrepresented within the subspecialty. The purpose of this study was to analyze trends in gender authorship within the field of ophthalmic plastic and reconstructive surgery.

Methods: This retrospective observational study sampled articles published in Ophthalmic Plastic and Reconstructive Surgery (OPRS) and Orbit during the years 1985, 1995, 2005, 2015, and 2020. Data reviewed included article type, total number of authors, and the gender of each article's first and senior author.

Results: Nine hundred ninety-nine articles were analyzed, including 701 in OPRS and 298 in Orbit. Of 3,716 total authors, 1,151 (31%) were women, including 297 (29.7%) first authors, and 191 (21.5%) senior authors. Women authorship in OPRS in 1985 (first, 3.9%; senior, 3.3%; all, 3.2%) significantly increased by 2020 (first, 44.6%; senior, 27.9%; all, 42%). Women authorship in Orbit in 1985 (first, 0%; senior, 4.5%; all, 7.4%) also significantly increased by 2020 (first, 43.3%; senior, 34%; all, 42.9%). In a subanalysis of OPRS original investigations alone, women first authorship increased from 3.1% in 1985 to 35.8% in 2020 (p < 0.001) and women senior authorship increased from 4.3% in 1985 to 25% in 2020 (p = 0.001). In a subanalysis of Orbit original investigations alone, women first authorship increased from 0% in 1985 to 65.4% in 2020 (p < 0.001) and women senior authorship increased from 5.3% in 1985 to 42.3% in 2020 (p < 0.001).

Conclusions: Despite a significant increase in women authorship over the past several decades, women remain underrepresented within the oculoplastic literature, particularly in regard to senior authorship. When considering original investigations alone, there has been a significant increase in women first and senior authorship in both OPRS and Orbit.
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http://dx.doi.org/10.1097/IOP.0000000000002013DOI Listing
July 2021

Persons living with HIV treated in acute HIV infection report good health-related quality of life in Thailand.

AIDS Care 2021 Jun 30:1-8. Epub 2021 Jun 30.

SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.

The health-related quality of life (HRQoL) among persons living with HIV (PLWHA) who initiate ART during acute HIV infection (AHI) is not well studied. Participants in the SEARCH010/RV254 cohort initiated ART during AHI. They completed the Thai version of the World Health Organisation Quality of Life instrument-BREF (WHOQOL-BREF) and Patient Health Questionnaire-9 (PHQ-9) prior to ART initiation and 24 weeks later. Of 452 participants, 406 (90%) completed the WHOQOL-BREF. The median age was 26 years (IQR 22-31), and 98% were men. All WHOQOL-BREF domains demonstrated good internal consistency (Cronbach's alpha >0.70). Confirmatory factor analysis validated the WHOQOL-BREF model. 90% of Pearson correlations between domain scores and general facet items were >0.50. HRQoL in all domains was worse among those with at least moderately severe depression (PHQ-9 ≥ 10) (<0.0001), supporting discriminant validity. At 24 weeks, there was an improvement of scores in all domains (physical, psychological, social, and environmental) and general facet items (<0.0001), and the range of mean domain scores was 14.7-15.6 (SD 2.3-2.8). The majority of participants (58-63%) had improved HRQoL in the physical, psychological and environmental domains. It is concluded that HRQoL improves 6 months after initiation of ART in AHI, suggesting a benefit of early ART initiation.
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http://dx.doi.org/10.1080/09540121.2021.1944596DOI Listing
June 2021

Barriers experienced by organ procurement organizations in implementing the HOPE act and HIV-positive organ donation.

AIDS Care 2021 Jun 28:1-7. Epub 2021 Jun 28.

Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA.

In the seven years since the HIV Organ Policy Equity (HOPE) Act made HIV-positive organ donation to HIV-positive recipients legally permissible in the United States, there have been fewer HIV-positive organ donations than expected. Organ procurement organizations (OPOs) play a key role in the transplant system and barriers at OPOs may be partly responsible for the relatively low number of HIV-positive donors. To understand potential OPO barriers, we conducted semi-structured interviews with 20 OPO staff members. Interviews were recorded, transcribed, and analyzed using a conventional content analytic approach with two coders. OPO staff had high levels of knowledge about HOPE. Many had evaluated referrals of HIV-positive donors and approached families for authorization. Barriers to HIV-positive organ recovery identified included obtaining authorization for donation, potentially disclosing HIV status to next-of-kin, and fear of HIV infection among those engaged in organ recovery. Strategies to overcome these barriers include providing continuing education about the specific tasks required to procure organs from HIV-positive donors, implementing targeted interventions to reduce fear of infection, and developing partnerships with HIV advocacy and care organizations. Given the central role OPOs play, HIV-positive donations are unlikely to occur in significant numbers unless these barriers can be overcome.
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http://dx.doi.org/10.1080/09540121.2021.1945999DOI Listing
June 2021

Response to Letter: Delivering Complex Care: Designing for Patients and Physicians.

J Gen Intern Med 2021 Jun 18. Epub 2021 Jun 18.

Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

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http://dx.doi.org/10.1007/s11606-021-06958-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212902PMC
June 2021

Gender of Award Recipients in Major Ophthalmology Societies.

Am J Ophthalmol 2021 Jun 5. Epub 2021 Jun 5.

Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA. Electronic address:

Purpose: To assess the gender distribution of major ophthalmology society awards.

Design: Retrospective, observational study.

Methods: The study population included award recipients from nine ophthalmological societies: American Academy of Ophthalmology (AAO), American Association for Pediatric Ophthalmology and Strabismus (AAPOS), American Glaucoma Society (AGS), American Society of Cataract and Refractive Surgery (ASCRS), American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), American Society of Retina Specialists (ASRS), American Uveitis Society (AUS), Cornea Society, and North American Neuro-Ophthalmology Society (NANOS). A gender-specific pronoun and photograph of each award recipient were extracted from professional websites to assign their gender. Main outcome measures were gender distribution by award society, year (1970-2020), type (lectureship or not), category (achievement, education, research contribution, research item, international member achievement, public service - global health, service to society), and training level.

Results: Out of 2,150 recipients for 78 awards, 1,606 (74.7%) were men and 544 (25.3%) were women. The proportion of women recipients increased from 0% in 1970 to 33.2% in 2020 (P<0.001). Women representation varied within each society (P<0.01), with ASCRS having the highest percentage (40.8%). Women received 11.0% of awards accompanied by a lecture. Women received significantly greater research-related awards than achievement or service awards. Awards for trainees and early-career ophthalmologists had a greater proportion of women (39.8%) than the rest of the awards (21.5%) (P<0.001).

Conclusions: Overall women received awards (25.3%) at a higher prevalence than the average 1970-2020 American gender distributions of ophthalmologists. However, women are still underrepresented in many award categories and subspecialties.
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http://dx.doi.org/10.1016/j.ajo.2021.05.021DOI Listing
June 2021

Developing a protocol for adapting multimedia patient-reported outcomes measures for low literacy patients.

PLoS One 2021 4;16(6):e0252684. Epub 2021 Jun 4.

Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland, United States of America.

Background: Self-administration of patient-reported outcomes measures (PROMs) by patients with low literacy is a methodologic and implementation challenge. There is an increasing emphasis on patient-centered care and wider adoption of PROMs to understand outcomes and measure healthcare quality. However, there is a risk that the use of PROMs could perpetuate health disparities unless they are implemented in an inclusive fashion. We present a protocol to adapt validated, text-based PROMs to a multimedia format (mPROMs) to optimize self-administration in populations with limited literacy. We describe the processes used to develop the protocol and the planned protocol implementation.

Methods/design: Our study protocol development was guided by the International Quality of Life Assessment (IQOLA) protocol for translating and culturally adapting PROMs to different languages. We used the main components of IQOLA's protocol to generate a conceptual framework to guide development of a Multimedia Adaptation Protocol (MAP). The MAP, which incorporates human-centered design (HCD) and takes a community-engaged research approach, includes four stages: forward adaptation, backward adaptation, qualitative evaluation, and validation. The MAP employs qualitative and quantitative methods including observation, cognitive and discovery interviews, ideation workshops, prototyping, user testing, co-creation interviews, and psychometric testing. An iterative design is central to the MAP and consistent with both the IQOLA protocol and HCD processes. We will pilot test and execute the MAP to adapt the Patient Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Short Form for use in a mixed literacy hand and upper extremity patient population in Baltimore, Maryland.

Discussion: The MAP provides an approach for adapting PROMs to a multimedia format. We encourage others to evaluate and test this approach with other questionnaires and patient populations. The development and use of mPROMs has the potential to expand our ability to accurately capture PROs in limited literacy populations and promote equity in PRO measurement.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252684PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177453PMC
June 2021

Promoting the Psychological Well-Being of Healthcare Providers Facing the Burden of Adverse Events: A Systematic Review of Second Victim Support Resources.

Int J Environ Res Public Health 2021 05 11;18(10). Epub 2021 May 11.

Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Policlinico G.B. Rossi Piazzale L.A. Scuro 10, 37134 Verona, Italy.

Given the negative impact of adverse events on the wellbeing of healthcare providers, easy access to psychological support is crucial. We aimed to describe the types of support resources available in healthcare organizations, their benefits for second victims, peer supporters' experiences, and implementation challenges. We also explored how these resources incorporate aspects of Safety I and Safety II. We searched six databases up to 19 December 2019 and additional literature, including weekly search alerts until 21 January 2021. Two reviewers independently performed all methodological steps (search, selection, quality assessment, data extraction, formal narrative synthesis). The 16 included studies described 12 second victim support resources, implemented between 2006 and 2017. Preliminary data indicated beneficial effects not only for the affected staff but also for the peer responders who considered their role to be challenging but gratifying. Challenges during program implementation included persistent blame culture, limited awareness of program availability, and lack of financial resources. Common goals of the support programs (e.g., fostering coping strategies, promoting individual resilience) are consistent with Safety II and may promote system resilience. Investing in second victim support structures should be a top priority for healthcare institutions adopting a systemic approach to safety and striving for just culture.
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http://dx.doi.org/10.3390/ijerph18105080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151650PMC
May 2021

Massive open online course (MOOC) learning builds capacity and improves competence for patient safety among global learners: A prospective cohort study.

Nurse Educ Today 2021 Sep 26;104:104984. Epub 2021 May 26.

School of Nursing, Johns Hopkins University, Baltimore, MD, USA; School of Medicine, Johns Hopkins University, Baltimore, MD, USA.

Background: Education about patient safety has historically been limited in health professionals curricula and largely inaccessible to the general public. We developed a massive open online course (MOOC), The Science of Safety in Healthcare, to present the foundational patient safety principles to a broad global audience of health professionals, learners, and patients interested in patient safety.

Objectives: To describe the Science of Safety in Healthcare MOOC, its effects on patient safety competence, and the satisfaction of course participants.

Methods: The five-week video-based course was delivered in 2013 and 2014, and was organized in five modules: 1) overview of science of safety and safety culture, 2) enabling and contextual factors that influence patient safety and quality, 3) methods to improve safety and quality, 4) translating evidence intro practice and leading change, and 5) summary and opportunities for capacity building. Each module had three or four segments. Participants were introduced to key concepts, and tools and skills to promote patient safety. Participants completed the Health Professional Education in Patient Safety Survey (H-PEPSS), which measures patient safety competence, and a course satisfaction survey. Pre- and post- course H-PEPSS scores were compared using paired t-tests. Course satisfaction surveys were administered at the completion of the course and six months later.

Results: A total of 20,957, and 9679 participants enrolled in the course in 2013 and 2014, respectively. About half of participants were 25-44 years old (57%), and female (54%). Participants joined from over 100 countries. The majority were health professionals (61%) or health professionals in training (7%). Mean H-PEPSS scores improved after course completion, with significant increases on all survey domains in both years (p < 0.01). Mean score differences were: Teamwork 0.68 (95% CI: 0.64, 0.71), Communication 0.70 (95% CI: 0.66, 0.73), Managing Risk 0.79 (95% CI: 0.76, 0.82), Human Environment 0.64 (95% CI: 0.61, 0.68), Recognizing and Responding 0.64 (95% CI: 0.61, 0.68), and Culture 0.72 (95% CI: 0.68, 0.75). About 8% of participants in each cohort earned a certificate of completion. At 6-months post-course, the majority of the participants agreed or agreed strongly that the course content was useful (93%) and that the course positively influenced their clinical practice (69%) and communication (84%).

Conclusions: The MOOC course allowed educators to reach a large, diverse audience. The course was well-received and participants reported a significant increase in patient safety competence. As with most MOOCs, rates of completion were low.
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http://dx.doi.org/10.1016/j.nedt.2021.104984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316390PMC
September 2021

Distinctions in the Management, Patient Impact, and Clinical Profiles of Pachyonychia Congenita Subtypes.

Skin Appendage Disord 2021 Apr 5;7(3):194-202. Epub 2021 Feb 5.

Department of Dermatology, Weill Cornell Medicine, New York, New York, USA.

Introduction: Pachyonychia congenita (PC) is a rare dermatosis that confers lifelong physical and emotional morbidities in affected patients. However, the clinical findings, treatments, and psychosocial impact of this disease have not been adequately described. The International PC Research Registry (IPCRR), a multinational initiative to collect data on PC patients, has allowed an opportunity to distinguish the salient features of this disease. We aimed to characterize the breadth and extent of nail disease, treatments, and quality of life in PC patients, and to describe any significant differences in clinical presentation or treatment of PC subtypes.

Methods: The most recent IPCRR patient survey data consisting of an 857-response questionnaire and a 102-response addendum were analyzed in a retrospective analysis. The survey data were collected as part of a multinational, multicenter initiative and comprise the largest representative population of PC to date. Participants (survey respondents) were included in the study based on questionnaire responses and a genetic confirmation of having a PC subtype.

Results: A total of 857 survey responses were collected. Genetic variations among PC subtypes influence nail disease onset and severity of symptoms. Nail disease negatively impacts patients' emotional health, especially during the adolescent and young adult years. Nail treatment tools vary little in terms of effectiveness and acquired infection rates.

Conclusion And Discussion: Patients with different PC subtypes have distinct clinical nail presentations and psychosocial impact. Genetic testing should be used to confirm PC diagnoses. Further characterization of PC, especially the rarer subtypes, may allow for more individualized patient education.
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http://dx.doi.org/10.1159/000513340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138248PMC
April 2021

Determination of Patient Sentiment and Emotion in Ophthalmology: Infoveillance Tutorial on Web-Based Health Forum Discussions.

J Med Internet Res 2021 May 17;23(5):e20803. Epub 2021 May 17.

Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, United States.

Background: Clinical data in social media are an underused source of information with great potential to allow for a deeper understanding of patient values, attitudes, and preferences.

Objective: This tutorial aims to describe a novel, robust, and modular method for the sentiment analysis and emotion detection of free text from web-based forums and the factors to consider during its application.

Methods: We mined the discussion and user information of all posts containing search terms related to a medical subspecialty (oculoplastics) from MedHelp, the largest web-based platform for patient health forums. We used data cleaning and processing tools to define the relevant subset of results and prepare them for sentiment analysis. We executed sentiment and emotion analyses by using IBM Watson Natural Language Understanding to generate sentiment and emotion scores for the posts and their associated keywords. The keywords were aggregated using natural language processing tools.

Results: Overall, 39 oculoplastic-related search terms resulted in 46,381 eligible posts within 14,329 threads. Posts were written by 18,319 users (117 doctors; 18,202 patients) and included 201,611 associated keywords. Keywords that occurred ≥500 times in the corpus were used to identify the most prominent topics, including specific symptoms, medication, and complications. The sentiment and emotion scores of these keywords and eligible posts were analyzed to provide concrete examples of the potential of this methodology to allow for a better understanding of patients' attitudes. The overall sentiment score reflects a positive, neutral, or negative sentiment, whereas the emotion scores (anger, disgust, fear, joy, and sadness) represent the likelihood of the presence of the emotion. In keyword grouping analyses, medical signs, symptoms, and diseases had the lowest overall sentiment scores (-0.598). Complications were highly associated with sadness (0.485). Forum posts mentioning body parts were related to sadness (0.416) and fear (0.321). Administration was the category with the highest anger score (0.146). The top 6 forum subgroups had an overall negative sentiment score; the most negative one was the Neurology forum, with a score of -0.438. The Undiagnosed Symptoms forum had the highest sadness score (0.448). The least likely fearful posts were those from the Eye Care forum, with a score of 0.260. The overall sentiment score was much more negative before the doctor replied. The anger, disgust, fear, and sadness emotion scores decreased in likelihood, whereas joy was slightly more likely to be expressed after doctors replied.

Conclusions: This report allows physicians and researchers to efficiently mine and perform sentiment analysis on social media to better understand patients' perspectives and promote patient-centric care. Important factors to be considered during its application include evaluating the scope of the search; selecting search terms and understanding their linguistic usages; and establishing selection, filtering, and processing criteria for posts and keywords tailored to the desired results.
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http://dx.doi.org/10.2196/20803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167608PMC
May 2021

Phases of psychological response in COVID-19: A preliminary heuristic.

Am J Disaster Med 2021 Winter;16(1):5-12

Professor and Director, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.

Objective: To explore the putative phases of the psychological response to disaster: preimpact, impact, heroic, honeymoon, disillusionment, and recovery, and make recommendations for corresponding interventions.

Conclusions: Disasters such as the COVID-19 pandemic are often characterized by chaos and uncertainty. As a result, public health disaster planning and response represent formidable challenges. Although disasters can result from a wide array of hazards, regardless of the agent at work, they may follow a rather predictable trajectory of psychological phases. A heuristic of those phases can provide an opportunity for a more organized disaster mental health response and more efficient utilization of scarce resources.
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http://dx.doi.org/10.5055/ajdm.2021.0381DOI Listing
May 2021

Molecular mechanisms and treatments for ocular symblephara.

Surv Ophthalmol 2021 Apr 29. Epub 2021 Apr 29.

Department of Ophthalmology, Stanford University School of Medicine. Electronic address:

There are currently no effective methods to prevent or durably treat ocular symblephara, the adhesions between the palpebral and bulbar conjunctiva. How symblephara form at the molecular level is largely unknown. We present here an overview of current clinical symblephara treatments and describe potential molecular mechanisms behind conjunctival adhesion formation that may inform future symblephara treatment and prevention options. Understanding how symblephara form at the molecular level will facilitate treatment development. Preventative therapies may be possible by targeting symblephara progenitor cells immediately after injuries, while novel therapeutics should be aimed at modulating TGF-β pathways and effector cells in conjunctival scarring to treat symblephara formation more effectively.
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http://dx.doi.org/10.1016/j.survophthal.2021.04.008DOI Listing
April 2021

Development of a Patient Reported Measure of Experimental Transplants with HIV and Ethics in the United States (PROMETHEUS).

J Patient Rep Outcomes 2021 Mar 18;5(1):28. Epub 2021 Mar 18.

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background: Transplantation of HIV-positive (HIV+) donor organs for HIV+ recipients (HIV D+/R+) is now being performed as research in the United States, but raises ethical concerns. While patient-reported outcome measures are increasingly used to evaluate clinical interventions, there is no published measure to aptly capture patients' experiences in the unique context of experimental HIV D+/R+ transplantation. Therefore, we developed PROMETHEUS (patient-reported measure of experimental transplants with HIV and ethics in the United States). To do so, we created a conceptual framework, drafted a pilot battery using existing and new measures related to this context, and refined it based on cognitive and pilot testing. PROMETHEUS was administered 6-months post-transplant in a clinical trial evaluating these transplants. We analyzed data from the first 20 patient-participants for reliability and validity by calculating Cronbach's alpha and reviewing item performance characteristics.

Results: PROMETHEUS 1.0 consisted of 29 items with 5 putative subscales: Emotions; Trust; Decision Making; Transplant; and Decision Satisfaction. Overall, responses were positive. Cronbach's alpha was > 0.8 for all subscales except Transplant, which was 0.38. Two Transplant subscale items were removed due to poor reliability and construct validity.

Conclusions: We developed PROMETHEUS to systematically capture patient-reported experiences with this novel experimental transplantation program, nested it in an actual clinical trial, and obtained preliminary data regarding its performance.
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http://dx.doi.org/10.1186/s41687-021-00297-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973329PMC
March 2021

Development and Preliminary Validation of the Patient-Reported Outcome Measure for Vascular Malformation Questionnaire: A Prospective Cohort Study.

J Vasc Interv Radiol 2021 05 4;32(5):683-690.e4. Epub 2021 Mar 4.

Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, The Johns Hopkins Hospital, Baltimore, Maryland. Electronic address:

Purpose: To develop and validate the Patient-Reported Outcome Measure for Vascular Malformation (PROVAM) questionnaire to assess the health-related quality of life in patients with vascular malformations.

Materials And Methods: We developed and validated PROVAM using a mixed methods design during a prospective clinical trial at a vascular anomalies clinic. From July 2019 to February 2020, 108 consecutive patients completed 130 questionnaires. The 30-item instrument assessed the domains of pain, emotional/social well-being, functional impact, and treatment satisfaction. Two additional items assessed ease of understanding and relevance. The primary outcomes of instrument reliability and validity were evaluated across several indices. The secondary outcome of responsiveness evaluated total score changes for patients who completed questionnaires both before and after treatment.

Results: Instrument reliability, as measured by Cronbach alpha, was ≥0.79 for pain, emotional/social well-being, and functional impact domains. Primary domain structure was confirmed by factor analysis (P <. 001) and convergent construct validity for all but 1 Likert scale item. In the subgroup analysis of 13 participants who completed PROVAM before and after treatment, instrument responsiveness, as measured by the total score, showed a significant decrease (median, -10 points; interquartile range [IQR], -3 to -16; P = .04). Participants found the questions easy to understand (median, 5 points; IQR, 4-5 on a 5-point scale) and relevant (median score, 4; IQR, 3-5).

Conclusions: Preliminary data support the reliability and validity of PROVAM in measuring the health-related quality of life in patients with vascular malformations.
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http://dx.doi.org/10.1016/j.jvir.2021.01.263DOI Listing
May 2021

Impact of COVID-19 on longitudinal ophthalmology authorship gender trends.

Graefes Arch Clin Exp Ophthalmol 2021 Mar 3;259(3):733-744. Epub 2021 Feb 3.

Department of Ophthalmology, Stanford University School of Medicine, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA.

Background: The COVID-19 pandemic increased the gender gap in academic publishing. This study assesses COVID-19's impact on ophthalmology gender authorship distribution and compares the gender authorship proportion of COVID-19 ophthalmology-related articles to previous ophthalmology articles.

Methods: This cohort study includes authors listed in all publications related to ophthalmology in the COVID-19 Open Research Dataset and CDC COVID-19 research database. Articles from 65 ophthalmology journals from January to July 2020 were selected. All previous articles published in the same journals were extracted from PubMed. Gender-API determined authors' gender.

Results: Out of 119,457 COVID-19-related articles, we analyzed 528 ophthalmology-related articles written by 2518 authors. Women did not exceed 40% in any authorship positions and were most likely to be middle, first, and finally, last authors. The proportions of women in all authorship positions from the 2020 COVID-19 group (29.6% first, 31.5% middle, 22.1% last) are significantly lower compared to the predicted 2020 data points (37.4% first, 37.0% middle, 27.6% last) (p < .01). The gap between the proportion of female authors in COVID-19 ophthalmology research and the 2020 ophthalmology-predicted proportion (based on 2002-2019 data) is 6.1% for overall authors, 7.8% for first authors, and 5.5% for last and middle authors. The 2020 COVID-19 authorship group (1925 authors) was also compared to the 2019 group (33,049 authors) based on journal category (clinical/basic science research, general/subspecialty ophthalmology, journal impact factor).

Conclusions: COVID-19 amplified the authorship gender gap in ophthalmology. When compared to previous years, there was a greater decrease in women's than men's academic productivity.
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http://dx.doi.org/10.1007/s00417-021-05085-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857347PMC
March 2021

What We Have Learned from Two Decades of Epidemics and Pandemics: A Systematic Review and Meta-Analysis of the Psychological Burden of Frontline Healthcare Workers.

Psychother Psychosom 2021 1;90(3):178-190. Epub 2021 Feb 1.

Section of Clinical Psychology, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy,

In light of the current coronavirus disease 2019 (COVID-19) pandemic and potential future infectious disease outbreaks, a comprehensive understanding of the negative effects of epidemics and pandemics on healthcare workers' mental health could inform appropriate support interventions. Thus, we aimed to synthesize and quantify the psychological and psychosomatic symptoms among frontline medical staff. We searched four databases up to March 19, 2020 and additional literature, with daily search alerts set up until October 26, 2020. Studies reporting psychological and/or psychosomatic symptoms of healthcare workers caring for patients with severe acute respiratory syndrome, H1N1, Ebola, Middle East respiratory syndrome, or COVID-19 were eligible for inclusion. Two reviewers independently conducted the search, study selection, quality appraisal, data extraction, and synthesis and involved a third reviewer in case of disagreement. We used random effects modeling to estimate the overall prevalence rates of psychological/psychosomatic symptoms and the I2 statistic. We included 86 studies, reporting data from 75,991 participants. Frontline staff showed a wide range of symptoms, including concern about transmitting the virus to the family (60.39%, 95% CI 42.53-76.96), perceived stress (56.77%, 95% CI 34.21-77.95), concerns about own health (45.97%, 95% CI 31.08-61.23), sleeping difficulties (39.88%, 95% CI 27.70-52.72), burnout (31.81%, 95% CI 13.32-53.89), symptoms of depression (25.72%, 95% CI 18.34-33.86), symptoms of anxiety (25.36%, 95% CI 17.90-33.64), symptoms of posttraumatic stress disorder (24.51%, 95% CI 18.16-31.46), mental health issues (23.11%, 95% CI 15.98-31.10), and symptoms of somatization (14.68%, 95% CI 10.67-19.18). We found consistent evidence for the pervasive and profound impact of large-scale outbreaks on the mental health of frontline healthcare workers. As the CO-VID-19 crisis continues to unfold, guaranteeing easy access to support structures for the entire healthcare workforce is vitally important.
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http://dx.doi.org/10.1159/000513733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018214PMC
May 2021

Cost analysis of the use of buffered lidocaine 1%, epinephrine 1:100,000 with sodium bicarbonate in a 3:1 ratio over a 9:1 ratio.

J Am Acad Dermatol 2021 Jul 29;85(1):e21-e22. Epub 2021 Jan 29.

Department of Dermatology, Metropolitan Hospital, New York, New York.

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http://dx.doi.org/10.1016/j.jaad.2020.12.091DOI Listing
July 2021

National trends in gender and ethnicity in dermatology training: 2006 to 2018.

J Am Acad Dermatol 2021 Jan 28. Epub 2021 Jan 28.

Department of Dermatology, Weill Cornell Medicine, New York, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.01.077DOI Listing
January 2021

RISE: Exploring Volunteer Retention and Sustainability of a Second Victim Support Program.

J Healthc Manag 2021 Jan-Feb 01;66(1):19-32

Center for Health Services and Outcomes Research, Johns Hopkins Bloomberg School of Public Health.

Executive Summary: The Resilience In Stressful Events (RISE) program that supports healthcare professionals traumatized by stressful clinical events has had a stable, volunteer-based membership since its inception in 2011 at Johns Hopkins Hospital. For this study, we explored RISE members' perceptions of the program that contribute to their retention and the program's sustainability. We distributed a survey with quantitative and qualitative elements to assess perceptions in seven domains of interest. The response rate was 100%. Pearson chi-squared tests established statistical associations among quantitative variables. Qualitative data were explored using content analysis. Of 27 respondents, 19 had been members for 3 or more years. The training completion percentage was 100%, and the annual turnover percentage was 12%. Members found their duties to be meaningful (100%), personally satisfying (96%), and positively impactful (93%). A total of 89% reported confidence in their competency to perform RISE duties, 84% in their autonomy, and 56% in their personal resilience; 28% reported some burnout from RISE duties. Cronbach's α for these domain scores ranged from 0.65 to 0.97. Content analysis also revealed positive perceptions of RISE volunteering and personal empowerment. Members indicated a personal affinity with RISE and gains in energy and enjoyment from their membership. Contributing factors to volunteer retention may include members' perceptions that RISE builds valued skills and supports their affinity for others.
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http://dx.doi.org/10.1097/JHM-D-19-00264DOI Listing
January 2021

Probing sulfatide-tissue lectin recognition with functionalized glycodendrimersomes.

iScience 2021 Jan 10;24(1):101919. Epub 2020 Dec 10.

Institute of Physiological Chemistry, Faculty of Veterinary Medicine, Ludwig-Maximilians-University Munich, Veterinärstr. 13, 80539 Munich, Germany.

The small 3--sulfated galactose head group of sulfatides, an abundant glycosphingolipid class, poses the (sphinx-like) riddle on involvement of glycan bridging by tissue lectins (sugar code). First, synthesis of head group derivatives for functionalization of amphiphilic dendrimers is performed. Aggregation of resulting (biomimetic) vesicles, alone or in combination with lactose, demonstrates bridging by a tissue lectin (galectin-4). Physiologically, this can stabilize glycolipid-rich microdomains (rafts) and associate sulfatide-rich regions with specific glycoproteins. Further testing documents importance of heterobivalency and linker length. Structurally, sulfatide recognition by galectin-8 is shown to involve sphingosine's OH group as substitute for the 3'-hydroxyl of glucose of lactose. These discoveries underscore functionality of this small determinant on biomembranes intracellularly and on the cell surface. Moreover, they provide a role model to examine counterreceptor capacity of more complex glycans of glycosphingolipids and to start their bottom-up glycotope surface programming.
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http://dx.doi.org/10.1016/j.isci.2020.101919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773886PMC
January 2021

The Role of Institution-Based Peer Support for Health Care Workers Emotionally Affected by Workplace Violence.

Jt Comm J Qual Patient Saf 2021 03 17;47(3):146-156. Epub 2020 Nov 17.

Background: Academic health centers with peer support programs have identified a significant increase in requests linked to workplace violence (WPV) exposure. However, no known research has focused on supportive interventions for health care workers exposed to WPV. This study aimed to describe the expansion of two long-standing programs-University of Missouri Health Care's (MU Health Care) forYOU Team, The Johns Hopkins Hospital's (JHH) RISE (Resilence in Stressful Events) team-to WPV support, retrospectively summarize the related data, and share generalizable lessons.

Methods: A retrospective extraction and summary of the forYOU and RISE databases and the MU Health Care and JHH databases was performed tracking hospitalwide data on WPV. Two cases describe the experience of WPV victims.

Results: Between 2009 and 2019, forYOU documented 834 peer support interventions, 75 (9.0%) related to WPV (57 one-on-one encounters, 18 group support encounters). In 2018-2019 the forYOU Team experienced an increase in WPV encounters, with 43 of the team's activations (20%) related to WPV. Between 2011 and 2019, RISE recorded 367 peer support interventions, 80 (21.8%) of which were WPV-related (61 group support encounters, 19 one-on-one encounters). Forty-eight (60.0%) of these 80 encounters occurred in 2018-2019 alone, marking an increase in WPV encounters. Nurses were the most frequent callers of both programs.

Conclusion: This study indicates the growing need for health care workers' support in the aftermath of WPV exposure in today's health care environment. Health care institutions should take a holistic approach to WPV, including timely access to interventional peer support programs.
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http://dx.doi.org/10.1016/j.jcjq.2020.11.005DOI Listing
March 2021

A cross-sectional study of onychotillomania and onychophagia in graduate students.

Dermatol Ther 2021 01 18;34(1):e14639. Epub 2020 Dec 18.

Department of Dermatology, Weill Cornell Medicine, New York, NY, USA.

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http://dx.doi.org/10.1111/dth.14639DOI Listing
January 2021

Leveraging Free Volume Manipulation to Improve the Membrane Separation Performance of Amine-Functionalized PIM-1.

Angew Chem Int Ed Engl 2021 Mar 12;60(12):6593-6599. Epub 2021 Feb 12.

Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, 02139, USA.

Gas-separation polymer membranes display a characteristic permeability-selectivity trade-off that has limited their industrial use. The most comprehensive approach to improving performance is to devise strategies that simultaneously increase fractional free volume, narrow free volume distribution, and enhance sorption selectivity, but generalizable methods for such approaches are exceedingly rare. Here, we present an in situ crosslinking and solid-state deprotection method to access previously inaccessible sorption and diffusion characteristics in amine-functionalized polymers of intrinsic microporosity. Free volume element (FVE) size can be increased while preserving a narrow FVE distribution, enabling below-upper bound polymers to surpass the H /N , H /CH , and O /N upper bounds and improving CO -based selectivities by 200 %. This approach can transform polymers into chemical analogues with improved performance, thereby overcoming traditional permeability-selectivity trade-offs.
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http://dx.doi.org/10.1002/anie.202012441DOI Listing
March 2021

Reply re: "COVID-19 Recommendations From Ophthalmic and Plastic Reconstructive Surgery Societies Worldwide".

Ophthalmic Plast Reconstr Surg 2020 Nov/Dec;36(6):624-625

Department of Ophthalmology, Stanford University School of Medicine, Stanford, California.

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http://dx.doi.org/10.1097/IOP.0000000000001856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204576PMC
November 2020

Leadership Principles to Decrease Psychological Casualties in COVID-19 and Other Disasters of Uncertainty.

Disaster Med Public Health Prep 2020 Oct 22:1-3. Epub 2020 Oct 22.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.

Coronavirus disease (COVID-19) is a "disaster of uncertainty" with ambiguity about its nature and trajectory. These features amplify its psychological toxicity and increase the number of psychological casualties it inflicts. Uncertainty was fueled by lack of knowledge about the lethality of a disaster, its duration, and ambiguity in messaging from leaders and health care authorities. Human resilience can have a buffering effect on the psychological impact. Experts have advocated "flattening the curve" to slow the spread of the infection. Our strategy for crisis leadership is focused on flattening the rise in psychological casualties by increasing resilience among health care workers. This paper describes an approach employed at Johns Hopkins to promote and enhance crisis leadership. The approach is based on 4 factors: vision for the future, decisiveness, effective communication, and following a moral compass. We make specific actionable recommendations for implementing these factors that are being disseminated to frontline leaders and managers. The COVID-19 pandemic is destined to have a strong psychological impact that extends far beyond the end of quarantine. Following these guidelines has the potential to build resilience and thus reduce the number of psychological casualties and speed the return to normal - or at least the new normal in the post-COVID world.
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http://dx.doi.org/10.1017/dmp.2020.395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873453PMC
October 2020

Effect of a Multifactorial Fall Injury Prevention Intervention on Patient Well-Being: The STRIDE Study.

J Am Geriatr Soc 2021 Jan 9;69(1):173-179. Epub 2020 Oct 9.

Brigham and Women's Hospital, Boston, Massachusetts, USA.

Background/objectives: In the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study, a multifactorial intervention was associated with a nonsignificant 8% reduction in time to first serious fall injury but a significant 10% reduction in time to first self-reported fall injury relative to enhanced usual care. The effect of the intervention on other outcomes important to patients has not yet been reported. We aimed to evaluate the effect of the intervention on patient well-being including concern about falling, anxiety, depression, physical function, and disability.

Design: Pragmatic cluster-randomized trial of 5,451 community-living persons at high risk for serious fall injuries.

Setting: A total of 86 primary care practices within 10 U.S. healthcare systems.

Participants: A random subsample of 743 persons aged 75 and older.

Measurements: The well-being measures, assessed at baseline, 12 months, and 24 months, included a modified version of the Fall Efficacy Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scales, and Late-Life Function and Disability Instrument.

Results: Participants in the intervention (n = 384) and control groups (n = 359) were comparable in age: mean (standard deviation) of 81.9 (4.7) versus 81.8 (5.0) years. Mean scores were similar between groups at 12 and 24 months for concern about falling, physical function, and disability, whereas the intervention group's mean scores on anxiety and depression were .7 points lower (i.e., better) at 12 months and .6 to .8 points lower at 24 months. For each of these outcomes, differences between the groups' adjusted least square mean changes from baseline to 12 and 24 months, respectively, were quantitatively small. The overall difference in means between groups over 2 years was statistically significant only for depression, favoring the intervention: -1.19 (99% confidence interval, -2.36 to -.02), with 3.5 points representing a minimally important difference.

Conclusions: STRIDE's multifactorial intervention to reduce fall injuries was not associated with clinically meaningful improvements in patient well-being.
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http://dx.doi.org/10.1111/jgs.16854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178516PMC
January 2021

A national webinar for dermatology applicants during the COVID-19 pandemic.

J Am Acad Dermatol 2021 Feb 17;84(2):574-576. Epub 2020 Sep 17.

Division of Dermatology, Washington University School of Medicine, St. Louis, MO.

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http://dx.doi.org/10.1016/j.jaad.2020.09.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497741PMC
February 2021

Delivering Complex Care: Designing for Patients and Physicians.

J Gen Intern Med 2021 03 15;36(3):772-774. Epub 2020 Sep 15.

Department of Medicine, General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

The management of high-utilizing patients is an area of active research with broad implications for the healthcare system. There are significant operational challenges to designing primary care models for these medically complex, high-needs patients. Although it is crucial to provide a high degree of continuity of care for this population, managing a cohort of these patients can lead to provider over-work and attrition. This may be magnified by the lack of training dedicated to addressing the unique care needs of these patients. While academic medical centers would seem well suited to care for individuals with multimorbidity needing intensive and specialized treatment, primary care providers in this setting need additional support to be clinically available for patients while pursuing scholarship and teaching. Formally recognizing intensive outpatient care as a specialty within internal medicine would help overcome some of these challenges. This would require a committed effort to high-level systems changes including a new focus on graduate medical education, the creation of division-level infrastructure within academic departments of medicine, and realistic levels of financial support to make this a viable career path.
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http://dx.doi.org/10.1007/s11606-020-06212-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947090PMC
March 2021

International guidance on the selection of patient-reported outcome measures in clinical trials: a review.

Qual Life Res 2021 Jan 14;30(1):21-40. Epub 2020 Sep 14.

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Purpose: Patient-reported outcomes (PROs) are increasingly used in clinical trials to provide patients' perspectives regarding symptoms, health-related quality of life, and satisfaction with treatments. A range of guidance documents exist for the selection of patient-reported outcome measures (PROMs) in clinical trials, and it is unclear to what extent these documents present consistent recommendations.

Methods: We conducted a targeted review of publications and regulatory guidance documents that advise on the selection of PROMs for use in clinical trials. A total of seven guidance documents from the US Food and Drug Administration, European Medicines Agency, and scientific consortia from professional societies were included in the final review. Guidance documents were analyzed using a content analysis approach comparing them with minimum standards recommended by the International Society for Quality of Life Research.

Results: Overall there was substantial agreement between guidance regarding the appropriate considerations for PROM selection within a clinical trial. Variations among the guidance primarily related to differences in their format and differences in the perspectives and mandates of their respective organizations. Whereas scientific consortia tended to produce checklist or rating-type guidance, regulatory groups tended to use more narrative-based approaches sometimes supplemented with lists of criteria.

Conclusion: The consistency in recommendations suggests an emerging consensus in the field and supports use of any of the major guidance documents available to guide PROM selection for clinical trials without concern of conflicting recommendations. This work represents an important first step in the international PROTEUS Consortium's ongoing efforts to optimize the use of PROs in clinical trials.
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http://dx.doi.org/10.1007/s11136-020-02625-zDOI Listing
January 2021
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