Publications by authors named "Karen Tang"

54 Publications

Gold-decorated TiO nanofibrous hybrid for improved solar-driven photocatalytic pollutant degradation.

Chemosphere 2021 Feb 25;265:129114. Epub 2020 Nov 25.

Institute of Materials Research and Engineering, Agency for Science, Technology and Research (A∗STAR), 2 Fusionopolis Way, 138634, Singapore. Electronic address:

TiO-based nanomaterials are among the most promising photocatalysts for degrading organic dye pollutants. In this work, Au-TiO nanofibers were fabricated by the electrospinning technique, followed by calcination in air at 500 °C. Morphological and structural analyses revealed that the composite consists of TiO nanofibers with embedded Au nanoparticles that are extensively distributed throughout the porous fibrous structure of TiO. The photocatalytic performance of these Au-embedded TiO nanofibers was evaluated in the photodegradation of Rhodamine B and methylene blue under solar simulator irradiation. Compared with pristine TiO nanofibers, the Au-embedded TiO nanofibers displayed far better photocatalytic degradation efficiency. The plasmon resonance absorption of Au nanoparticles in the visible spectral region and the effective charge separation at the heterojunction of the Au-TiO hybrid are the key factors that have led to the considerable enhancement of the photocatalytic activity. The results of this study clearly demonstrate the potential of Au-TiO electrospun nanofibers as solar-light-responsive photocatalysts for the effective removal of dye contaminants from aquatic environments.
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http://dx.doi.org/10.1016/j.chemosphere.2020.129114DOI Listing
February 2021

Risk of Depression in Patients With Psoriatic Disease: A Systematic Review and Meta-Analysis.

J Cutan Med Surg 2020 Dec 2:1203475420977477. Epub 2020 Dec 2.

2129 Department of Community Health Sciences, University of Calgary, AB, Canada.

Background: Previous systematic reviews have assessed the prevalence and odds ratio (OR) of depression for patients with psoriatic disease. Due to probable bidirectional effects, prevalence and prevalence ORs are difficult to interpret. No prior reviews have quantified the relative risk (RR) of depression following a diagnosis of psoriatic disease.

Objective: To estimate the RR of depression in individuals with psoriasis and in psoriatic arthritis (PsA), clear-to-moderate psoriasis, and moderate-to-severe psoriasis subgroups.

Methods: Observational studies investigating the risk of depression in adults with psoriatic disease were systematically searched for in Medline, EMBASE, PsycINFO, and CINAHL databases; 4989 unique references were screened. Studies that reported measures of incident depression in psoriasis patients were included. Thirty-one studies were included into the systematic review, of which 17 were meta-analyzed. Random effects models were employed to synthesize relevant data. Sources of heterogeneity were explored with subgroup analysis and meta-regression.

Results: Seventeen studies were included in meta-analyses. The pooled RR of depression in psoriasis patients compared to nonpsoriasis controls was 1.48 (95% CI: 1.16-1.89). Heterogeneity was high (I = 99.8%). Subgroup analysis and meta-regression did not indicate that PsA status or psoriasis severity (clear-to-mild, moderate-to-severe) were sources of heterogeneity. No evidence of publication bias was found.

Conclusions: This review demonstrates that the risk of depression is greater in patients with psoriasis and PsA. Future research should focus on developing strategies to address the mental health needs of this patient population for depression, including primary prevention, earlier detection, and treatment strategies.
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http://dx.doi.org/10.1177/1203475420977477DOI Listing
December 2020

Prevalence of antimicrobial resistance genes and its association with restricted antimicrobial use in food-producing animals: a systematic review and meta-analysis.

J Antimicrob Chemother 2021 Feb;76(3):561-575

Mastitis Network, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada.

Background: There is ongoing debate regarding potential associations between restrictions of antimicrobial use and prevalence of antimicrobial resistance (AMR) in bacteria.

Objectives: To summarize the effects of interventions reducing antimicrobial use in food-producing animals on the prevalence of AMR genes (ARGs) in bacteria from animals and humans.

Methods: We published a full systematic review of restrictions of antimicrobials in food-producing animals and their associations with AMR in bacteria. Herein, we focus on studies reporting on the association between restricted antimicrobial use and prevalence of ARGs. We used multilevel mixed-effects models and a semi-quantitative approach based on forest plots to summarize findings from studies.

Results: A positive effect of intervention [reduction in prevalence or number of ARGs in group(s) with restricted antimicrobial use] was reported from 29 studies for at least one ARG. We detected significant associations between a ban on avoparcin and diminished presence of the vanA gene in samples from animals and humans, whereas for the mecA gene, studies agreed on a positive effect of intervention in samples only from animals. Comparisons involving mcr-1, blaCTX-M, aadA2, vat(E), sul2, dfrA5, dfrA13, tet(E) and tet(P) indicated a reduced prevalence of genes in intervention groups. Conversely, no effects were detected for β-lactamases other than blaCTX-M and the remaining tet genes.

Conclusions: The available body of scientific evidence supported that restricted use of antimicrobials in food animals was associated with an either lower or equal presence of ARGs in bacteria, with effects dependent on ARG, host species and restricted drug.
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http://dx.doi.org/10.1093/jac/dkaa443DOI Listing
February 2021

Engineering luminescent pectin-based hydrogel for highly efficient multiple sensing.

Int J Biol Macromol 2021 Jan 2;166:869-875. Epub 2020 Nov 2.

Institute of Materials Research and Engineering, Agency for Science, Technology, and Research (A*STAR), 2 Fusionopolis Way, Innovis, 138634, Singapore. Electronic address:

Luminescent hydrogels with sensing capabilities have attracted much interest in recent years, especially those responsive to stimuli, making such materials potential for various applications. Pectin is a high-molecular-weight carbohydrate polymer that has the ability to form hydrogel upon heating or mixing with divalent cations. However, intrinsic pectin gels are weak and lack of functionalities. In this study, lanthanide ions and silk fibroin derived carbon dots were incorporated into Pectin/PVA hydrogel (PPH) to form luminescent tough hydrogels. The luminescence of the hydrogel can be tuned by adjusting the ratio of blue emission carbon dots to Eu ions (red emission) and Tb ions (green emission). Such incorporation of emitters only slightly changed the mechanical properties of the tough hydrogel. Notably, the luminescent Pectin/PVA hydrogel (LPPH) showed chromic response to external stimuli, like pH and metal ions. By measuring the ratio of luminescent intensity at 473 nm and 617 nm (I/I), the pH response can be quantified in high sensitivity. In addition, the specific detection of Cu and Fe ions using the fabricated hydrogel were demonstrated, the mechanism was also proposed. The different chromic responses to Fe and Fe endow the luminescent tough Pectin/PVA hydrogel potential for multiple sensing applications.
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http://dx.doi.org/10.1016/j.ijbiomac.2020.10.243DOI Listing
January 2021

CD30 expression: a diagnostic pitfall for primary cutaneous gamma delta T cell lymphoma.

Ann Hematol 2020 Aug 28. Epub 2020 Aug 28.

Department of Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong.

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http://dx.doi.org/10.1007/s00277-020-04229-6DOI Listing
August 2020

The Role of Liquid Biopsies in Pediatric Brain Tumors.

J Neuropathol Exp Neurol 2020 09;79(9):934-940

Department of Neuropathology, New York.

Early detection and serial therapeutic monitoring for pediatric brain tumors are essential for diagnosis and therapeutic intervention. Currently, neuropathological diagnosis relies on biopsy of tumor tissue and surgical intervention. There is a great clinical need for less invasive methods to molecularly characterize the tumor and allow for more reliable monitoring of patients during treatment and to identify patients that might potentially benefit from targeted therapies, particularly in the setting where diagnostic tissue cannot be safely obtained. In this literature review, we highlight recent studies that describe the use of circulating tumor DNA, circulating tumor cells, circulating RNA and microRNA, and extracellular vesicles as strategies to develop liquid biopsies in pediatric central nervous system tumors. Liquid biomarkers have been demonstrated using plasma, urine, and cerebrospinal fluid. The use of liquid biopsies to help guide diagnosis, determine treatment response, and analyze mechanisms of treatment resistance is foreseeable in the future. Continued efforts to improve signal detection and standardize liquid biopsy procedures are needed for clinical application.
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http://dx.doi.org/10.1093/jnen/nlaa068DOI Listing
September 2020

Orbital Rosai-Dorfman disease initially diagnosed as IgG4-related disease: a case report.

Acta Neuropathol Commun 2020 07 18;8(1):113. Epub 2020 Jul 18.

Department of Pathology, NYU Grossman School of Medicine, NYU Langone Health, 550 First Ave, MSB 5th Floor, New York, NY, 10016, USA.

Inflammatory orbital lesions include a broad list of diagnoses, many of them with overlapping clinical and radiographic features. They often present a diagnostic conundrum, even to the most experienced orbital specialist, thus placing considerable weight on surgical biopsy and histopathological analysis. However, histopathological diagnosis is also inherently challenging due to the rarity of these lesions and the overlaps in histologic appearance among distinct disease entities. We herein present the case of an adolescent male with a subacutely progressive orbital mass that generated a significant diagnostic dilemma. Early orbital biopsy was consistent with a benign fibro-inflammatory lesion, but corticosteroid therapy was ineffective in halting disease progression. After an initial substantial surgical debulking, histopathological analysis revealed several key features consistent with IgG4-related disease (IgG4-RD), a systemic fibro-inflammatory process typically accompanied by multifocal tumor-like lesions. Surprisingly, within months, there was clear evidence of clinical and radiographic disease progression despite second-line rituximab treatment, prompting a second surgical debulking. This final specimen displayed distinctive features of Rosai-Dorfman disease (RDD), a systemic inflammatory disease characterized by uncontrolled histiocytic proliferation. Interestingly, certain features of this re-excision specimen were still reminiscent of IgG4-RD, which not only reflects the difficulty in differentiating RDD from IgG4-RD in select cases, but also illustrates that these diagnoses may exist along a spectrum that likely reflects a common underlying pathogenetic mechanism. This case emphasizes the importance of surgical biopsy or resection and histopathological analysis in diagnosing-and, ultimately, treating-rare, systemic inflammatory diseases involving the orbit, and, furthermore, highlights the shared histopathological features between RDD and IgG4-RD.
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http://dx.doi.org/10.1186/s40478-020-00995-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368749PMC
July 2020

Exploring DNA Methylation for Prognosis and Analyzing the Tumor Microenvironment in Pleomorphic Xanthoastrocytoma.

J Neuropathol Exp Neurol 2020 08;79(8):880-890

Department of Neuropathology, New York University Langone Health, New York, New York.

Pleomorphic xanthoastrocytoma (PXA) is a rare type of brain tumor that affects children and young adults. Molecular prognostic markers of PXAs remain poorly established. Similar to gangliogliomas, PXAs show prominent immune cell infiltrate, but its composition also remains unknown. In this study, we correlated DNA methylation and BRAF status with clinical outcome and explored the tumor microenvironment. We performed DNA methylation in 21 tumor samples from 18 subjects with a histological diagnosis of PXA. MethylCIBERSORT was used to deconvolute the PXA microenvironment by analyzing the associated immune cell-types. Median age at diagnosis was 16 years (range 7-32). At median follow-up of 30 months, 3-year and 5-year overall survival was 73% and 71%, respectively. Overall survival ranged from 1 to 139 months. Eleven out of 18 subjects (61%) showed disease progression. Progression-free survival ranged from 1 to 89 months. Trisomy 7 and CDKN2A/B (p16) homozygous deletion did not show any association with overall survival (p = 0.67 and p = 0.74, respectively). Decreased overall survival was observed for subjects with tumors lacking the BRAF V600E mutation (p = 0.02). PXAs had significantly increased CD8 T-cell epigenetic signatures compared with previously profiled gangliogliomas (p = 0.0019). The characterization of immune cell-types in PXAs may have implications for future development of immunotherapy.
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http://dx.doi.org/10.1093/jnen/nlaa051DOI Listing
August 2020

MyHealthyGut: Findings from a pilot randomized controlled trial on adherence to a gluten-free diet and quality of life among adults with celiac disease or gluten intolerance.

Digit Health 2020 Jan-Dec;6:2055207620903627. Epub 2020 Feb 2.

Faculty of Kinesiology, University of Calgary, Canada.

Aims: The purpose of this study was to assess the effectiveness of a smartphone app (MyHealthyGut) in helping adults self-manage celiac disease or gluten intolerance and improve their gut health.

Methods: Adults diagnosed with celiac disease or gluten intolerance ( = 115) were randomized into two groups: experimental group 1 (had access to the app for a one-month period) or wait list control (WLC). After one month, WLC participants were given one-month access to the app (experimental group 2). An online questionnaire was administered to assess (a) user satisfaction with the app and (b) changes in the following patient-reported outcomes: adherence to a gluten-free diet, quality of life (QoL), self-regulatory efficacy, and feelings of depression and anxiety. Generalized estimating equations were used to assess changes in the outcome variables over time between the groups.

Results: Participants reported high levels of app usability, were satisfied with features of the app, and felt that the app was best suited for people newly diagnosed with celiac disease. Participants in the experimental groups reported improvements in adherence, gastrointestinal symptoms (experimental group 1 only), QoL, self-regulatory efficacy (experimental group 2 only), anxiety (experimental group 1 only), and depression (experimental group 2 only). Experimental group 1 and the WLC group reported significantly worse adherence after using the app based on the Celiac Dietary Adherence Test, which was in contrast to the accidental and purposeful measures of gluten consumption and symptoms for experimental group 1 but consistent with reports of accidental and purposeful gluten consumption and symptoms for the WLC group.

Conclusions: Based on feedback from the participants, the app may be best suited for individuals newly diagnosed or struggling with celiac disease or gluten intolerance. After using the MyHealthyGut app for a one-month period, adults with celiac disease reported improvements in psychosocial outcomes. Further iterations of the app are needed to meet the needs of this population better. MyHealthyGut is the first evidence-based app designed to help people with celiac disease or gluten intolerance.
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http://dx.doi.org/10.1177/2055207620903627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997956PMC
February 2020

Gambling disorder and comorbid behavioral addictions: Demographic, clinical, and personality correlates.

Psychiatry Res 2020 02 7;284:112763. Epub 2020 Jan 7.

Impulse Control Disorders Outpatient Unit, Institute and Department of Psychiatry, University of São Paulo, São Paulo, Brazil.

Gambling disorder (GD) frequently co-occurs with substance use disorders. However, the extent to which GD co-occurs with behavioral addictions (BAs) and the demographic, clinical, and personality correlates of comorbid GD and BA is largely unknown. The aims of the present research were to address this gap among people seeking treatment for GD (N = 458) in São Paulo, Brazil. Structured clinical interviews diagnosed individuals with GD and other psychiatric disorders. The Shorter PROMIS questionnaire was used to identify BAs (work, exercise, food bingeing, sex, and shopping). Questionnaires assessed demographic characteristics, gambling behavior, and personality. Of the total sample, 206 (45.0%) participants met the criteria of having at least one behavioral addiction (GD+BA). The most common comorbid BA was food bingeing (8.1%) with the least common being exercise (3.6%). In a multivariate logistic regression, individuals with GD+BA tended to be younger, and had greater rates of comorbid post-traumatic stress disorder and bulimia nervosa compared to participants who did not present with a comorbid BA. Taken together, individuals with GD+BA present with increased psychopathology. These results may have important implications for the assessment and treatment of individuals with GD and comorbid BAs.
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http://dx.doi.org/10.1016/j.psychres.2020.112763DOI Listing
February 2020

Discharge against medical advice: 'deviant' behaviour or a health system quality gap?

BMJ Qual Saf 2020 04 30;29(4):348-352. Epub 2019 Dec 30.

Medicine, University of Calgary Cumming School of Medicine and the O'Brien Institute for Public Health, Calgary, Alberta, Canada.

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http://dx.doi.org/10.1136/bmjqs-2019-010332DOI Listing
April 2020

GOPC-ROS1 Fusion Due to Microdeletion at 6q22 Is an Oncogenic Driver in a Subset of Pediatric Gliomas and Glioneuronal Tumors.

J Neuropathol Exp Neurol 2019 12;78(12):1089-1099

Department of Hematology, Oncology, and Bone Marrow Transplant, Nationwide Children's Hospital and The Ohio State University.

ROS1 is a transmembrane receptor tyrosine kinase proto-oncogene that has been shown to have rearrangements with several genes in glioblastoma and other neoplasms, including intrachromosomal fusion with GOPC due to microdeletions at 6q22.1. ROS1 fusion events are important findings in these tumors, as they are potentially targetable alterations with newer tyrosine kinase inhibitors; however, whether these tumors represent a distinct entity remains unknown. In this report, we identify 3 cases of unusual pediatric glioma with GOPC-ROS1 fusion. We reviewed the clinical history, radiologic and histologic features, performed methylation analysis, whole genome copy number profiling, and next generation sequencing analysis for the detection of oncogenic mutation and fusion events to fully characterize the genetic and epigenetic alterations present in these tumors. Two of 3 tumors showed pilocytic features with focal expression of synaptophysin staining and variable high-grade histologic features; the third tumor aligned best with glioblastoma and showed no evidence of neuronal differentiation. Copy number profiling revealed chromosome 6q22 microdeletions corresponding to the GOPC-ROS1 fusion in all 3 cases and methylation profiling showed that the tumors did not cluster together as a single entity or within known methylation classes by t-Distributed Stochastic Neighbor Embedding.
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http://dx.doi.org/10.1093/jnen/nlz093DOI Listing
December 2019

Comparison of different approaches to antibiotic restriction in food-producing animals: stratified results from a systematic review and meta-analysis.

BMJ Glob Health 2019 31;4(4):e001710. Epub 2019 Aug 31.

Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Background: We have previously reported, in a systematic review of 181 studies, that restriction of antibiotic use in food-producing animals is associated with a reduction in antibiotic-resistant bacterial isolates. While informative, that report did not concretely specify whether different types of restriction are associated with differential effectiveness in reducing resistance. We undertook a sub-analysis of the systematic review to address this question.

Methods: We created a classification scheme of different approaches to antibiotic restriction: (1) complete restriction; (2) single antibiotic-class restriction; (3) single antibiotic restriction; (4) all non-therapeutic use restriction; (5) growth promoter and prophylaxis restriction; (6) growth promoter restriction and (7) other/undetermined. All studies in the original systematic review that were amenable to meta-analysis were included into this substudy and coded by intervention type. Meta-analyses were conducted using random effects models, stratified by intervention type.

Results: A total of 127 studies were included. The most frequently studied intervention type was complete restriction (n=51), followed by restriction of non-therapeutic (n=33) and growth promoter (n=19) indications. None examined growth promoter and prophylaxis restrictions together. Three and seven studies examined single antibiotic-class and single antibiotic restrictions, respectively; these two intervention types were not significantly associated with reductions in antibiotic resistance. Though complete restrictions were associated with a 15% reduction in antibiotic resistance, less prohibitive approaches also demonstrated reduction in antibiotic resistance of 9%-30%.

Conclusion: Broad interventions that restrict global antibiotic use appear to be more effective in reducing antibiotic resistance compared with restrictions that narrowly target one specific antibiotic or antibiotic class. Importantly, interventions that allow for therapeutic antibiotic use appear similarly effective compared with those that restrict all uses of antibiotics, suggesting that complete bans are not necessary. These findings directly inform the creation of specific policies to restrict antibiotic use in food-producing animals.
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http://dx.doi.org/10.1136/bmjgh-2019-001710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6730577PMC
August 2019

Examination of unintended consequences of antibiotic use restrictions in food-producing animals: Sub-analysis of a systematic review.

One Health 2019 Jun 15;7:100095. Epub 2019 May 15.

Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.

Antimicrobial resistance is considered one of the greatest threats to global and public health today. The World Health Organization, the Food and Agriculture Organization, and the World Organisation for Animal Health, known as the Tripartite Collaboration, have called for urgent action. We have previously published a systematic review of 181 studies, demonstrating that interventions that restrict antibiotic use in food-producing animals are associated with a reduction in antibiotic resistant bacterial isolates in both animals and humans. What remains unknown, however, are whether (and what) unintended consequences may arise from such interventions. We therefore undertook a sub-analysis of the original review to address this research question. A total of 47 studies described potential consequences of antibiotic restrictions. There were no consistent trends to suggest clear harm. There may be increased bacterial contamination of food products, the clinical significance of which remains unclear. There is a need for rigorous evaluation of the unintended consequences of antibiotic restrictions in human health, food availability, and economics, given their possible widespread implications.
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http://dx.doi.org/10.1016/j.onehlt.2019.100095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538949PMC
June 2019

Mutant Isocitrate Dehydrogenase Inhibitors as Targeted Cancer Therapeutics.

Front Oncol 2019 17;9:417. Epub 2019 May 17.

Department of Neurosurgery, New York University School of Medicine, NYU Langone Health, New York, NY, United States.

The identification of heterozygous neomorphic isocitrate dehydrogenase (IDH) mutations across multiple cancer types including both solid and hematologic malignancies has revolutionized our understanding of oncogenesis in these malignancies and the potential for targeted therapeutics using small molecule inhibitors. The neomorphic mutation in IDH generates an oncometabolite product, 2-hydroxyglutarate (2HG), which has been linked to the disruption of metabolic and epigenetic mechanisms responsible for cellular differentiation and is likely an early and critical contributor to oncogenesis. In the past 2 years, two mutant IDH (mutIDH) inhibitors, Enasidenib (AG-221), and Ivosidenib (AG-120), have been FDA-approved for IDH-mutant relapsed or refractory acute myeloid leukemia (AML) based on phase 1 safety and efficacy data and continue to be studied in trials in hematologic malignancies, as well as in glioma, cholangiocarcinoma, and chondrosarcoma. In this review, we will summarize the molecular pathways and oncogenic consequences associated with mutIDH with a particular emphasis on glioma and AML, and systematically review the development and preclinical testing of mutIDH inhibitors. Existing clinical data in both hematologic and solid tumors will likewise be reviewed followed by a discussion on the potential limitations of mutIDH inhibitor monotherapy and potential routes for treatment optimization using combination therapy.
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http://dx.doi.org/10.3389/fonc.2019.00417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534082PMC
May 2019

The Effect of Cardiac Rehabilitation Attendance on Sexual Activity Outcomes in Cardiovascular Disease Patients: A Systematic Review.

Can J Cardiol 2018 12;34(12):1590-1599

Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address:

Background: Decreased sexual activity (SA) is a common problem in patients with cardiovascular disease (CVD). Although there is evidence that cardiac rehabilitation (CR) is effective in improving physical outcomes and overall quality of life, its effects on SA remain unclear. In this systematic review we assessed the association between CR attendance and SA outcomes in adults with CVD.

Methods: Electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL) were systematically searched in January 2018. Original studies that compared attendance to CR vs no attendance to CR in adults 18 years and older with diagnosed CVD that also reported on SA outcomes were included. A narrative synthesis was conducted because the data did not permit meta-analysis.

Results: Fourteen studies were identified: 6 randomized controlled trials, 5 nonrandomized controlled trials, and 3 prospective cohort studies. All CR programs included an exercise-based component and 4 included an SA-specific component. Seven studies reported a significant benefit in SA outcomes in the CR group, 1 study reported significant harm, and 11 studies reported a nonsignificant difference.

Conclusions: The effect of CR on SA outcomes was generally reported to be equivocal or positive. CR showed some promise in improving sexual functioning and frequency, with mixed results with regard to sexual resumption and satisfaction. In conclusion, it remains uncertain if CR consistently improves sexual outcomes in adults with CVD but these data suggest that further exploration might be justified.
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http://dx.doi.org/10.1016/j.cjca.2018.08.020DOI Listing
December 2018

Next-generation sequencing with a 54-gene panel identified unique mutational profile and prognostic markers in Chinese patients with myelofibrosis.

Ann Hematol 2019 Apr 4;98(4):869-879. Epub 2018 Dec 4.

Department of Medicine, The University of Hong Kong, Hong Kong, China.

Current prognostication in myelofibrosis (MF) is based on clinicopathological features and mutations in a limited number of driver genes. The impact of other genetic mutations remains unclear. We evaluated for mutations in a myeloid panel of 54 genes using next-generation sequencing. Multivariate Cox regression analysis was used to determine prognostic factors for overall survival (OS) and leukaemia-free survival (LFS), based on mutations of these genes and relevant clinical and haematological features. One hundred and one patients (primary MF, N = 70; secondary MF, N = 31) with a median follow-up of 49 (1-256) months were studied. For the entire cohort, inferior OS was associated with male gender (P = 0.04), age > 65 years (P = 0.04), haemoglobin < 10 g/dL (P = 0.001), CUX1 mutation (P = 0.003) and TP53 mutation (P = 0.049); and inferior LFS was associated with male gender (P = 0.03), haemoglobin < 10 g/dL (P = 0.04) and SRSF2 mutations (P = 0.008). In primary MF, inferior OS was associated with male gender (P = 0.03), haemoglobin < 10 g/dL (P = 0.002), platelet count < 100 × 10/L (P = 0.02), TET2 mutation (P = 0.01) and CUX1 mutation (P = 0.01); and inferior LFS was associated with haemoglobin < 10 g/dL (P = 0.02), platelet count < 100 × 10/L (P = 0.02), TET2 mutations (P = 0.01) and CUX1 mutations (P = 0.04). These results showed that clinical and haematological features and genetic mutations should be considered in MF prognostication.
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http://dx.doi.org/10.1007/s00277-018-3563-7DOI Listing
April 2019

HIV and religion in HIV-infected Asians and their families: A qualitative study.

Appl Nurs Res 2018 12 19;44:18-24. Epub 2018 Sep 19.

University of California Los Angeles, School of Nursing, United States of America. Electronic address:

Aim: This paper examines HIV-infected Asian Americans' experiences with religion throughout the course of their illness and their family relationships.

Background: As the number of Asians in the United States continues to grow, health professionals are beginning notice obvious gaps of knowledge in caring for this population, including HIV-infected individuals. Little is known about the impact of religion and faith on Asian Americans with HIV and their families. The study focuses on the participants' reported experiences to understand the variety of roles religion can play in the progression of a highly stigmatized chronic disease.

Methods: An in-depth interview was conducted in San Francisco and New York City with 30 HIV-infected Asians. Narrative samples and summarized responses was used to highlight themes that emerged from the participants' anecdotes. Interpretive content analysis was employed.

Results: These groups were categorized as (a) those who did not adhere to any religion, (b) those of tenuous religious faith with conflicted feelings, and (c) those of strong religious faith with congruent beliefs. Within these three groups, various themes were synthesized from the members' perceptions and past experiences with religion. Within each group, participants displayed various stages of reconciliation with their current faith-related beliefs and escape the family stress from their religion practices. Each participant's story shown the vast range of human understanding and faith experiences including self-actualization, acculturation, and depression.

Conclusions: This research provides new insight on the challenge of managing HIV-infected patients in a culturally and religiously appropriate manner.
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http://dx.doi.org/10.1016/j.apnr.2018.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220712PMC
December 2018

Long-term risk of cardiovascular mortality in lymphoma survivors: A systematic review and meta-analysis.

Cancer Med 2018 09 15;7(9):4801-4813. Epub 2018 Aug 15.

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Cardiovascular disease has been identified as one of the late complications of cancer therapy. The purpose of this study was to quantify the long-term risk of cardiovascular mortality among lymphoma survivors relative to that of the general population. A systematic review and meta-analysis were conducted. Articles were identified in November 2016 by searching EMBASE, MEDLINE, and CINAHL databases. Observational studies were included if they assessed cardiovascular mortality in patients with lymphoma who survived for at least 5 years from time of diagnosis or if they had a median follow-up of 10 years. A pooled standardized mortality ratio (SMR) was estimated using a DerSimonian and Laird random-effects model. The Q and I statistics were used to assess heterogeneity. Funnel plots and Begg's and Egger's tests were used to evaluate publication bias. Of the 7450 articles screened, 27 studies were included in the systematic review representing 46 829 Hodgkin and 14 764 non-Hodgkin lymphoma survivors. The pooled number of deaths attributable to cardiovascular disease among Hodgkin and non-Hodgkin disease was estimated to be 7.31 (95% CI: 5.29-10.10; I  = 95.4%) and 5.35 (95% CI: 2.55-11.24; I  = 94.0%) times that of the general population, respectively. This association was greater among Hodgkin lymphoma survivors treated before the age of 21 (pooled SMR = 13.43; 95% CI: 9.22-19.57; I  = 78.9%). There was a high degree of heterogeneity and a high risk of bias due to confounding in this body of literature. Lymphoma survivors have an increased risk of fatal cardiovascular events compared to the general population and should be targeted for cardiovascular screening and prevention campaigns.
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http://dx.doi.org/10.1002/cam4.1572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143935PMC
September 2018

An Exploration of the Content and Usability of Web-Based Resources Used by Individuals to Find and Access Family Physicians.

Healthc Policy 2018 05;13(4):35-49

Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB.

Background: The most commonly recommended strategy in Canada for patients wishing to find a regular family physician (FP) is through the use of websites with FP listings. We aimed to explore the content and usability of these websites.

Methods: We identified publicly available websites with FP listings in Western Canada, analyzing them thematically through open coding for website content and conducting framework analysis for website usability.

Results: Twelve unique websites were identified and grouped into three categories: (1) Physician regulatory authorities ("Colleges"); (2) Governmental; and (3) Miscellaneous. College websites provided the greatest detail about the FPs and enabled searching, though had low readability. Governmental websites listed basic contact information and were credible but contained less detail than College websites. Miscellaneous websites were narrower in focus and therefore easier to navigate but lacked updated and accurate information.

Conclusions: Many websites help patients find FPs. Their content and usability are variable, suggesting a need for guidance in the development of these resources.
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http://dx.doi.org/10.12927/hcpol.2018.25495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044261PMC
May 2018

MyHealthyGut: development of a theory-based self-regulatory app to effectively manage celiac disease.

Mhealth 2018 11;4:19. Epub 2018 Jun 11.

Health and Wellness Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Background: Celiac disease affects approximately 1% of the North American population and the only treatment is to follow a strict gluten-free (GF) diet. Unfortunately, the GF diet can be challenging, and poor adherence can lead to detrimental physical and psychological health outcomes for people with celiac disease. The goal of this study was to design, develop and pilot test a smartphone app (MyHealthyGut), to promote effective self-management of celiac disease and improve gut health. In Part 1, feedback from end-users (adults with celiac disease) regarding the desired functions and content of an app to manage celiac disease was gathered. Part 2 was a pilot test of the MyHealthyGut app with end-users and healthcare professionals.

Methods: Part 1: 118 adults diagnosed with celiac disease participated in the initial survey. Based on findings from this study, version 1.0 of the app was created. Part 2: 12 adults with celiac disease engaged in focus groups to provide feedback after testing the app for a 1-week period; and seven healthcare professionals (dietitians and physicians) provided online feedback about the app after using it for a 2-week period.

Results: Part 1: over 90% of participants indicated a need for an app for celiac disease. Ease of use, available functions, nutritious GF recipes and cost were the top four most important perceived factors to 40-60% of participants for an app to manage celiac disease. Over 25% of participants also indicated it was important to have a list of the top 100 GF foods and evidence-based supplements, the ability to track symptoms and cooking tips. Part 2: focus group participants suggested revisions to the app pertaining to functionality and ease of use (e.g., clearly marked way-finding buttons, enhance onboarding), improving the symptom journaling feature, and app content (e.g., add information on irritable bowel syndrome). The majority of healthcare professionals reported positive perceptions of the app and reported similar revisions to content, functionality and ease of use.

Conclusions: Health-related mobile applications make smartphones useful tools in providing point of care to the user. Participants reported a need for the MyHealthyGut app, listed desired content, features and functions and provided feedback to revise the content, features and functions of version 1.0 of the MyHealthyGut app. MyHealthyGut is the first evidence-based app that may be helpful in empowering users to effectively self-manage celiac disease and promote general gut health.
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http://dx.doi.org/10.21037/mhealth.2018.05.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044051PMC
June 2018

Impact of Telehealth Interventions on Processes and Quality of Care for Patients With ESRD.

Am J Kidney Dis 2018 10 23;72(4):592-600. Epub 2018 Apr 23.

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. Electronic address:

Caring for patients with end-stage renal disease (ESRD) requiring dialysis is intensive and expensive. Telehealth may improve the access and efficiency of ESRD care. For this perspective, we systematically reviewed studies that examined the effectiveness of telehealth versus or in addition to usual care for ESRD management. 10 studies were identified, including 7 randomized trials and 3 cohort studies. Study populations, modes of delivery (including telephone, telemetry, or videoconferencing), and the outcomes evaluated varied substantially between studies. Two studies examined telehealth interventions versus standard ESRD care and demonstrated mixed results on processes of care, no differences in laboratory surrogate markers of ESRD care, and reduced or similar rates of hospitalization. Eight studies evaluated the addition of telehealth to usual care and demonstrated no significant improvements in processes of care or surrogate laboratory measures, variable impacts on hospitalization rates, and mixed impacts on some domains of quality of life, including improvement in mental health. Although potential benefits of telehealth in ESRD care have been reported, optimal designs for delivery and elements of care that may be improved through telehealth remain uncertain.
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http://dx.doi.org/10.1053/j.ajkd.2018.02.353DOI Listing
October 2018

An exploration of the subjective social status construct in patients with acute coronary syndrome.

BMC Cardiovasc Disord 2018 02 6;18(1):22. Epub 2018 Feb 6.

Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.

Background: Perception of low subjective social status (SSS) relative to others in society or in the community has been associated with increased risk of cardiovascular disease. Our objectives were to determine whether low SSS in society was associated with barriers to access to care or hospital readmission in patients with established cardiovascular disease, and whether perceptions of discordantly high SSS in the community modified this association.

Methods: We conducted a prospective cohort study from 2009 to 2013 in Canada, United States, and Switzerland in patients admitted to hospital with acute coronary syndrome (ACS). Data on access to care and SSS variables were obtained at baseline. Readmission data were obtained 12 months post-discharge. We conducted multivariable logistic regression to model the odds of access to care and readmission outcomes in those with low versus high societal SSS.

Results: One thousand ninety patients admitted with ACS provided both societal and community SSS rankings. The low societal SSS cohort had greater odds of reporting that their health was affected by lack of health care access (OR 1.48, 95% CI 1.11, 1.97) and of experiencing cardiac readmissions (1.88, 95% CI 1.15, 3.06). Within the low societal SSS cohort, there was a trend toward fewer access to care barriers for those with discordantly high community SSS though findings varied based on the outcome variable. There were no statistically significant differences in readmissions based on community SSS rankings.

Conclusion: Low societal SSS is associated with increased barriers to access to care and cardiac readmissions. Though attenuated, these trends remained even when adjusting for clinical and sociodemographic factors, suggesting that perceived low societal SSS has health effects above and beyond objective socioeconomic factors. Furthermore, high community SSS may potentially mitigate the risk of experiencing barriers to access to health care in those with low societal SSS, though these associations were not statistically significant. Subjective social status relative to society versus relative to the community seem to represent distinct concepts. Insight into the differences between these two SSS constructs is imperative in the understanding of cardiovascular health and future development of public health policies.
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http://dx.doi.org/10.1186/s12872-018-0759-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801903PMC
February 2018

Restricting the use of antibiotics in food-producing animals and its associations with antibiotic resistance in food-producing animals and human beings: a systematic review and meta-analysis.

Lancet Planet Health 2017 Nov;1(8):e316-e327

Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. Electronic address:

Background: Antibiotic use in human medicine, veterinary medicine, and agriculture has been linked to the rise of antibiotic resistance globally. We did a systematic review and meta-analysis to summarise the effect that interventions to reduce antibiotic use in food-producing animals have on the presence of antibiotic-resistant bacteria in animals and in humans.

Methods: On July 14, 2016, we searched electronic databases (Agricola, AGRIS, BIOSIS Previews, CAB Abstracts, MEDLINE, Embase, Global Index Medicus, ProQuest Dissertations, Science Citation Index) and the grey literature. The search was updated on Jan 27, 2017. Inclusion criteria were original studies that reported on interventions to reduce antibiotic use in food-producing animals and compared presence of antibiotic-resistant bacteria between intervention and comparator groups in animals or in human beings. We extracted data from included studies and did meta-analyses using random effects models. The main outcome assessed was the risk difference in the proportion of antibiotic-resistant bacteria.

Findings: A total of 181 studies met inclusion criteria. Of these, 179 (99%) described antibiotic resistance outcomes in animals, and 81 (45%) of these studies were included in the meta-analysis. 21 studies described antibiotic resistance outcomes in humans, and 13 (62%) of these studies were included in the meta-analysis. The pooled absolute risk reduction of the prevalence of antibiotic resistance in animals with interventions that restricted antibiotic use commonly ranged between 10 and 15% (total range 0-39), depending on the antibiotic class, sample type, and bacteria under assessment. Similarly, in the human studies, the pooled prevalence of antibiotic resistance reported was 24% lower in the intervention groups compared with control groups, with a stronger association seen for humans with direct contact with food-producing animals.

Interpretation: Interventions that restrict antibiotic use in food-producing animals are associated with a reduction in the presence of antibiotic-resistant bacteria in these animals. A smaller body of evidence suggests a similar association in the studied human populations, particularly those with direct exposure to food-producing animals. The implications for the general human population are less clear, given the low number of studies. The overall findings have directly informed the development of WHO guidelines on the use of antibiotics in food-producing animals.

Funding: World Health Organization.
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http://dx.doi.org/10.1016/S2542-5196(17)30141-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5785333PMC
November 2017

Weekend Surgical Care and Postoperative Mortality: A Systematic Review and Meta-Analysis of Cohort Studies.

Med Care 2018 02;56(2):121-129

Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.

Background: An association between weekend health care delivery and poor outcomes has become known as the "weekend effect." Evidence for such an association among surgery patients has not previously been synthesized.

Objective: To systematically review associations between weekend surgical care and postoperative mortality.

Methods: We searched PubMed, EMBASE, and references of relevant articles for studies that compared postoperative mortality either; (1) according to the day of the week of surgery for elective operations, or (2) according to weekend versus weekday admission for urgent/emergent operations. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for postoperative mortality (≤90 d or inpatient mortality) were pooled using random-effects models.

Results: Among 4027 citations identified, 10 elective surgery studies and 19 urgent/emergent surgery studies with a total of >6,685,970 and >1,424,316 patients, respectively, met the inclusion criteria. Pooled odds of mortality following elective surgery rose in a graded manner as the day of the week of surgery approached the weekend [Monday OR=1 (reference); Tuesday OR=1.04 (95% CI=0.97-1.11); Wednesday OR=1.08 (95% CI=0.98-1.19); Thursday OR=1.12 (95% CI=1.03-1.22); Friday OR=1.24 (95% CI=1.10-1.38)]. Mortality was also higher among patients who underwent urgent/emergent surgery after admission on the weekend relative to admission on weekdays (OR=1.27; 95% CI=1.08-1.49).

Conclusions: Postoperative mortality rises as the day of the week of elective surgery approaches the weekend, and is higher after admission for urgent/emergent surgery on the weekend compared with weekdays. Future research should focus on clarifying underlying causes of this association and potentially mitigating its impact.
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http://dx.doi.org/10.1097/MLR.0000000000000860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770102PMC
February 2018

Barriers to data quality resulting from the process of coding health information to administrative data: a qualitative study.

BMC Health Serv Res 2017 Nov 22;17(1):766. Epub 2017 Nov 22.

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor TRW, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.

Background: Administrative health data are increasingly used for research and surveillance to inform decision-making because of its large sample sizes, geographic coverage, comprehensivity, and possibility for longitudinal follow-up. Within Canadian provinces, individuals are assigned unique personal health numbers that allow for linkage of administrative health records in that jurisdiction. It is therefore necessary to ensure that these data are of high quality, and that chart information is accurately coded to meet this end. Our objective is to explore the potential barriers that exist for high quality data coding through qualitative inquiry into the roles and responsibilities of medical chart coders.

Methods: We conducted semi-structured interviews with 28 medical chart coders from Alberta, Canada. We used thematic analysis and open-coded each transcript to understand the process of administrative health data generation and identify barriers to its quality.

Results: The process of generating administrative health data is highly complex and involves a diverse workforce. As such, there are multiple points in this process that introduce challenges for high quality data. For coders, the main barriers to data quality occurred around chart documentation, variability in the interpretation of chart information, and high quota expectations.

Conclusions: This study illustrates the complex nature of barriers to high quality coding, in the context of administrative data generation. The findings from this study may be of use to data users, researchers, and decision-makers who wish to better understand the limitations of their data or pursue interventions to improve data quality.
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http://dx.doi.org/10.1186/s12913-017-2697-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700659PMC
November 2017

HOMINID: a framework for identifying associations between host genetic variation and microbiome composition.

Gigascience 2017 12;6(12):1-7

Department of Genetics, Cell Biology, and Development, University of Minnesota, 321 Church St SE, 6-160 Jackson Hall, Minneapolis MN 55455, USA.

Recent studies have uncovered a strong effect of host genetic variation on the composition of host-associated microbiota. Here, we present HOMINID, a computational approach based on Lasso linear regression, that given host genetic variation and microbiome taxonomic composition data, identifies host single nucleotide polymorphisms (SNPs) that are correlated with microbial taxa abundances. Using simulated data, we show that HOMINID has accuracy in identifying associated SNPs and performs better compared with existing methods. We also show that HOMINID can accurately identify the microbial taxa that are correlated with associated SNPs. Lastly, by using HOMINID on real data of human genetic variation and microbiome composition, we identified 13 human SNPs in which genetic variation is correlated with microbiome taxonomic composition across body sites. In conclusion, HOMINID is a powerful method to detect host genetic variants linked to microbiome composition and can facilitate discovery of mechanisms controlling host-microbiome interactions.
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http://dx.doi.org/10.1093/gigascience/gix107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5740987PMC
December 2017

Blood pressure at age 60-65 versus age 70-75 and vascular dementia: a population based observational study.

BMC Geriatr 2017 10 27;17(1):252. Epub 2017 Oct 27.

Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, T2N 1N4, Canada.

Background: Vascular dementia (VaD) is the second most common form of dementia. However, there were mixed evidences about the association between blood pressure (BP) and risk of VaD in midlife and late life and limited evidence on the association between pulse pressure and VaD.

Methods: This is a population-based observational study. 265,897 individuals with at least one BP measurement between the ages of 60 to 65 years and 211,116 individuals with at least one BP measurement between the ages of 70 to 75 years were extracted from The Health Improvement Network in United Kingdom. Blood pressures were categorized into four groups: normal, prehypertension, stage 1 hypertension, and stage 2 hypertension. Cases of VaD were identified from the recorded clinical diagnoses. Multivariable survival analysis was used to adjust other confounders and competing risk of death. All the analysis were stratified based on antihypertensive drug use status. Multiple imputation was used to fill in missing values.

Results: After accounting for the competing risk of death and adjustment for potential confounders, there was an association between higher BP levels in the age 60-65 cohort with the risk of developing VaD (hazard ratio [HR] 1.53 (95% confidence interval: 1.04, 2.25) for prehypertension, 1.90 (1.30, 2.78) for stage 1 hypertension, and 2.19 (1.48, 3.26) for stage 2 hypertension) in the untreated group. There was no statistically significant association between BP levels and VaD in the treated group in the age 60-65 cohort and age 70-75 cohort. Analysis on Pulse Pressure (PP) stratified by blood pressure level showed that PP was not independently associated with VaD.

Conclusion: High BP between the ages of 60 to 65 years is a significant risk for VaD in late midlife. Greater efforts should be placed on early diagnosis of hypertension and tight control of BP for hypertensive patients for the prevention of VaD.
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http://dx.doi.org/10.1186/s12877-017-0649-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5658926PMC
October 2017

Coder perspectives on physician-related barriers to producing high-quality administrative data: a qualitative study.

CMAJ Open 2017 Aug;5(3):E617-E622

Affiliations: Departments of Medicine (Tang) and Community Health Sciences (Lucyk, Quan), University of Calgary, Calgary, Alta.

Background: Professional coding specialists ("coders") are experts at translating patient chart information into alphanumerical codes, which are then widely used in research and health policy decision-making. Coders rely solely on documentation by health care providers to complete this task. We aimed to explore physician-related barriers to coding that results in high-quality administrative data.

Methods: In a qualitative study conducted from December 2015 to March 2016, we recruited 28 coders who worked in health care facilities in Alberta using purposive and snowball sampling. Semistructured interviews were conducted, audio-recorded and transcribed. The interviews delved into coder training, work environment, documentation and coding standards. Thematic content analysis of transcripts was performed by 2 study investigators through line-by-line coding and constant comparison, after which the codes were collated into themes.

Results: Five themes emerged regarding physician-related barriers in coding of high-quality administrative data: 1) coders are limited in their ability to add to, modify or interpret physician documentation, which supersedes all other chart documentation, 2) physician documentation is incomplete and nonspecific, 3) chart information tends to be replete with errors and discrepancies, 4) physicians and coders use different terminology to describe clinical diagnoses and 5) there is a communication divide between coders and physicians, such that questions and issues regarding physician documentation cannot be reconciled.

Interpretation: Physicians play a major role in influencing the quality of administrative data. There is a need for physicians to advocate for culture change in physicians' attitudes toward coders and chart documentation, in recognition of the importance of accurate chart information.
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http://dx.doi.org/10.9778/cmajo.20170036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621953PMC
August 2017

A systematic review of the cost and cost-effectiveness of electronic discharge communications.

BMJ Open 2017 07 2;7(6):e014722. Epub 2017 Jul 2.

The Department Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

Background: The transition between acute care and community care can be a vulnerable period in a patients' treatment due to the potential for postdischarge adverse events. The vulnerability of this period has been attributed to factors related to the miscommunication between hospital-based and community-based physicians. Electronic discharge communication has been proposed as one solution to bridge this communication gap. Prior to widespread implementation of these tools, the costs and benefits should be considered.

Objective: To establish the cost and cost-effectiveness of electronic discharge communications compared with traditional discharge systems for individuals who have completed care with one provider and are transitioning care to a new provider.

Methods: We conducted a systematic review of the published literature, using best practices, to identify economic evaluations/cost analyses of electronic discharge communication tools. Inclusion criteria were: (1) economic analysis and (2) electronic discharge communication tool as the intervention. Quality of each article was assessed, and data were summarised using a component-based analysis.

Results: One thousand unique abstracts were identified, and 57 full-text articles were assessed for eligibility. Four studies met final inclusion criteria. These studies varied in their primary objectives, methodology, costs reported and outcomes. All of the studies were of low to good quality. Three of the studies reported a cost-effectiveness measure ranging from an incremental daily cost of decreasing average discharge note completion by 1 day of $0.331 (2003 Canadian), a cost per page per discharge letter of €9.51 and a dynamic net present value of €31.1 million for a 5-year implementation of the intervention. None of the identified studies considered clinically meaningful patient or quality outcomes.

Discussion: Economic analyses of electronic discharge communications are scarcely reported, and with inconsistent methodology and outcomes. Further studies are needed to understand the cost-effectiveness and value for patient care.
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http://dx.doi.org/10.1136/bmjopen-2016-014722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734286PMC
July 2017