Publications by authors named "Simon Lam"

190 Publications

Effect of clinical pharmacist interventions on cost in an integrated health system specialty pharmacy.

J Manag Care Spec Pharm 2021 Mar;27(3):379-384

Department of Pharmacy, Cleveland Clinic, Cleveland, OH.

Patients who are prescribed specialty medications require close monitoring, including assessment of laboratory parameters, toxicities, and adherence. Specialty pharmacies integrated within a health system are able to access records, assess therapy, and efficiently communicate with prescribers. To analyze interventions made by clinical pharmacists within the Cleveland Clinic Specialty Pharmacy (CCSP) regarding cost avoidance for the health care system and improvements in patient safety. This was a retrospective, observational study that analyzed pharmacist interventions regarding specialty hematology/oncology medications. Interventions were measured with pharmacist documentation within the electronic health record (EHR). The primary endpoint was the cost-avoidance effect of clinical pharmacist interventions resulting from pharmacist access to the EHR. Secondary endpoints included pharmacist interventions that led to additional ancillary or supportive care, time taken to perform interventions, total interventions according to new or refill status, and total interventions performed according to insurance subtype. 547 interventions were identified during the study period, with a total cost avoidance of $1,508,131. The intervention with the highest overall cost savings was discontinuation of therapy ($290,091). The highest cost savings, based on intervention type, was lack of follow-up ($30,892). The medication with the highest overall cost savings was abiraterone ($273,160). Gilteritinib was associated with the highest cost saving per intervention ($28,350). The indication with the highest overall cost savings was prostate cancer ($402,601), while cutaneous T-cell lymphoma had the highest cost savings per intervention ($25,424). CCSP pharmacist interventions led to significant overall cost savings to the health care system. Although not measured in this study, it is reasonable to expect that decreased medication use may also translate into less financial burden for patients, as well as for pharmacy benefit managers. Access to the EHR and integration within the health care system may have facilitated the cost savings. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no conflicts of interest to disclose.
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http://dx.doi.org/10.18553/jmcp.2021.27.3.379DOI Listing
March 2021

Face Mask Wearing Behaviors, Depressive Symptoms, and Health Beliefs Among Older People During the COVID-19 Pandemic.

Front Med (Lausanne) 2021 5;8:590936. Epub 2021 Feb 5.

School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.

The COVID-19 pandemic has affected more than 100 countries. Despite the global shortage of face masks, the public has adopted universal mask wearing as a preventive measure in many Asian countries. The COVID-19 mortality rate is higher among older people, who may find that wearing a face mask protects their physical health but jeopardizes their mental health. This study aimed to explore the associations between depressive symptoms, health beliefs, and face mask wearing behaviors among older people. By means of an online survey conducted between March and April 2020, we assessed depressive symptoms, health beliefs regarding COVID-19, and face mask use and reuse among community-dwelling older people. General linear models were employed to explore the associations among these variables. Of the 355 valid participants, 25.6% experienced depressive symptoms. Health beliefs regarding the perceived severity of disease ( = 0.001) and perceived efficacy of practicing preventive measures ( = 0.005) were positively associated with face mask use. Those who reused face masks ( = 0.008) had a stronger belief in disease severity ( < 0.001), had poorer cues to preventive measures ( = 0.002), and were more likely to experience depressive symptoms. Mask reuse was significantly associated with depression only among those who perceived the disease as serious ( = 0.025) and those who had poorer cues to preventive measures ( = 0.004). In conclusion, health beliefs regarding perceived severity and efficacy contributed to more frequent face mask use, which was unrelated to depressive symptoms. Older people who had a stronger belief in disease severity had less adequate cues to preventive measures and reused face masks experienced greater depressive symptoms. A moderation effect of health beliefs (i.e., disease severity and cues to preventive measures) on face mask reuse and depression was observed.
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http://dx.doi.org/10.3389/fmed.2021.590936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892765PMC
February 2021

Author's Response: Abrupt Discontinuation vs. Down-Titration of Vasopressin in Patients Recovering from Septic Shock.

Shock 2021 Feb 3. Epub 2021 Feb 3.

Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.

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http://dx.doi.org/10.1097/SHK.0000000000001749DOI Listing
February 2021

COVID-19 experience in mainland China: Nursing lessons for the United States of America.

Nurs Forum 2021 Feb 3. Epub 2021 Feb 3.

School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.

COVID-19 emerged in Wuhan, China, and began its worldwide journey. As the severity of the virus became known, the Chinese National Government mobilized resources, and their centralized management was critical to the containment of the epidemic. Healthcare agencies and providers were overwhelmed with patients, many of whom were critically ill and died. Nurses adapted to the work using personal protective equipment, but its initial scarcity contributed to stressful working conditions. Nurses in the United States can take several lessons from the experiences of their Chinese nurse colleagues, including the benefit of centralized management of the epidemic, the need for specialized treatment facilities, and the importance of a national stockpile of critical equipment and supplies. A fully funded United States Department of Health and Human Services Office of Pandemics and Emerging Threats is necessary. A nursing department within the office and a national mobilization plan to send nurses to support local efforts during a pandemic or other threat are likewise essential. Continuous training for nurses, especially caring for patients with infectious diseases in intensive care units, stress management, and how to comfort the dying, are also useful lessons.
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http://dx.doi.org/10.1111/nuf.12546DOI Listing
February 2021

COVID-19 experience in mainland China: Nursing lessons for the United States of America.

Nurs Forum 2021 Feb 3. Epub 2021 Feb 3.

School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.

COVID-19 emerged in Wuhan, China, and began its worldwide journey. As the severity of the virus became known, the Chinese National Government mobilized resources, and their centralized management was critical to the containment of the epidemic. Healthcare agencies and providers were overwhelmed with patients, many of whom were critically ill and died. Nurses adapted to the work using personal protective equipment, but its initial scarcity contributed to stressful working conditions. Nurses in the United States can take several lessons from the experiences of their Chinese nurse colleagues, including the benefit of centralized management of the epidemic, the need for specialized treatment facilities, and the importance of a national stockpile of critical equipment and supplies. A fully funded United States Department of Health and Human Services Office of Pandemics and Emerging Threats is necessary. A nursing department within the office and a national mobilization plan to send nurses to support local efforts during a pandemic or other threat are likewise essential. Continuous training for nurses, especially caring for patients with infectious diseases in intensive care units, stress management, and how to comfort the dying, are also useful lessons.
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http://dx.doi.org/10.1111/nuf.12546DOI Listing
February 2021

Incidence and Clinical Impact of Major Bleeding Following Left Atrial Appendage Occlusion: Insights from the Amplatzer™ Amulet™ LAA Occluder Observational Study.

EuroIntervention 2021 Jan 26. Epub 2021 Jan 26.

Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.

Background: Major bleeding (MB) events are independent predictors of mortality after cardiac interventional procedures. The clinical relevance of MB following left atrial appendage occlusion (LAAO) remains unclear.

Aims: This study aimed to investigate the incidence and clinical impact of MB after LAAO in a real-world population at high-risk for bleeding and contraindicated to anticoagulation.

Methods: The 2-year results of the Amplatzer™ Amulet™ Occluder Observational Study were analyzed. An independent committee adjudicated MBs according to the Bleeding Academic Research Consortium scale. Cox proportional hazards regression identified variables associated with MB events and mortality.

Results: The MB rate was 7.2%/year, with a rate of 10.1%/year during year one, decreasing to 4.0%/year over year two. The most common bleeding location was gastrointestinal, accounting for 48% of MBs. Pre-LAAO MB was associated with an increased risk for post-LAAO MB (HR 2.34; 95% CI 1.37-3.99). The occurrence of post-LAAO MB was associated with increased mortality (37.3% vs 12.7%; p<0.0001), mainly driven by events occurring beyond the peri-procedural period. The annualized rate of ischemic stroke or TIA was similar in patients with and without MB (2.3% vs 3.3%; p=0.446). MB post-LAAO was a strong independent predictor of mortality (HR 3.07; 95% CI 2.15-4.40).

Conclusions: In real-world patients at high bleeding risk, MB following LAAO was not uncommon and associated with a significant increase in mortality, without increasing the risk of stroke.
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http://dx.doi.org/10.4244/EIJ-D-20-01309DOI Listing
January 2021

Characterizing Critical Care Pharmacy Services Across the United States.

Crit Care Explor 2021 Jan 8;3(1):e0323. Epub 2021 Jan 8.

Department of Pharmacy, Cleveland Clinic, Cleveland, OH.

Involvement of clinical pharmacists in the ICU attenuates costs, avoids adverse drug events, and reduces morbidity and mortality. This survey assessed services and activities of ICU pharmacists.

Design: A 27-question, pretested survey.

Setting: 1,220 U.S. institutions.

Subjects: Critical care pharmacists.

Interventions: Electronic questionnaire of pharmacy services and activities across clinical practice, education, scholarship, and administration.

Measurements And Main Results: A total of 401 (response rate of 35.4%) surveys representing 493 ICUs were completed. Median daily ICU census was 12 (interquartile range, 6-20) beds with 1 (interquartile range, 1-1.5) pharmacist full-time equivalent per ICU. Direct clinical ICU pharmacy services were available in 70.8% of ICUs. Pharmacists attended rounds 5 days (interquartile range, 4-5 d) per week with a median patient-to-pharmacist ratio of 17 (interquartile range, 12-26). The typical workweek consisted of 50% (interquartile range, 40-60%) direct ICU patient care, 10% (interquartile range, 8-16%) teaching, 8% (interquartile range, 5-18%) order processing, 5% (interquartile range, 0-20%) direct non-ICU patient care, 5% (interquartile range, 2-10%) administration, 5% (interquartile range, 0-10%) scholarship, and 0% (interquartile range, 0-5%) drug distribution. Common clinical activities as a percentage of the workweek were reviewing drug histories (28.5%); assessing adverse events (27.6%); and evaluating (26.1%), monitoring (23.8%), and managing (21.4%) drug therapies. Services were less likely to occur overnight or on weekends. Telemedicine was rarely employed. Dependent prescriptive authority (per protocol or via practice agreements) was available to 51.1% of pharmacists and independent prescriptive authority was provided by 13.4% of pharmacists. Educational services most frequently provided were inservices (97.6%) and experiential training of students or residents (89%). Education of ICU healthcare members was provided at a median of 5 times/mo (interquartile range, 3-15 times/mo). Most respondents were involved with ICU or departmental policies/guidelines (84-86.8%) and 65.7% conducted some form of scholarship.

Conclusions: ICU pharmacists have diverse and versatile responsibilities and provide several key clinical and nonclinical services. Initiatives to increase the availability of services are warranted.
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http://dx.doi.org/10.1097/CCE.0000000000000323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803868PMC
January 2021

Observational study of compliance with infection control practices among healthcare workers in subsidized and private residential care homes.

BMC Infect Dis 2021 Jan 14;21(1):75. Epub 2021 Jan 14.

School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR.

Background: The elderly population in Hong Kong is rapidly growing, and the need for residential care homes (RCHs) is increasing. The risk of being infected with micro-organisms increases among the frail and the vulnerable elderly population as their immunity system begins to deteriorate. Furthermore, the residents in RCHs are at high risk of healthcare-associated infections (HAIs) due to the confined living environments and individual co-morbidities. In relation to this, infection control practice (ICP) is considered a crucial and effective approach in preventing HAIs. This study aimed to observe the daily ICP of healthcare workers in RCH settings.

Methods: An observational study was conducted to observe daily ICP among healthcare workers in private and subsidized RCHs. Each RCH was separated into different units based on the location (common area and bedroom area) and nature of residents for successive days. The ICP episodes were observed until 200 opportunities in each unit. The ICP episodes were recorded by an electronic tool called "eRub," which is an ICP checklist based on international guidelines.

Results: The most frequent observed ICP episodes were hand hygiene (n = 1053), the use of gloves (n = 1053) and respiratory protection (n = 1053). The overall compliance of hand hygiene was poor, with only 15% of participants performing this during the "five moments for hand hygiene." Furthermore, the observations showed that 77.9% improperly performed the use of gloves, and 31.8% failed to wear a mask during the care provision for the elderly. However, the results showed that most healthcare workers can wear the mask in a proper way when they should. Generally, the personal care workers were the worst in terms of hand hygiene and use of gloves compared with the other types of healthcare workers.

Conclusions: Despite the fact that the practice of hand hygiene, the use of gloves, and respiratory protection were the important elements of ICP, overall compliance to these elements was still poor. Personal care workers had the most frequent contact with the residents, but they had the worst compliance rate. Hence, continued monitoring and training among healthcare workers is needed, particularly personal care workers, in this healthcare service setting.
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http://dx.doi.org/10.1186/s12879-021-05767-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807399PMC
January 2021

Rationale and design of the ADAPT-TAVR trial: a randomised comparison of edoxaban and dual antiplatelet therapy for prevention of leaflet thrombosis and cerebral embolisation after transcatheter aortic valve replacement.

BMJ Open 2021 Jan 5;11(1):e042587. Epub 2021 Jan 5.

Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea

Introduction: Optimal antithrombotic strategy following transcatheter aortic valve replacement (TAVR) is still unknown. We hypothesised that the direct factor Xa inhibitor edoxaban can potentially prevent subclinical leaflet thrombosis and cerebral embolisation compared with conventional dual antiplatelet therapy (DAPT) in patients undergoing TAVR.

Methods And Analysis: The ADAPT-TAVR trial is an international, multicentre, randomised, open-label, superiority trial comparing edoxaban-based strategy and DAPT strategy in patients without an indication for oral anticoagulation who underwent successful TAVR. A total of 220 patients are randomised (1:1 ratio), 1-7 days after successful TAVR, to receive either edoxaban (60 mg daily or 30 mg daily if patients had dose-reduction criteria) or DAPT using aspirin (100 mg daily) plus clopidogrel (75 mg daily) for 6 months. The primary endpoint was an incidence of leaflet thrombosis on four-dimensional, volume-rendered cardiac CT imaging at 6 months post-TAVR. The key secondary endpoints were the number of new lesions and new lesion volume on brain diffusion-weighted MRI and the changes in neurological and neurocognitive function assessment between immediate post-TAVR and 6 months of study drug administration. Detailed clinical information on thromboembolic and bleeding events were also assessed.

Ethics And Dissemination: Ethic approval has been obtained from the Ethics Committee/Institutional Review Board of Asan Medical Center (approval number: 2017-1317) and this trial is also approved by National Institute of Food and Drug Safety Evaluation of Republic of Korea (approval number: 31511). Results of this study will be disseminated in scientific publication in reputed journals.

Trial Registration Number: NCT03284827.
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http://dx.doi.org/10.1136/bmjopen-2020-042587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786793PMC
January 2021

Comparative data on left atrial appendage occlusion efficacy and clinical outcomes by age group in the Amplatzer™ Amulet™ Occluder Observational Study.

Europace 2021 Feb;23(2):238-246

Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

Aims: Left atrial appendage occlusion (LAAO) may be considered for patients with non-valvular atrial fibrillation (NVAF) and a relative/formal contraindication to anticoagulation. This study aimed to summarize the impact of aging on LAAO outcomes at short and long-term follow-up.

Methods And Results: We compared subjects aged <70, ≥70 and <80, and ≥80 years old in the prospective, multicentre Amplatzer™ Amulet™ Occluder Observational Study (Abbott, Plymouth, MN, USA). Serious adverse events (SAEs) were reported from implant through a 2-year post-LAAO visit and adjudicated by an independent clinical events committee. Overall, 1088 subjects were prospectively enrolled. There were 265 subjects (24.4%) <70 years old, 491 subjects (45.1%) ≥70 and <80 years old, and 332 subjects (30.5%) ≥80 years old, with the majority (≥80%) being contraindicated to anticoagulation. As expected, CHA2DS2-VASc and HAS-BLED Scores increased with age. Implant success was high (≥98.5%) across all groups, and the proportion of subjects with a procedure- or device-related SAE was similar between groups. At follow-up, the observed ischaemic stroke rate was not significantly different between groups, and corresponding risk reductions were 62, 56, and 85% when compared with predicted rates for subjects <70, ≥70 and <80, and ≥80 years old, respectively. Major bleeding and mortality rates increased with age, while the incidence of device-related thrombus tended to increase with age.

Conclusions: Despite the increased risk for ischaemic stroke with increasing age in AF patients, LAAO reduced the risk for ischaemic stroke compared with the predicted rate across all age groups without differences in procedural SAEs.
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http://dx.doi.org/10.1093/europace/euaa262DOI Listing
February 2021

Development and evaluation of a technology-enhanced, enquiry-based learning program on managing neonatal extravasation injury: A pre-test/post-test mixed-methods study.

Nurse Educ Today 2021 Feb 24;97:104672. Epub 2020 Nov 24.

School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom. Electronic address:

Background: Extravasation injury remains a significant preventable cause of morbidity and mortality in neonates. Equipping nursing students with the requisite knowledge and skills is essential for appropriate prevention, early detection, and management of extravasation injury.

Objectives: To develop a technology-enhanced, enquiry-based learning program for nursing students on the prevention and management of neonatal extravasation injury and examine its impact on their knowledge, approaches to studying and experience of learning.

Design: A pre-test/post-test study with qualitative evaluation.

Settings: Two university pre-registration nursing programs in Hong Kong.

Participants: A total of 192 senior-year nursing students.

Methods: A novel learning program was developed comprising 25 scenario-based video vignettes supplemented with critical-thinking exercises, discussion guides, interactive games, reading materials and a 3-hour in-class interactive workshop. Students received unlimited online access to the program. Data were collected at baseline and one-month post-workshop. Outcomes were students' level of knowledge of prevention and management of extravasation injuries and related care, approaches to studying, and experience of learning. Paired t-tests were performed on pre- post-test outcome data and individual semi-structured interviews were conducted at one-month post-workshop, transcribed verbatim and analyzed thematically.

Results: There were statistically significant improvements in students' level of knowledge and use of a deep approach to learning at one month compared with baseline. Students were highly satisfied with the program, appreciating the video vignettes and interactive small group discussions with academics and clinicians. Suggestions for enhancing the program included more time for the workshop, interaction with clinicians, and details on the administration of neonatal medications and dosages.

Conclusions: This study showed that a novel technology-enhanced, enquiry-based learning program was effective in enhancing nursing students' knowledge of the prevention and management of neonatal extravasation injury, approaches to studying and experience of learning.
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http://dx.doi.org/10.1016/j.nedt.2020.104672DOI Listing
February 2021

Hemodynamic Response to Vasopressin Dosage of 0.03 Units/Min vs. 0.04 Units/Min in Patients With Septic Shock.

J Intensive Care Med 2020 Nov 28:885066620977181. Epub 2020 Nov 28.

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.

Background: Arginine vasopressin (AVP) is suggested as an adjunct to norepinephrine in patients with septic shock. Guidelines recommend an AVP dosage up to 0.03 units/min, but 0.04 units/min is commonly used in practice based on initial studies. This study was designed to compare the incidence of hemodynamic response between initial fixed-dosage AVP 0.03 units/min and AVP 0.04 units/min.

Methods: This retrospective, multi-hospital health system, cohort study included adult patients with septic shock receiving AVP as an adjunct to catecholamine vasopressors. Patients were excluded if they received an initial dosage other than 0.03 units/min or 0.04 units/min, or AVP was titrated within the first 6 hours of therapy. The primary outcome was hemodynamic response, defined as a mean arterial pressure ≥65 mm Hg and a decrease in catecholamine dosage at 6 hours after AVP initiation. Inverse probability of treatment weighting (IPTW) based on the propensity score for initial AVP dosage receipt was utilized to estimate adjusted exposure effects.

Results: Of the 1536 patients included in the observed data, there was a nearly even split between initial AVP dosage of 0.03 units/min (n = 842 [54.8%]) and 0.04 units/min (n = 694 [45.2%]). Observed patients receiving AVP 0.03 units/min were more frequently treated at the main campus academic medical center (96.3% vs. 52.2%, p < 0.01) and in a medical intensive care unit (87.4% vs. 39.8%, p < 0.01). The IPTW analysis included 1379 patients with achievement of baseline covariate balance. There was no evidence for a difference between groups in the incidence of hemodynamic response (0.03 units/min 50.0% vs. 0.04 units/min 53.1%, adjusted relative risk 1.06 [95% CI 0.94, 1.20]).

Conclusions: Initial AVP dosing varied by hospital and unit type. Although commonly used, an initial AVP dosage of 0.04 units/min was not associated with a higher incidence of early hemodynamic response to AVP in patients with septic shock.
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http://dx.doi.org/10.1177/0885066620977181DOI Listing
November 2020

Association Between Depression, Health Beliefs, and Face Mask Use During the COVID-19 Pandemic.

Front Psychiatry 2020 22;11:571179. Epub 2020 Oct 22.

Faculty of Health Sciences, University of Macau, Macau, China.

The 2019 novel coronavirus (COVID-19) pandemic is associated with increases in psychiatric morbidity, including depression. It is unclear if people with depressive symptoms understand or apply COVID-19 information differently to the general population. Therefore, this study aimed to examine associations between depression, health beliefs, and face mask use during the COVID-19 pandemic among the general population in Hong Kong. This study gathered data from 11,072 Hong Kong adults via an online survey. Respondents self-reported their demographic characteristics, depressive symptoms (PHQ-9), face mask use, and health beliefs about COVID-19. Hierarchical logistic regression was used to identify independent variables associated with depression. The point-prevalence of probable depression was 46.5% ( = 5,150). Respondents reporting higher mask reuse ( = 1.24, 95%CI 1.17-1.34), wearing masks for self-protection ( = 1.03 95%CI 1.01-1.06), perceived high susceptibility ( = 1.15, 95%CI 1.09-1.23), and high severity ( = 1.33, 95%CI 1.28-1.37) were more likely to report depression. Depression was less likely in those with higher scores for cues to action ( = 0.82, 95%CI 0.80-0.84), knowledge of COVID-19 ( = 0.95, 95%CI 0.91-0.99), and self-efficacy to wear mask properly ( = 0.90 95%CI 0.83-0.98). We identified a high point-prevalence of probable major depression and suicidal ideation during the COVID-19 outbreak in Hong Kong, but this should be viewed with caution due to the convenience sampling method employed. Future studies should recruit a representative probability sample in order to draw more reliable conclusions. The findings highlight that COVID-19 health information may be a protective factor of probable depression and suicidal ideation during the pandemic. Accurate and up-to-date health information should be disseminated to distressed and vulnerable subpopulations, perhaps using digital health technology, and social media platforms to prompt professional help-seeking behavior.
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http://dx.doi.org/10.3389/fpsyt.2020.571179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642487PMC
October 2020

Serum Matrix Metalloproteinase 7 Is a Diagnostic Biomarker of Biliary Injury and Fibrosis in Pediatric Autoimmune Liver Disease.

Hepatol Commun 2020 Nov 24;4(11):1680-1693. Epub 2020 Sep 24.

Division of Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center Cincinnati OH USA.

In autoimmune liver disease (AILD), including autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and overlap syndrome of AIH and PSC (ASC), the presence of biliary injury portends a worse prognosis. We studied serum matrix metalloproteinase 7 (sMMP7) as a biomarker for pediatric sclerosing cholangitis (SC). We prospectively enrolled 54 children (median age, 16 years) with AILD (AIH, n = 26; ASC, n = 16; and PSC, n = 12) at our center. The sMMP7 concentrations were higher in patients with SC compared to those without cholangiopathy ( < 0.001). An sMMP7 concentration >23.7 ng/mL had a sensitivity and specificity of 79% and 96%, respectively, and outperformed alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT) in segregating patients with SC. Serum concentrations correlated with liver gene expression levels for ( = 0.70;  < 0.001). Using immunofluorescence, MMP7 was localized primarily to the cholangiocytes of patients with SC. In 46 subjects with liver biopsy available for blinded review, elevation in sMMP7 concentrations segregated with the presence of lymphocytic and neutrophilic cholangitis and periductal fibrosis and correlated with Ishak, Ludwig, and Nakanuma scoring systems. Liver stiffness measured by magnetic resonance elastography also correlated with sMMP7 concentrations ( = 0.56;  < 0.01). Using magnetic resonance cholangiopancreatography plus (MRCP+), sMMP7 in 34 patients correlated with the number of biliary dilatations ( = 0.54;  < 0.01) and strictures ( = 0.56;  < 0.01). MMP7 as a marker of biliary injury was validated in an independent cohort of children with ulcerative colitis. Higher sMMP7 concentrations also correlated with a history of SC-related complication. : MMP7 is a promising biomarker for pediatric SC that diagnostically outperforms ALP and GGT. sMMP7 may directly reflect biliary injury and fibrosis, the main drivers of disease progression in SC.
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http://dx.doi.org/10.1002/hep4.1589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603534PMC
November 2020

Bioluminescence-based hygiene evaluation of public washroom environment: Repeated measurement of posthandwashing facilities on baseline and before and after cleaning schedule.

Am J Infect Control 2020 Oct 27. Epub 2020 Oct 27.

School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR; Squina International Centre for Infection Control, The Hong Kong Polytechnic University, Hong Kong SAR.

Background: The risk of hand recontamination is often neglected after using hand washing facilities, which can increase the spread of pathogens. The study aimed to evaluate the hygienic condition of posthandwashing facilities in public washrooms at different timeslots, particularly those near food courts and restaurants located in shopping malls.

Methods: This observational study was conducted in 12 public washrooms that ranged from low-end, middle-end, to high-end category on 3 different timeslots including baseline, T1 (immediate postcleaning) and T2 (1-hour postcleaning, with counting the footfall). Hand-touch surfaces with a high risk of recontamination after handwashing, which included paper tower dispensers, air drying outlets, and exit door handles, were evaluated by the surface adenosine triphosphate (ATP) bioluminescence method (ATP-value). ATP-values <500 relative light units (RLUs) were considered a good hygiene. Cleaning schedules and footfalls of each sampled washroom were obtained by direct observations.

Results: The overall mean ATP value of washroom was 785 RLU (N = 108); the ATP values of female and male washrooms at T2 were 203 and 3,718 RLUs, respectively. The highest ATP value was found on the exit door handles of male washrooms (range = 13-26,695 RLUs, mean = 3,229 RLU). Regarding passed/failed hygiene conditions, there were significant differences in the proportion of exit door handles between genders (P = .018) and timeslots (P = .007) as well as that of paper towel button/screw between timeslots (P= .025).

Conclusion: Attention should be paid at the exit door handles of male washrooms, where are high risks of cross and re-contamination.
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http://dx.doi.org/10.1016/j.ajic.2020.10.015DOI Listing
October 2020

Discharge prescription optimization by emergency medicine pharmacists in an academic emergency department in the United States.

Int J Clin Pharm 2020 Oct 29. Epub 2020 Oct 29.

Division of Ambulatory and Integration, Banner Health, Phoenix, AZ, USA.

Background Emergency medicine (EM) pharmacists may be uniquely positioned to optimize discharge prescriptions for emergency department (ED) patients but the clinical significance of interventions and association with patient outcomes are not well-described. Objective To evaluate the clinical significance of EM pharmacist interventions completed during review of ED discharge prescriptions. Setting This study was conducted in an academic medical center ED. Methods: This was a retrospective observational study of patients discharged with prescriptions from the ED over two months. EM pharmacists reviewed discharge prescriptions and provided drug therapy recommendations. Two independent reviewers rated the clinical significance of interventions. High risk criteria were proposed a priori and included in a multivariable logistic regression analysis to identify variables independently associated with pharmacist intervention. Main Outcome Measure The primary outcome measure was the rate, type, and clinical significance of interventions associated with EM pharmacist review of discharge prescriptions. Results A total of 3107 prescriptions for 1648 patients were reviewed. Interventions occurred for 7.3% of patients with 29% of interventions rated as significant. The intervention rate was higher in patients with at least 1 high risk criteria versus those without (9.6% vs. 3.7%, p < 0.0001). An incremental increase in the number of discharge prescriptions was independently associated with pharmacist intervention. The 30 day readmission rates did not differ between patients with and without pharmacist review (27.4% vs. 26.2%, p = 0.38). Conclusion: Pharmacist review of discharge prescriptions resulted in clinically significant interventions but did not impact readmission rates. An incremental increase in the number of discharge prescriptions was associated with pharmacist intervention.
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http://dx.doi.org/10.1007/s11096-020-01179-xDOI Listing
October 2020

Effectiveness and Safety of Twice Daily Versus Thrice Daily Subcutaneous Unfractionated Heparin for Venous Thromboembolism Prophylaxis at a Tertiary Medical Center.

J Pharm Pract 2020 Oct 5:897190020961210. Epub 2020 Oct 5.

Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.

Background: The direct comparison of twice daily (BID) and thrice daily (TID) dosing of subcutaneous low dose unfractionated heparin (LDUH) for venous thromboembolism (VTE) prophylaxis in a mixed inpatient population is not well-studied.

Objective: This study evaluated the effectiveness and safety of BID compared to TID dosing of LDUH for prevention of VTE.

Methods: Retrospective, single-center analysis of patients who received LDUH for VTE prophylaxis between July and September 2015. Outcomes were identified by ICD-9 codes. A matched cohort was created using propensity scores and multivariate analysis was conducted to identify independent risk factors for VTE. The primary outcome was incidence of symptomatic VTE.

Results: In the full cohort, VTE occurred in 0.71% of patients who received LDUH BID compared to 0.77% of patients who received LDUH TID ( = 0.85). There was no difference in major ( = 0.85) and minor ( = 0.52) bleeding between the BID and TID groups. For the matched cohort, VTE occurred in 1.4% of BID patients and 2.1% of TID patients ( = 0.32). Major bleed occurred in 0.36% of BID patients and 0.52% of TID patients ( = 0.7), while a minor bleed was seen in 3.4% of BID patients and 2.1% of TID patients ( = 0.13). Personal history of VTE ( = 0.002) and weight ( = 0.035) were independently associated with increased risk of VTE.

Conclusion: This study did not demonstrate a difference in effectiveness or safety between BID and TID dosing of LDUH for VTE prevention.
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http://dx.doi.org/10.1177/0897190020961210DOI Listing
October 2020

The Impact of CHADS-VASc and HAS-BLED Scores on Clinical Outcomes in the Amplatzer Amulet Study.

JACC Cardiovasc Interv 2020 Sep;13(18):2099-2108

Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

Objectives: The aim of this study was to evaluate the impact of CHADS-VASc and HAS-BLED scores on ischemic and bleeding events of patients enrolled in the Amplatzer Amulet Observational Study.

Background: Baseline CHADS-VASc and HAS-BLED scores have been validated in atrial fibrillation patients to guide about anticoagulation but not in patients treated by left atrial appendage occlusion (LAAO).

Methods: Subjects were stratified according to CHADS-VASc and HAS-BLED scores. Clinical outcomes were collected through 2 years and adjudicated by an independent committee.

Results: Subjects were considered at low (n = 156), moderate (n = 715), and high (n = 215) risk for ischemic stroke, corresponding to CHADS-VASc scores of <3, 3 to 5, and ≥6, respectively. The annual rates of ischemic stroke were 1.1%, 2.0%, and 3.5%, respectively. When compared with the predicted rate, LAAO reduced the risk of ischemic stroke by 56%, 69%, and 68%. Device-related thrombus occurred in 0.7%, 1.5%, and 3.0% of subjects at low, moderate, and high risk for ischemic stroke, respectively. The HAS-BLED score was ≤3 in 629 subjects and >3 in 456 subjects, respectively. Non-peri-procedural major bleeding was reduced by 11% and 9% compared with predicted rates in the low and high bleeding risk groups, respectively.

Conclusions: LAAO with the Amplatzer Amulet reduced the risk of ischemic stroke compared with the predicted rate, with a greater magnitude among patients at high thromboembolic risk without increasing the bleeding risk. (Amplatzer™Amulet™ Post-Market Study [Amulet™PMS]; NCT02447081).
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http://dx.doi.org/10.1016/j.jcin.2020.06.003DOI Listing
September 2020

Factors associated with the use and reuse of face masks among Brazilian individuals during the COVID-19 pandemic.

Rev Lat Am Enfermagem 2020 Sep 7;28:e3360. Epub 2020 Sep 7.

Universidade Federal da Paraíba, Departamento de Enfermagem Clinica, João Pessoa, PB, Brazil.

Objective: to identify the factors associated with the use and reuse of masks among Brazilian individuals in the context of the COVID-19 pandemic.

Method: cross-sectional study conducted in the five Brazilian regions, among adult individuals, via an electronic form disseminated in social media, addressing general information and the use of masks. Bivariate analysis and binary logistic regression were used to identify the factors associated with the use and reuse of masks.

Results: 3,981 (100%) individuals participated in the study. In total, 95.5% (CI 95%: 94.8-96.1) reported using masks. Fabric masks were more frequently reported (72.7%; CI 95%: 71.3-74.1), followed by surgical masks (27.8%; CI 95%: 26.5-29.2). The percentage of reuse was 71.1% (CI 95%: 69.7-72.5). Most (55.8%; CI 95%: 51.7-60.0) of those exclusively wearing surgical masks reported its reuse. Being a woman and having had contact with individuals presenting respiratory symptoms increased the likelihood of wearing masks (p≤0.001). Additionally, being a woman decreased the likelihood of reusing surgical masks (p≤0.001).

Conclusion: virtually all the participants reported the use of masks, most frequently fabric masks. The findings draw attention to a risky practice, that of reusing surgical and paper masks. Therefore, guidelines, public policies, and educational strategies are needed to promote the correct use of masks to control and prevent COVID-19.
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http://dx.doi.org/10.1590/1518-8345.4604.3360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478877PMC
September 2020

Abrupt Discontinuation Versus Down-Titration of Vasopressin in Patients Recovering from Septic Shock.

Shock 2021 Feb;55(2):210-214

Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio.

Purpose: To compare patient outcomes based on management of arginine vasopressin (AVP) during the recovery phase of septic shock (abrupt vs. tapering discontinuation).

Patients And Methods: Multicenter, retrospective cohort study of patients receiving AVP with concomitant norepinephrine for septic shock. Primary outcome measure was time to intensive care unit (ICU) discharge (from decision to titrate or stop AVP). Secondary outcomes included ICU and hospital mortality, and incidence of hypotension.

Results: A total of 958 (73%) abrupt discontinuation and 360 (27%) down-titration patients were included. Patient characteristics and septic shock treatment courses were similar between groups. Median time to ICU discharge was similar between abrupt discontinuation (7.9 days, 95% CI 7.2-8.7 days) and tapered patients (7.3 days, 95% CI 6.3-9.3 days, P = 0.60). After controlling for baseline discrepancies, down-titration was not an independent predictor of time to ICU discharge (HR = 0.99, 95% CI: 0.85-1.15, P = 0.91). There was no difference in ICU mortality (21.8% vs. 18.0%, P = 0.13) or hospital mortality (28.9% vs. 31.1%, P = 0.44). Although incidence of hypotension was similar (39.7% vs. 41.7%, P = 0.53), patients in the down-titration group more frequently required an escalation of AVP dose (5.7% vs. 11.1%, P < 0.001). Median AVP duration was shorter in the abrupt discontinuation group (1.4 days [IQR: 0.6-2.6 days] vs. 1.8 days [IQR: 1.1-3.2 days], P < 0.001).

Conclusions: A difference in time to ICU discharge was not detected between abrupt AVP discontinuation and down-titration in patients recovering from septic shock. In patients recovering from septic shock, abrupt discontinuation of AVP appears to be safe and may lead to shortened AVP duration.
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http://dx.doi.org/10.1097/SHK.0000000000001609DOI Listing
February 2021

Prevalence of sleep disturbances during COVID-19 outbreak in an urban Chinese population: a cross-sectional study.

Sleep Med 2020 10 18;74:18-24. Epub 2020 Jul 18.

School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China.

Objective: The COVID-19 pandemic is a large-scale public health emergency that likely precipitated sleep disturbances in the community. This study aimed to investigate the prevalence and correlates of sleep disturbances during the early phase of COVID-19 pandemic.

Methods: This web-based cross-sectional study recruited 1138 Hong Kong adults using convenience sampling over a two-week period from 6th April 2020. The survey collected data on sleep disturbances, mood, stress, stock of infection control supplies, perceived risk of being infected by COVID-19, and sources for acquiring COVID-19 information. The participants were asked to compare their recent sleep and sleep before the outbreak. The Insomnia Severity Index (ISI) was used to assess their current insomnia severity. Prevalence was weighted according to 2016 population census.

Results: The weighted prevalence of worsened sleep quality, difficulty in sleep initiation, and shortened sleep duration since the outbreak were 38.3%, 29.8%, and 29.1%, respectively. The prevalence of current insomnia (ISI score of ≥10) was 29.9%. Insufficient stock of masks was significantly associated with worsened sleep quality, impaired sleep initiation, shortened sleep duration, and current insomnia in multivariate logistic regression (adjusted OR = 1.57, 1.72, 1.99, and 1.96 respectively, all p < 0.05).

Conclusion: A high proportion of people in Hong Kong felt that their sleep had worsened since the COVID-19 outbreak. Insufficient stock of masks was one of the risk factors that were associated with sleep disturbances. Adequate and stable supply of masks may play an important role to maintain the sleep health in the Hong Kong general population during a pandemic outbreak.
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http://dx.doi.org/10.1016/j.sleep.2020.07.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367777PMC
October 2020

Timing of resumption of beta-blockers after discontinuation of vasopressors is not associated with post-operative atrial fibrillation in critically ill patients recovering from non-cardiac surgery: A retrospective cohort analysis.

J Crit Care 2020 12 15;60:177-182. Epub 2020 Aug 15.

Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Outcomes Research Consortium, Cleveland, OH, United States of America.

Background: Post-operative atrial fibrillation is a complication with high morbidity. In patients on prior-to-admission beta-blockers, early post-operative beta-blockade reduces atrial fibrillation risk; however, this benefit is not studied in hemodynamically unstable patients requiring vasopressors.

Methods: A retrospective analysis was performed at two high-volume centers of adult patients on home beta-blockers, undergoing non-cardiac surgery between 2005 and 2015, and who required post-operative vasopressors. Patients were divided into early beta-blockers (within 24 h) or delayed from vasopressor cessation. The primary outcome was the atrial fibrillation incidence. A propensity score was developed for early beta-blockers and used for adjustment.

Results: Eight-hundred seventy one patients required post-operative vasopressors; 423 in the early group and 448 in the delayed group. In the delayed beta-blocker group, intraoperative hypotension was more common (21.6% versus 24.1%, p < 0.001), APACHE III scores higher (56.6 versus 50.8, p < 0.001) and more post-operative norephinephrine use (56.7% veruss 30.3%, p < 0.001). Eighty eight patients developed atrial fibrillation: 40 in the early group, and 48 in the delayed group (p = 0.538). After adjustment, early beta-blockade was not associated with changed incidence of atrial fibrillation.

Conclusions: In patients requiring postoperative vasopressors, early beta-blockade did not protect against postoperative atrial fibrillation.
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http://dx.doi.org/10.1016/j.jcrc.2020.08.009DOI Listing
December 2020

Perceived Risk and Protection From Infection and Depressive Symptoms Among Healthcare Workers in Mainland China and Hong Kong During COVID-19.

Front Psychiatry 2020 15;11:686. Epub 2020 Jul 15.

Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.

Psychological health among healthcare workers (HCWs) has become a major concern since the COVID-19 outbreak. HCWs perceived risks of contracting COVID-19, in relation to depression were investigated. It was hypothesized that perceived high risk of contracting COVID-19 (close contact with cases, inadequate provision of personal protective equipment, insufficient infection control training, and presence of symptoms) would be significant predictors of depression. Our cross-sectional survey was completed by HCWs across three regions (Hubei, Guangdong, Hong Kong) between March 9 to April 9 2020 using convenience sampling. Depression was assessed using the 9-item Patient Health Questionnaire (PHQ-9). Prevalence of depression was 50.4% (95% CI: 44.5-56.2), 15.1% (10.1-21.9) and 12.9% (10.3-16.2) for HCWs in Hong Kong, Hubei and Guangdong, respectively. The strongest significant risk factors for depression, after adjustment, were HCWs who reported the greatest extent of feeling susceptible to contracting COVID-19 and those who reported the greatest difficulty obtaining face masks. HCWs whose family/peers greatly encouraged face mask use had lower prevalence of depression. Access to adequate supplies of personal protective equipment is essential for the psychological health of HCWs working in stressful environments, through potentially easing their perceptions of vulnerability to COVID-19.
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http://dx.doi.org/10.3389/fpsyt.2020.00686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378321PMC
July 2020

Moderating effect of age on the relationships between pre-frailty and body measures.

Health Soc Care Community 2020 Aug 3. Epub 2020 Aug 3.

Nursing Department, The 5th Affiliated Hospital of Zunyi Medical University, Zhuhai, China.

This study aims to investigate the relationship between body measures and the presence of two frailty-related phenotypes, and the moderating effect of age on this relationship. This is a secondary data analysis of the baseline data of an interventional study. The participants were residents of seven districts in Hong Kong, aged 55 or older, able to ambulate independently and to function well cognitively. Pre-frailty refers to the presence of two frailty-related phenotypes: low physical activity or poor handgrip strength or both. Included in the study were 199 individuals with a mean age of 73.43 (SD 7.54). Regression models showed that body weight (OR = 0.95, 95% CI 0.92-0.99, p < .05) was significantly associated with pre-frailty, as was body height (OR = 0.88, 95% CI 0.83-0.94, p < .001). Age is a significant moderator of the relationship between pre-frailty and body weight and body height. The effect of body weight (beta = -0.044, p < .05) and height (beta = -0.16, p < .001) on pre-frailty was significant and negative in the younger age groups. The findings indicate that raw body measures (i.e. body weight, body height) are more predictive of pre-frailty than BMI in older Chinese people. However, in the old-old group, these measures are not significant predictors of pre-frailty in Chinese community-dwelling adults. Practitioners should consider adopting body measures as predictors of pre-frailty in the younger-old population.
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http://dx.doi.org/10.1111/hsc.13114DOI Listing
August 2020

Genome Sequences of SARS-CoV-2 Strains Detected in Hong Kong.

Microbiol Resour Announc 2020 Jul 30;9(31). Epub 2020 Jul 30.

Molecular Pathology Division, Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong

We sequenced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes from deep throat saliva samples of three imported cases in Hong Kong by Nanopore sequencing. Epidemiological and clinical features of these coronavirus disease 2019 (COVID-19) cases were presented for genomic epidemiology studies.
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http://dx.doi.org/10.1128/MRA.00697-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393966PMC
July 2020

Psychometric testing of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) subscale in a longitudinal study of cancer patients treated with chemotherapy.

Health Qual Life Outcomes 2020 Jul 23;18(1):246. Epub 2020 Jul 23.

School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR.

Background: The aim of this study was to evaluate the psychometric properties of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) subscale in a longitudinal study of cancer patients treated with chemotherapy.

Methods: Patients were assessed with the FACT/GOG-Ntx subscale, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy Scale 20 (EORTC QLQ-CIPN20), National Cancer Institute -Common Terminology Criteria for Adverse Events (NCI-CTCAE), and light touch test using 10 g monofilament for up to ten assessment points from baseline (prior to initiation of first chemotherapy), after the end of each cycle (up to 6 cycles, 3 weeks per cycle), and at 6, 9, and 12 months after starting chemotherapy. Psychometric analyses included internal consistency reliability, convergent validity, factorial validity, sensitivity to change and responsiveness (minimal clinically important difference, MCID).

Results: Cronbach's alpha coefficients of the FACT/GOG-Ntx subscale were 0.82-0.89 across assessment points. The subscale strongly correlated with the EORTC QLQ-CIPN20 (r = 0.79-0.93) but low-to-moderately correlated with the NCI-CTCAE sensory (r = 0.23-0.45) and motor items (r = 0.15-0.50) as well as the monofilament test (r = 0.23-0.47). The hypothesized 4-factor structure of the FACT/GOG-Ntx subscale was not confirmed at assessment points (χ2/df = 2.26-8.50; all P < 0.001). The subscale exhibited small-to-moderate sensitivity to change (r = 0.17-0.37). The MCIDs were between 1.38 and 3.68.

Conclusion: The FACT/GOG-Ntx subscale has satisfactory reliability, validity, sensitivity to change and responsiveness to evaluate CIPN in cancer patients. Future research is needed to explore the factorial structure of the FACT/GOG-Ntx subscale as the published four-factor structure was not supported in this study.
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http://dx.doi.org/10.1186/s12955-020-01493-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376939PMC
July 2020

Public knowledge of the influence of modifiable cardiovascular risk factors on dementia: a systematic literature review and meta-analysis.

Aging Ment Health 2020 Jul 7:1-15. Epub 2020 Jul 7.

School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.

Objectives: This systematic review examined whether the general public are aware of the influence of modifiable cardiovascular risk factors (CVRFs) on dementia.

Methods: Following PRISMA guidelines, five electronic databases (PubMed, Medline, CINAHL, ProQuest, and Scopus) were searched for studies published from 2009-2019, using the key terms "knowledge," "modifiable cardiovascular risk factors," and "dementia." Standardized critical appraisal instruments were used to evaluate the quality of the studies.

Results: Of the 1,533 articles that were screened, 26 were included in this review. Modifiable CVRFs of dementia included behavioral factors (physical inactivity, poor dietary practices, high alcohol consumption, and heavy smoking) and medical conditions (hypertension, diabetes mellitus, hypercholesterolemia, and obesity). Although the association between CVRFs and dementia was identified (pooled prevalence is 24-50%), overall knowledge about this relationship in the general public was low. Sociodemographic variables, such as higher education, better economic status, and prior contact with a person with dementia, positively influenced dementia risk knowledge. Ethnic minorities showed good awareness of dementia risk from cardiovascular-related conditions.

Conclusion: Despite dementia is considered as a public health priority by World Health Organization, knowledge of the modifiable CVRFs and dementia is low in the general population. Public health policymakers should develop appropriate educational programs and interventions to equip the communities and vulnerable groups with this understanding so that they can be prepared to reduce dementia risk.
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http://dx.doi.org/10.1080/13607863.2020.1786801DOI Listing
July 2020

Current Status of COVID-19 Therapies and Drug Repositioning Applications.

iScience 2020 Jul 20;23(7):101303. Epub 2020 Jun 20.

Science for Life Laboratory, KTH - Royal Institute of Technology, Stockholm 17121, Sweden; Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London SE1 9RT, UK. Electronic address:

The rapid and global spread of a new human coronavirus (SARS-CoV-2) has produced an immediate urgency to discover promising targets for the treatment of COVID-19. Drug repositioning is an attractive approach that can facilitate the drug discovery process by repurposing existing pharmaceuticals to treat illnesses other than their primary indications. Here, we review current information concerning the global health issue of COVID-19 including promising approved drugs and ongoing clinical trials for prospective treatment options. In addition, we describe computational approaches to be used in drug repurposing and highlight examples of in silico studies of drug development efforts against SARS-CoV-2.
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http://dx.doi.org/10.1016/j.isci.2020.101303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305759PMC
July 2020

Improvement in the Current Therapies for Hepatocellular Carcinoma Using a Systems Medicine Approach.

Adv Biosyst 2020 06 8;4(6):e2000030. Epub 2020 Apr 8.

Science for Life Laboratory, KTH - Royal Institute of Technology, Stockholm, SE 17121, Sweden.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death primarily due to the lack of effective targeted therapies. Despite the distinct morphological and phenotypic patterns of HCC, treatment strategies are restricted to relatively homogeneous therapies, including multitargeted tyrosine kinase inhibitors and immune checkpoint inhibitors. Therefore, more effective therapy options are needed to target dysregulated metabolic and molecular pathways in HCC. Integrative genomic profiling of HCC patients provides insight into the most frequently mutated genes and molecular targets, including telomerase reverse transcriptase, the TP53 gene, and the Wnt/β-catenin signaling pathway oncogene (CTNNB1). Moreover, emerging techniques, such as genome-scale metabolic models may elucidate the underlying cancer-specific metabolism, which allows for the discovery of potential drug targets and identification of biomarkers. De novo lipogenesis has been revealed as consistently upregulated since it is required for cell proliferation in all HCC patients. The metabolic network-driven stratification of HCC patients in terms of redox responses, utilization of metabolites, and subtype-specific pathways may have clinical implications to drive the development of personalized medicine. In this review, the current and emerging therapeutic targets in light of molecular approaches and metabolic network-based strategies are summarized, prompting effective treatment of HCC patients.
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http://dx.doi.org/10.1002/adbi.202000030DOI Listing
June 2020

Two versions of perspectives on caring for older patients scale: Translation and psychometric testing among Chinese nursing students.

Nurs Health Sci 2020 Dec 1;22(4):903-912. Epub 2020 Jul 1.

School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.

This study aimed to translate the Perspectives on Caring for Older Patients scale into Chinese, both the full and the shortened versions, and test its psychometric properties among Chinese nursing students. In this methodological research, the scale were translated and administered to 307 nursing students recruited from two universities in mainland China. The psychometric testing mainly included internal consistency reliability using Cronbach's alphas, 2-week test-retest reliability using the intraclass correlation coefficient, convergent validity with Kogan's Attitude toward Older People scale, and factorial validity using exploratory factor analysis. Cronbach's alphas for the full and the shortened version scales were 0.77 and 0.75, respectively. The intraclass correlation coefficient values of both versions exceeded 0.70 and their scores were moderately correlated with the Kogan's Attitude toward Older People scale's scores. While exploratory factor analyses revealed a six-factor structure for the full version with factor loadings of five items below 0.3, the shortened version identified two factors with all factor loadings above 0.3. This study concluded that the psychometric properties of the full version scale were adequate and similar to those of the shortened version except for factorial validity.
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http://dx.doi.org/10.1111/nhs.12745DOI Listing
December 2020