Publications by authors named "Sonam Choden"

7 Publications

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Application of the Bethesda system for reporting thyroid cytopathology for classification of thyroid nodules: A clinical and cytopathological characteristics in Bhutanese population.

Diagn Cytopathol 2021 Jul 28. Epub 2021 Jul 28.

Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.

Introduction: The existence of baseline data on the spectrum of thyroid nodules in Bhutanese patients is unknown. Fine-needle aspiration cytology (FNAC) is regarded as the gold standard diagnostic test for pre-op assessment of thyroid lesions.

Materials And Methods: We conducted a retrospective study, involving 765 patients who underwent FNAC of the thyroid gland, at Jigme Dorji Wangchuck National Referral Hospital, Thimphu, between January-2018 to December-2020. We aimed to assess the cytomorphological spectrum of thyroid nodules, classify them as per The Bethesda system for reporting thyroid cytopathology (TBSRTC), assess risk of malignancy (ROM), and evaluate the accuracy of FNAC in diagnosing thyroid malignancy.

Results: Colloid nodule (37.4%) and papillary thyroid carcinoma (4.2%) constituted the majority of benign and malignant cytological diagnoses, respectively. According to TBSRTC, majority of the cases (82.0%) fell under the Bethesda II category. Bethesda III was the least common (1.4%) category. As compared to histopathological diagnosis; the sensitivity, specificity, positive and the negative predictive values of FNAC in diagnosing thyroid malignancy were 90.0%, 93.3%, 93.10%, and 90.32% respectively. The ROM increased concurrently with the grade of the Bethesda category and was more or less close to the ROM reference range, published in the TBSRTC.

Conclusion: Benign thyroid nodules (82.0%) constituted a majority of thyroid nodules in Bhutanese patients. FNAC was found to be reliable in detecting thyroid malignancy. From the literature, TBSRTC was found to be a more convenient method for reporting thyroid cytology. Henceforth, as most institutes, we plan to implement TBSRTC for reporting thyroid cytopathology.
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http://dx.doi.org/10.1002/dc.24843DOI Listing
July 2021

The Development of the Rheumatology Informatics System for Effectiveness Learning Collaborative for Improving Patient-Reported Outcome Collection and Patient-Centered Communication in Adult Rheumatology.

ACR Open Rheumatol 2021 Jul 20. Epub 2021 Jul 20.

Zuckerberg San Francisco General Hospital, San Francisco, California.

Objective: Patient-reported outcomes (PROs) are an integral part of treat-to-target approaches in managing rheumatoid arthritis (RA). In clinical practice, however, routine collection, documentation, and discussion of PROs with patients are highly variable. The RISE LC (Rheumatology Informatics System for Effectiveness Learning Collaborative) was established to develop and share best practices in PRO collection and use across adult rheumatology practices in the United States METHODS: The goals of the RISE LC were developed through site surveys and in-person meetings. Participants completed a baseline survey on PRO collection and use in their practices. RISE LC learning sessions focused on improving communication around PROs with patients and enhancing shared decision-making in treatment plans. During the coronavirus disease 2019 (COVID-19) pandemic, the RISE LC pivoted to adapt PRO tools for telehealth.

Results: At baseline, all responding sites (n = 15) had established workflows for collecting PROs. Most sites used paper forms alone. PRO documentation in electronic health records was variable, with only half of the sites using structured data fields. To standardize and improve the use of PROs, participants iteratively developed a Clinical Disease Activity Index-based RA Disease Activity Communication Tool to solicit treatment goals and improve shared decision-making across sites. The COVID-19 pandemic necessitated developing a tool to gauge PROs via telehealth.

Conclusion: The RISE LC is a continuous, structured method for implementing strategies to improve PRO collection and use in rheumatological care, initially adapting from the Learning Collaborative model and extending to include features of a learning network. Future directions include measuring the impact of standardized PRO collection and discussion on shared decision-making and RA outcomes.
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http://dx.doi.org/10.1002/acr2.11310DOI Listing
July 2021

Characteristics and Population Size Estimation of Female Sex Workers in Bhutan.

Sex Transm Dis 2021 Oct;48(10):754-760

Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.

Background: Knowing the number of persons at risk for sexually transmitted diseases (STDs) and their risk behaviors are needed to allocate limited resources, set targets for prevention and care activities, gauge the reach of programs, and assess their impact. Female sex workers (FSWs) are a population at high risk for STD worldwide; little is known about FSW in Bhutan.

Methods: We conducted a community-based survey and population size exercise of FSW in Bhutan. The survey used a hybrid venue-based/peer-referral sampling method. Population size estimation methods were key informant mapping, census and enumeration, unique object multiplier, and capture-recapture.

Results: Of 517 women surveyed, 67.5% provided sex for money in the last year. Compared with FSWs at venues, FSWs referred by peers were more likely to have sex with alcohol (80.1% vs. 51.5%, P < 0.001) and more paying partners (mean, 3.5 vs. 2.0; P = 0.001), and less likely to have tested for an STD (28.3% vs. 51.0%, P < 0.001) or have outreach worker contact (27.6% vs. 41.5%, P = 0.007). The estimated number of FSWs in the 9 districts was 353 (95% confidence interval, 345-362). Extrapolation to the whole country projected 597 (417-777) FSWs nationally.

Conclusions: Our estimate of the number of FSW in Bhutan corresponds to 0.71% of adult urban women, a figure in line with other countries in South and Southeast Asia. Our data highlight the need for outreach beyond venues where women are employed to reach FSW at higher risk for STD but who have less access to interventions.
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http://dx.doi.org/10.1097/OLQ.0000000000001417DOI Listing
October 2021

An affordable immunohistochemical approach to estimate the prevalence of in large cohort studies-establishing the baseline rate of mutation in an institutional series of papillary thyroid carcinoma from Thailand.

Gland Surg 2020 Oct;9(5):1867-1877

Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Background: Papillary thyroid carcinoma (PTC) accounts for the majority of diagnoses of thyroid carcinoma. mutation is the most common genetic alteration in PTC, which has diagnostic and prognostic significance. The rate of mutation in PTC from Thailand has not been reported. Our purpose was to estimate the prevalence of mutation in a large institutional series using an affordable approach, which combined mutation-specific immunohistochemistry (IHC) with VE1 antibody and tissue microarray (TMA).

Methods: A total of 476 PTC cases plotted on TMA were employed for determining the mutation status in this study. The cancer tissue of initial 100 cases (pilot study) were analyzed for mutation by using both direct sequencing and VE1 immunostaining. For the subsequent PTC cases, VE1 IHC was used as an alternative to direct sequencing for the detection of mutation. Univariate and multivariate analyses were done to determine the association of clinicopathological variables with mutation.

Results: In the pilot study, VE1 IHC showed excellent analytical performance (κ=0.884) for detecting mutation in PTC TMA as compared to direct sequencing. The prevalence of in the whole cohort was 60.9% by using VE1 IHC. The mutation was commonly seen in tall cell (92.9%) and classic (70.2%) variants of PTC. Multivariate analysis (P<0.05) showed association of with histological type of tumor, extrathyroidal extension, and absence of Hashimoto's thyroiditis.

Conclusions: In conclusion, mutation was detected in 60.9% of Thai PTC and it was associated with several aggressive clinicopathological variables of thyroid cancer. VE1 IHC proved as a reliable method able to replace direct sequencing for detection of the mutation. A combination of mutation-specific IHC and TMA allows conducting large cohort studies more labor-saving and cost-efficiently.
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http://dx.doi.org/10.21037/gs-20-388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667104PMC
October 2020

VE1 Immunohistochemistry Improves the Limit of Genotyping for Detecting Mutation in Papillary Thyroid Cancer.

Cancers (Basel) 2020 Mar 5;12(3). Epub 2020 Mar 5.

Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.

Detection of BRAF is useful for making diagnosis and risk stratification of papillary thyroid carcinoma (PTC). Molecular testing, however, is not always available for routine clinical use. To assess the clinical utility and reliability of VE1 immunohistochemistry (IHC) for detecting BRAF mutation in PTC, VE1 IHC was performed on the tissue microarrays of 514 patients with PTC and was compared with Sanger sequencing results. Of 514 PTC cases, 433 (84.2%) were positive for VE1 expression. Among 6 discordant cases between VE1 IHC and Sanger sequencing, 3 initial VE1-false negative cases turned out to be true false negative on repeat testing, and 3 VE1-false positive cases showed BRAF mutation using digital PCR analysis. PTCs with low variant allele fraction were positive for VE1 IHC but were not detected using sequencing. VE1 IHC showed 99.3% sensitivity, 100% specificity, 100% positive predictive value, and 96.4% negative predictive value. The BRAF mutation was significantly associated with older age, multifocality, extrathyroidal extension, lymph node metastasis, and advanced tumor stage. In conclusion, VE1 IHC is a reliable method for detecting BRAF mutation in PTC specimens.
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http://dx.doi.org/10.3390/cancers12030596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139976PMC
March 2020

Demographic Characteristics of Participants in Rheumatoid Arthritis Randomized Clinical Trials: A Systematic Review.

JAMA Netw Open 2019 11 1;2(11):e1914745. Epub 2019 Nov 1.

Division of Rheumatology, University of California, San Francisco.

Importance: Racial/ethnic minority groups, women, and elderly people experience a disproportionate burden of disease in rheumatoid arthritis (RA), making it particularly important to examine drug therapies in these populations. Despite a national health agenda to improve representation of diverse populations in randomized clinical trials (RCTs), there have been few large-scale analyses examining RCT demographic characteristics within rheumatology and none focusing on RA.

Objective: To characterize the representation of racial/ethnic minority groups, women, and elderly people through a comprehensive systematic review of RA RCTs.

Data Sources: A literature search of PubMed's MEDLINE database was conducted to identify RA RCTs in adults 19 years and older published in English between January 1, 2008, and January 1, 2018.

Study Selection: Randomized double-blind RCTs examining any systemic, disease-modifying therapy were included. Secondary analyses of previously published RCTs were excluded. Of 1195 identified records, 240 articles (20.1%) met final selection criteria. The analysis focused on RCTs with at least 1 US-based site.

Data Extraction And Synthesis: Data were extracted and synthesized according to the PRISMA guidelines for systematic reviews. Studies were screened for eligibility criteria. Demographic data on the age, sex, and race/ethnicity of RCT participants were extracted. Data analysis was conducted from October 25, 2018, to March 15, 2019.

Main Outcomes And Measures: Representation of race/ethnicity and sex, defined as the proportion of total participants that belonged to each racial/ethnic group or sex. Trends in proportions over time were examined and compared with US demographic data.

Results: A total of 240 RCTs with 77 071 participants were included. Of 126 RCTs with at least 1 US-based site (52.5%), the enrollment of minority racial/ethnic groups was significantly lower than their representation within the US Census population (16% vs 40%; P < .001), and the enrollment of men was significantly lower than the incidence of RA in men nationally (20.4% vs 28.6%; P < .001). There was no trend toward improved representation of racial/ethnic minority groups or men over time.

Conclusions And Relevance: Given the disproportionate burden of RA among racial/ethnic minority groups, it is imperative that policy makers better incentivize the inclusion of racial/ethnic minority groups in RA RCTs.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.14745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902779PMC
November 2019

Quality improvement initiatives in rheumatology: an integrative review of the last 5 years.

Curr Opin Rheumatol 2019 03;31(2):98-108

Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.

Purpose Of Review: We reviewed recent quality improvement initiatives in the field of rheumatology to identify common strategies and themes leading to measurable change.

Recent Findings: Efforts to improve quality of care in rheumatology have accelerated in the last 5 years. Most studies in this area have focused on interventions to improve process measures such as increasing the collection of patient-reported outcomes and vaccination rates, but some studies have examined interventions to improve health outcomes. Increasingly, researchers are studying electronic health record (EHR)-based interventions, such as standardized templates, flowsheets, best practice alerts and order sets. EHR-based interventions were most successful when reinforced with provider education, reminders and performance feedback. Most studies also redesigned workflows, distributing tasks among clinical staff. Given the common challenges and solutions facing rheumatology clinics under new value-based payment models, there are important opportunities to accelerate quality improvement by building on the successful efforts to date. Structured quality improvement models such as the learning collaborative may help to disseminate successful initiatives across practices.

Summary: Review of recent quality improvement initiatives in rheumatology demonstrated common solutions, particularly involving leveraging health IT and workflow redesign.
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http://dx.doi.org/10.1097/BOR.0000000000000586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391997PMC
March 2019
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