Lancet Regional Health-Americas最新文献

{"title":"Venous thromboembolism prevention program implementation in a community oncology practice: a cohort study","authors":"Steven Ades ,&nbsp;Yonatan Resnick ,&nbsp;Jacob Barker ,&nbsp;Karlyn Martin ,&nbsp;Ryan Thomas ,&nbsp;Karen Libby ,&nbsp;John Winters ,&nbsp;Chris Holmes","doi":"10.1016/j.lana.2024.100866","DOIUrl":"10.1016/j.lana.2024.100866","url":null,"abstract":"<div><h3>Background</h3><p>While national guidelines recommend Venous Thromboembolism (VTE) risk assessment in cancer outpatients and consideration of pharmacologic prophylaxis in high-risk patients, prophylaxis rates are low in community oncology practices. A successful model for guideline implementation (the Vermont Model, VM) is validated in an academic tertiary oncology setting. We undertook an implementation study to determine the success of this model in a multi-site community oncology practice. The study objectives were to: 1) adapt the VM to the community practice setting; 2) implement the adapted VM into practice; and 3) evaluate clinical and implementation outcomes.</p></div><div><h3>Methods</h3><p>The study was carried out in three phases: (1) Pre-implementation, a multidisciplinary team addressed the need to adapt the VM to the local context including electronic medical record (EMR) optimisation and clinician education; (2) implementation of the strategies adapted to the local context, informed by VM and adapted based on stakeholder feedback; (3) prospective evaluation of clinical and implementation outcomes at six months after implementation.</p></div><div><h3>Findings</h3><p>Following creation of a comprehensive initiation roadmap for the adaptation of VM program to the community practice, 302 cancer outpatients initiating new treatment met inclusion criteria over a 6 month implementation period. VTE risk education was provided to 100% of patients, and 98% (296) of patients received a VTE risk assessment. Of 52 patients (18%) who scored as high risk based on a modified Khorana (Protecht) score, 14 (27%) initiated prophylaxis. Barriers to program adaptation included EMR optimization challenges and practice-level responsibility assignment, time constraints, concern about potential drug interactions, and financial &amp; insurance issues.</p></div><div><h3>Interpretation</h3><p>Implementation of a multidisciplinary VTE prevention model in the community-based oncology setting successfully increased VTE education and risk assessment rates. AC prophylaxis rates were modestly increased, highlighting the need to understand and address barriers to anticoagulant prophylaxis prescribing in this setting.</p></div><div><h3>Funding</h3><p>Northern New England Clinical Oncology Society Research Funding Program.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100866"},"PeriodicalIF":7.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001935/pdfft?md5=d3206742b6cc98a6f5792bb988967117&pid=1-s2.0-S2667193X24001935-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sports betting scandals highlight knowledge gaps for gambling harm","authors":"Luke Clark ,&nbsp;Michael J.A. Wohl","doi":"10.1016/j.lana.2024.100879","DOIUrl":"10.1016/j.lana.2024.100879","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100879"},"PeriodicalIF":7.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002060/pdfft?md5=afb0db3ce57b9e84558578892c19efb4&pid=1-s2.0-S2667193X24002060-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A surveillance study of cancer incidence and mortality among young adults in Costa Rica","authors":"Rachel Slimovitch ,&nbsp;Jaimie Z. Shing ,&nbsp;Romain Fantin ,&nbsp;Juan C. Vanegas ,&nbsp;Carolina Porras ,&nbsp;Rolando Herrero ,&nbsp;Meredith S. Shiels ,&nbsp;Mónica S. Sierra ,&nbsp;Erica S. Stephens ,&nbsp;Allan Hildesheim ,&nbsp;Aimée R. Kreimer ,&nbsp;Alejandro Calderón ,&nbsp;Loretto J. Carvajal","doi":"10.1016/j.lana.2024.100872","DOIUrl":"10.1016/j.lana.2024.100872","url":null,"abstract":"<div><h3>Background</h3><p>There has been an increase in certain cancers among young adults (YA) aged 20–39, particularly in Latin America. This is the first study to examine cancer incidence and mortality in YA in Costa Rica, focusing on sex-specific patterns.</p></div><div><h3>Methods</h3><p>Invasive cancer cases (excluding non-melanoma skin cancer) in YA from 2006 to 2015 were obtained from the Costa Rican National Registry of Tumors. Utilising SEER∗Stat software, age-standardized incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Trends and annual percent changes (APCs) in IRs were estimated using the Joinpoint regression analysis program. Cancer deaths from 2000 to 2021 were obtained from the Costa Rican National Institute of Statistics and Census. Age-standardised mortality rates were calculated using STATA®17.</p></div><div><h3>Findings</h3><p>YA comprised 10.7% of all invasive cancer cases diagnosed from 2006 to 2015. The age-standardized incidence rate (ASIR) of invasive cancer in YA was 50.9/100,000 person-years. The ASIR was twofold higher for females compared to males (IRR = 2.03, 95% CI:1.94, 2.13). This difference increased with age, peaking in the 35–39-year age group (IRR = 2.84, 95% CI:2.62, 3.10). Thyroid, breast, and cervical cancer were the most common in females. Testicular cancer was the most common in males. Leading causes of cancer-related deaths included cervical and breast cancer in females and stomach and brain/nervous system cancer in males.</p></div><div><h3>Interpretation</h3><p>The study highlights sex-specific patterns in cancer incidence and mortality among YA in Costa Rica to increase understanding and improve cancer outcomes in this age group.</p></div><div><h3>Funding</h3><p>This study was funded by the <span>Intramural Research Program</span> of the <span>National Cancer Institute</span>.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100872"},"PeriodicalIF":7.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001996/pdfft?md5=50ebab2883e4bb97bd74a7ae5c524134&pid=1-s2.0-S2667193X24001996-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociohistorical justice: a corrective framework to mend the modern harms of medical history","authors":"Carmen Black ,&nbsp;Shavonne Temple ,&nbsp;Amber Acquaye ,&nbsp;Christopher Fields ,&nbsp;Abigail Konopasky","doi":"10.1016/j.lana.2024.100874","DOIUrl":"10.1016/j.lana.2024.100874","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100874"},"PeriodicalIF":7.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002011/pdfft?md5=050c9283fc3a018904d27e6e485396c9&pid=1-s2.0-S2667193X24002011-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Our environment, our health, our challenge: perspectives from a Southern Brazil tragedy","authors":"Rafael Dall’Alba ,&nbsp;Marco André Germanò ,&nbsp;Carine B. Ferreira Nied ,&nbsp;Paula Emília Adamy ,&nbsp;Cristianne Famer Rocha","doi":"10.1016/j.lana.2024.100878","DOIUrl":"10.1016/j.lana.2024.100878","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100878"},"PeriodicalIF":7.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002059/pdfft?md5=aaad5d3cc59cfc1ab2061e5e34f58b0c&pid=1-s2.0-S2667193X24002059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of end-of-life discussions and palliative care: implications for neurological intensive care among Latinos in the U.S.","authors":"Monica M. Diaz ,&nbsp;Lesley A. Guareña ,&nbsp;Bettsie Garcia ,&nbsp;Christoper A. Alarcon-Ruiz ,&nbsp;Stella M. Seal ,&nbsp;Clio Rubinos ,&nbsp;Dulce M. Cruz-Oliver ,&nbsp;J. Ricardo Carhuapoma","doi":"10.1016/j.lana.2024.100873","DOIUrl":"10.1016/j.lana.2024.100873","url":null,"abstract":"<div><p>Goals of care (Goals-of-care) discussions and palliative care (PC) are crucial to providing comprehensive healthcare, particularly for acute neurological conditions requiring admission to a neurological intensive care unit. We identified gaps in the literature and describe insight for future research on end-of-life discussions and PC for U.S. Latinos with acute neurological conditions. We searched 10 databases including peer-reviewed abstracts and manuscripts of hospitalized U.S. Latinos with acute neurological and non-neurological conditions. We included 44 of 3231 publications and identified various themes: PC utilization, pre-established advanced directives in Goals-of-care discussions, Goals-of-care discussion outcomes, tracheostomy or percutaneous gastrostomy tube placement rates among hospitalized Latinos. Our review highlights that Latinos appear to have lower palliative care utilization compared with non-Latino Whites and may be less likely to have pre-established advanced directives, more likely to have gastrostomy or tracheostomy placement and less likely to have do-not-resuscitate status.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100873"},"PeriodicalIF":7.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X2400200X/pdfft?md5=08f8d85c1d015dccfb682f58937c86f1&pid=1-s2.0-S2667193X2400200X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural racism: a fundamental cause of drug overdose disparities","authors":"David T. Zhu","doi":"10.1016/j.lana.2024.100875","DOIUrl":"10.1016/j.lana.2024.100875","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100875"},"PeriodicalIF":7.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24002023/pdfft?md5=21ebbf1f957e17fe8522cb33fe12e16b&pid=1-s2.0-S2667193X24002023-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-guided identification of risk variants for adrenocortical tumours in TP53 p.R337H carrier children: a genetic association study","authors":"Bonald C. Figueiredo ,&nbsp;Florent Dupont ,&nbsp;Geoffrey Portelli ,&nbsp;Tatiana E.J. Costa ,&nbsp;Gislaine Custódio ,&nbsp;Mariana M. Paraizo ,&nbsp;Heloisa Komechen ,&nbsp;Hadrien Gascuel ,&nbsp;Maxime Bottau ,&nbsp;Elodie Callea ,&nbsp;Ana Paula Percicote ,&nbsp;Leila G. Telles ,&nbsp;Mehdi Jendoubi ,&nbsp;Enzo Lalli","doi":"10.1016/j.lana.2024.100863","DOIUrl":"10.1016/j.lana.2024.100863","url":null,"abstract":"<div><h3>Background</h3><p>Adrenocortical tumours (ACT) in children are part of the Li-Fraumeni cancer spectrum and are frequently associated with a germline <em>TP53</em> pathogenic variant. <em>TP53</em> p.R337H is highly prevalent in the south and southeast of Brazil and predisposes to ACT with low penetrance. Thus, we aimed to investigate whether genetic variants exist which are associated with an increased risk of developing ACT in <em>TP53</em> p.R337H carrier children.</p></div><div><h3>Methods</h3><p>A genetic association study was conducted in trios of children (14 girls, 7 boys) from southern Brazil carriers of <em>TP53</em> p.R337H with (<em>n</em> = 18) or without (<em>n</em> = 3) ACT and their parents, one of whom also carries this pathogenic variant (discovery cohort). Results were confirmed in a validation cohort of <em>TP53</em> p.R337H carriers with (<em>n</em> = 90; 68 girls, 22 boys) or without ACT (<em>n</em> = 302; 165 women, 137 men).</p></div><div><h3>Findings</h3><p>We analysed genomic data from whole exome sequencing of blood DNA from the trios. Using deep learning algorithms, according to a model where the affected child inherits from the non-carrier parent variant(s) increasing the risk of developing ACT, we found a significantly enriched representation of non-coding variants in genes involved in the cyclic AMP (cAMP) pathway known to be involved in adrenocortical tumorigenesis. One among those variants (rs2278986 in the <em>SCARB1</em> gene) was confirmed to be significantly enriched in the validation cohort of <em>TP53</em> p.R337H carriers with ACT compared to carriers without ACT (OR 1.858; 95% CI 1.146, 3.042, p = 0.01).</p></div><div><h3>Interpretation</h3><p>Profiling of the variant rs2278986 is a candidate for future confirmation and possible use as a tool for ACT risk stratification in <em>TP53</em> p.R337H carriers.</p></div><div><h3>Funding</h3><p><span>Centre National de la Recherche Scientifique</span> (CNRS), <span>Behring Foundation</span>, <span>Conselho Nacional de Desenvolvimento Científico e Tecnológico</span> (CNPq).</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100863"},"PeriodicalIF":7.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X2400190X/pdfft?md5=a1febed3f3ea3fb3dd7ea58e92302897&pid=1-s2.0-S2667193X2400190X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding reach, enhancing capacity: embracing the role of primary care in lung cancer screening and smoking cessation in the United States","authors":"Elochukwu Ezenwankwo ,&nbsp;Duong Thuy Nguyen ,&nbsp;Idorenyin Ubon Akpabio ,&nbsp;Jan M. Eberth","doi":"10.1016/j.lana.2024.100870","DOIUrl":"10.1016/j.lana.2024.100870","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100870"},"PeriodicalIF":7.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001972/pdfft?md5=952021c25dcb44a245e42313714dc66f&pid=1-s2.0-S2667193X24001972-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142020413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort study","authors":"Carlos J. Pérez Rivera ,&nbsp;Nicolás Lozano-Suárez ,&nbsp;Alejandro Velandia-Sánchez ,&nbsp;Maria Paula Vargas-Cuellar ,&nbsp;Luisa Fernanda Rojas-Serrano ,&nbsp;Camilo A. Polanía-Sandoval ,&nbsp;Daniela Lara-Espinosa ,&nbsp;Laura García-Zambrano ,&nbsp;Maria Paz Bohórquez-Tarazona ,&nbsp;Silvia Valentina Agudelo-Mendoza ,&nbsp;Paulo A. Cabrera-Rivera ,&nbsp;Leonardo Briceno-Ayala","doi":"10.1016/j.lana.2024.100862","DOIUrl":"10.1016/j.lana.2024.100862","url":null,"abstract":"<div><h3>Background</h3><p>Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia.</p></div><div><h3>Methods</h3><p>A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions.</p></div><div><h3>Findings</h3><p>3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively.</p></div><div><h3>Interpretation</h3><p>The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care.</p></div><div><h3>Funding</h3><p>This work was supported by <span>Universidad del Rosario</span> and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.</p></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"38 ","pages":"Article 100862"},"PeriodicalIF":7.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667193X24001893/pdfft?md5=e610997e5ae9fb05500259165df6e8b9&pid=1-s2.0-S2667193X24001893-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}