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Article ; Online: An Objective Structured Clinical Exam on Breaking Bad News for Clerkship Students

Lona Prasad / Steven Hockstein / Joseph E. Safdieh / Kevaughn Harvey / Paul J. Christos / Yoon Kang

MedEdPORTAL, Vol

In-Person Versus Remote Standardized Patient Approach

2023 Volume 19

Abstract: Introduction Telemedicine training for medical students is critical as that modality becomes integral to patient care. This formative standardized patient (SP) objective structured clinical exam (OSCE) lets students discuss miscarriage diagnosis and ... ...

Abstract	Introduction Telemedicine training for medical students is critical as that modality becomes integral to patient care. This formative standardized patient (SP) objective structured clinical exam (OSCE) lets students discuss miscarriage diagnosis and treatment virtually. Methods The SP OSCE was a mandatory session during the obstetrics and gynecology clerkship. Students received immediate feedback and optional individual reviews with clerkship directors. Students completed a nonmandatory survey at the end to describe their experience. SPIKES protocol student responses (i.e., proportion of correct responses) from in-person and remote SP versions were compared. Results Between July 2019 and March 2020, 79 students completed the in-person OSCE. Between July 2020 and June 2021, 149 students completed the remote SP encounter OSCE. Students who participated in the remote versus the in-person OSCE were more likely to admit their lack of knowledge when not equipped (p = .02), be seated during the encounter (p = .03), show listening body language (p = .13), assess the SP's perception (p = .19) and understanding (p = .20), and correct the SP's misunderstandings (p = .14). Of 84 students from eight rotations, including both in-person and remote formats, 99% believed learning objectives were clear, 91% felt preparation material was adequate, 95% thought the instructor summarized important points, 97% learned something in caring for gynecological patients, and 96% perceived the OSCE to be a worthwhile educational experience. Discussion The remote OSCE was well received by students. Breaking bad news virtually met assessment goals. Telemedicine training should be incorporated into medical school curricula.
Keywords	Telemedicine ; Breaking Bad News ; SPIKES Protocol ; Miscarriage ; Case-Based Learning ; Clinical Skills Assessment/OSCEs ; Medicine (General) ; R5-920 ; Education ; L
Subject code	370
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	Association of American Medical Colleges
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Clinical, regional, and genetic characteristics of Covid-19 patients from UK Biobank.

David A Kolin / Scott Kulm / Paul J Christos / Olivier Elemento

PLoS ONE, Vol 15, Iss 11, p e

2020 Volume 0241264

Abstract: Background Coronavirus disease 2019 (Covid-19) has rapidly infected millions of people worldwide. Recent studies suggest that racial minorities and patients with comorbidities are at higher risk of Covid-19. In this study, we analyzed the effects of ... ...

Abstract	Background Coronavirus disease 2019 (Covid-19) has rapidly infected millions of people worldwide. Recent studies suggest that racial minorities and patients with comorbidities are at higher risk of Covid-19. In this study, we analyzed the effects of clinical, regional, and genetic factors on Covid-19 positive status. Methods The UK Biobank is a longitudinal cohort study that recruited participants from 2006 to 2010 from throughout the United Kingdom. Covid-19 test results were provided to UK Biobank starting on March 16, 2020. The main outcome measure in this study was Covid-19 positive status, determined by the presence of any positive test for a single individual. Clinical risk factors were derived from UK Biobank at baseline, and regional risk factors were imputed using census features local to each participant's home zone. We used robust adjusted Poisson regression with clustering by testing laboratory to estimate relative risk. Blood types were derived using genetic variants rs8176719 and rs8176746, and genomewide tests of association were conducted using logistic-Firth hybrid regression. Results This prospective cohort study included 397,064 UK Biobank participants, of whom 968 tested positive for Covid-19. The unadjusted relative risk of Covid-19 for Black participants was 3.66 (95% CI 2.83-4.74), compared to White participants. Adjusting for Townsend deprivation index alone reduced the relative risk to 2.44 (95% CI 1.86-3.20). Comorbidities that significantly increased Covid-19 risk included chronic obstructive pulmonary disease (adjusted relative risk [ARR] 1.64, 95% CI 1.18-2.27), ischemic heart disease (ARR 1.48, 95% CI 1.16-1.89), and depression (ARR 1.32, 95% CI 1.03-1.70). There was some evidence that angiotensin converting enzyme inhibitors (ARR 1.48, 95% CI 1.13-1.93) were associated with increased risk of Covid-19. Each standard deviation increase in the number of total individuals living in a participant's locality was associated with increased risk of Covid-19 (ARR 1.14, 95% CI 1.08-1.20). ...
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Author Correction

Nature Communications, Vol 15, Iss 1, Pp 1-

Neoadjuvant durvalumab plus radiation versus durvalumab alone in stages I–III non-small cell lung cancer: survival outcomes and molecular correlates of a randomized phase II trial

2024 Volume 1

Keywords	Science ; Q
Language	English
Publishing date	2024-01-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Do people with hereditary cancer syndromes inform their at-risk relatives? A systematic review and meta-analysis

Muhammad Danyal Ahsan / Sarah R. Levi / Emily M. Webster / Hannah Bergeron / Jenny Lin / Priyanka Narayan / Becky Baltich Nelson / Xuan Li / Rana K. Fowlkes / Jesse T. Brewer / Charlene Thomas / Paul J. Christos / Eloise Chapman-Davis / Evelyn Cantillo / Kevin Holcomb / Ravi N. Sharaf / Melissa K. Frey

PEC Innovation, Vol 2, Iss , Pp 100138- (2023)

2023

Abstract: Purpose: To evaluate rates of familial disclosure of hereditary cancer syndrome information. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines (PROSPERO no.: CRD42020134276). Key electronic databases were ... ...

Abstract	Purpose: To evaluate rates of familial disclosure of hereditary cancer syndrome information. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines (PROSPERO no.: CRD42020134276). Key electronic databases were searched to identify studies evaluating hereditary cancer syndrome cascade relative disclosure. Eligible studies were subjected to meta-analysis. Results: Thirty-four studies met inclusion criteria. Among 11,711 included relatives, 70% (95% CI 60 - 78%) were informed of their risk of carrying a cancer-associated pathogenic variant; of 2,875 relatives informed of their risk who were evaluated for uptake of cascade testing, 43% (95% CI 27 - 61%) completed testing. Rates of disclosure were higher among female vs male relatives (79% [95% CI 73% - 84%] vs 67% [95% CI 57% - 75%]) and first-degree vs second-degree relatives (83% [95% CI 77% - 88%] vs 58% [95% CI 45 – 69%]). Conclusion: Nearly one-third of at-risk relatives remain uninformed of their risk of carrying a cancer-associated pathogenic variant. Even among those informed, fewer than half subsequently complete genetic testing, representing a critical missed opportunity for precision cancer prevention. Innovation: Five studies evaluating interventions to improve disclosure rates were generally ineffective. Urgent work is needed to elucidate barriers to relative disclosure by probands to develop targeted interventions that can optimize proband-mediated cascade genetic testing rates.
Keywords	Disclosure ; Cascade genetic testing ; Hereditary cancer syndromes ; Lynch syndrome ; Hereditary breast and ovarian cancer ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Improved Water and Waste Management Practices Reduce Diarrhea Risk in Children under Age Five in Rural Tanzania

Paul H. McClelland / Claire T. Kenney / Federico Palacardo / Nicholas L. S. Roberts / Nicholas Luhende / Jason Chua / Jennifer Huang / Priyanka Patel / Leonardo Albertini Sanchez / Won J. Kim / John Kwon / Paul J. Christos / Madelon L. Finkel

International Journal of Environmental Research and Public Health, Vol 19, Iss 4218, p

A Community-Based, Cross-Sectional Analysis

2022 Volume 4218

Abstract: Diarrhea remains a significant cause of morbidity and mortality among children in developing countries. Water, sanitation, and hygiene practices (WASH) have demonstrated improved diarrhea-related outcomes but may have limited implementation in certain ... ...

Abstract	Diarrhea remains a significant cause of morbidity and mortality among children in developing countries. Water, sanitation, and hygiene practices (WASH) have demonstrated improved diarrhea-related outcomes but may have limited implementation in certain communities. This study analyzes the adoption and effect of WASH-based practices on diarrhea in children under age five in the rural Busiya chiefdom in northwestern Tanzania. In a cross-sectional analysis spanning July-September 2019, 779 households representing 1338 under-five children were surveyed. Among households, 250 (32.1%) reported at least one child with diarrhea over a two-week interval. Diarrhea prevalence in under-five children was 25.6%. In per-household and per-child analyses, the strongest protective factors against childhood diarrhea included dedicated drinking water storage (OR 0.25, 95% CI 0.18–0.36; p < 0.001), improved waste management (OR 0.37, 95% CI 0.27–0.51; p < 0.001), and separation of drinking water (OR 0.38, 95% CI 0.24–0.59; p < 0.001). Improved water sources were associated with decreased risk of childhood diarrhea in per-household analysis (OR 0.72, 95% CI 0.52–0.99, p = 0.04), but not per-child analysis (OR 0.83, 95% CI 0.65–1.05, p = 0.13). Diarrhea was widely treated (87.5%), mostly with antibiotics (44.0%) and oral rehydration solution (27.3%). Targeting water transportation, storage, and sanitation is key to reducing diarrhea in rural populations with limited water access.
Keywords	WASH ; drinking water ; diarrhea ; children under five ; prevention ; hygiene ; Medicine ; R
Subject code	360
Language	English
Publishing date	2022-04-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Neoadjuvant durvalumab plus radiation versus durvalumab alone in stages I–III non-small cell lung cancer

Nature Communications, Vol 14, Iss 1, Pp 1-

survival outcomes and molecular correlates of a randomized phase II trial

2023 Volume 14

Abstract: Abstract We previously reported the results of a randomized phase II trial (NCT02904954) in patients with early-stage non-small cell lung cancer (NSCLC) who were treated with either two preoperative cycles of the anti-PD-L1 antibody durvalumab alone or ... ...

Abstract	Abstract We previously reported the results of a randomized phase II trial (NCT02904954) in patients with early-stage non-small cell lung cancer (NSCLC) who were treated with either two preoperative cycles of the anti-PD-L1 antibody durvalumab alone or combined with immunomodulatory doses of stereotactic radiation (DRT). The trial met its primary endpoint of major pathological response, which was significantly higher following DRT with no new safety signals. Here, we report on the prespecified secondary endpoint of disease-free survival (DFS) regardless of treatment assignment and the prespecified exploratory analysis of DFS in each arm of the trial. DFS at 2 and 3 years across patients in both arms of the trial were 73% (95% CI: 62.1–84.5) and 65% (95% CI: 52.5–76.9) respectively. For the exploratory endpoint of DFS in each arm of the trial, three-year DFS was 63% (95% CI: 46.0–80.4) in the durvalumab monotherapy arm compared to 67% (95% CI: 49.6–83.4) in the dual therapy arm. In addition, we report post hoc exploratory analysis of progression-free survival as well as molecular correlates of response and recurrence through high-plex immunophenotyping of sequentially collected peripheral blood and gene expression profiles from resected tumors in both treatment arms. Together, our results contribute to the evolving landscape of neoadjuvant treatment regimens for NSCLC and identify easily measurable potential biomarkers of response and recurrence.
Keywords	Science ; Q
Subject code	610
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mucosal immunization with integrase-defective lentiviral vectors protects against influenza virus challenge in mice.

Judith M Fontana / Paul J Christos / Zuleika Michelini / Donatella Negri / Andrea Cara / Mirella Salvatore

PLoS ONE, Vol 9, Iss 5, p e

2014 Volume 97270

Abstract: Recent reports highlight the potential for integrase-defective lentiviral vectors (IDLV) to be developed as vaccines due to their ability to elicit cell-mediated and humoral immune responses after intramuscular administration. Differently from their ... ...

Abstract	Recent reports highlight the potential for integrase-defective lentiviral vectors (IDLV) to be developed as vaccines due to their ability to elicit cell-mediated and humoral immune responses after intramuscular administration. Differently from their integrase-competent counterpart, whose utility for vaccine development is limited by the potential for insertional mutagenesis, IDLV possess a mutation in their integrase gene that prevents genomic integration. Instead, they are maintained as episomal DNA circles that retain the ability to stably express functional proteins. Despite their favorable profile, it is unknown whether IDLV elicit immune responses after intranasal administration, a route that could be advantageous in the case of infection with a respiratory agent. Using influenza as a model, we constructed IDLV expressing the influenza virus nucleoprotein (IDLV-NP), and tested their ability to generate NP-specific immune responses and protect from challenge in vivo. We found that administration of IDLV-NP elicited NP-specific T cell and antibody responses in BALB/c mice. Importantly, IDLV-NP was protective against homologous and heterosubtypic influenza virus challenge only when given by the intranasal route. This is the first report demonstrating that IDLV can induce protective immunity after intranasal administration, and suggests that IDLV may represent a promising vaccine platform against infectious agents.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2014-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Prevention during the epidemiologic shift to chronic illness

Abdul Razak Gehani / Laith J Abu-Raddad / Hiam Chemaitelly / Paul J Christos / Dirk Deleu / Alvin I Mushlin

Journal of Local and Global Health Perspectives, Vol 2013, Iss

A case control study of risk factors associated with cardiovascular disease in Qatar

2013 Volume 2013

Abstract: Background: Cardiovascular diseases (CVD) continue to be the leading cause of death worldwide. Countries in the Arabian Gulf region are prime examples of major shifts in demographic and epidemiologic profiles leading to an increased burden of chronic ... ...

Abstract	Background: Cardiovascular diseases (CVD) continue to be the leading cause of death worldwide. Countries in the Arabian Gulf region are prime examples of major shifts in demographic and epidemiologic profiles leading to an increased burden of chronic illness. This study estimated the association between five preventable conditions and risk factors and the development of myocardial infarction (MI) and cerebrovascular accidents (CVA) in the population of Qatar.Methods: We conducted a case control study among patients admitted to Hamad Medical Corporation with acute MI (n=512) or CVA (n=262) from June 2006–June 2008. Controls (n=382) were randomly selected from unrelated inpatient and outpatient departments. Data collected included socio-demographic information, medical/family history, lifestyle characteristics, and depression assessments.Results: Over two thirds of MI and half of CVA cases were younger than 55 years, with 12% and 7%, respectively, being under age 40. Cases were predominantly males, and Qatari nationals constituted 13% of MI and 25% of CVA cases. Approximately 40% of participants were overweight and an additional 30% were obese. Diabetes was the strongest preventable risk factor for MI (adjusted odds ratio [OR]=3.31, 95% CI 1.97–5.57) and CVA (adjusted OR=3.67, 95% CI 2.00–6.74). Hypertension was the second major preventable risk factor for CVA (adjusted OR=2.73, 95% CI 1.59-4.68) and an important factor for MI (adjusted OR=1.69, 95% CI 1.05–2.72). Minimal physical activity (defined as lack of vigorous or moderate activity for at least 10 minutes in the past month) increased the risk of MI and CVA by approximately 80%, while smoking increased the risk of MI two-fold. Exploratory analyses of the determinants of CVD among Qatari nationals identified diabetes, hypertension, high cholesterol, and smoking as potential preventable risk factors, but with higher odds ratios than other groups.Conclusions: Public health strategies to prevent MI and CVA should be based on alteration of risk factors found elsewhere in the world. However, the magnitude of these factors in Qatar suggests that the effectiveness of altering these risk factors is even more likely to have a significant impact. Designing population-level prevention interventions with awareness campaigns and supporting a culture of preventive health are critical for both Qatari nationals and the expatriate population.
Keywords	Public aspects of medicine ; RA1-1270 ; Medicine ; R ; DOAJ:Public Health ; DOAJ:Health Sciences
Subject code	610
Language	English
Publishing date	2013-03-01T00:00:00Z
Publisher	Bloomsbury Qatar Foundation Journals
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Circulating tumor cells from prostate cancer patients interact with E-selectin under physiologic blood flow.

Gunjan Gakhar / Vicente N Navarro / Madelyn Jurish / Guang Yu Lee / Scott T Tagawa / Naveed H Akhtar / Marco Seandel / Yue Geng / He Liu / Neil H Bander / Paraskevi Giannakakou / Paul J Christos / Michael R King / David M Nanus

PLoS ONE, Vol 8, Iss 12, p e

2013 Volume 85143

Abstract: Hematogenous metastasis accounts for the majority of cancer-related deaths, yet the mechanism remains unclear. Circulating tumor cells (CTCs) in blood may employ different pathways to cross blood endothelial barrier and establish a metastatic niche. ... ...

Abstract	Hematogenous metastasis accounts for the majority of cancer-related deaths, yet the mechanism remains unclear. Circulating tumor cells (CTCs) in blood may employ different pathways to cross blood endothelial barrier and establish a metastatic niche. Several studies provide evidence that prostate cancer (PCa) cell tethering and rolling on microvascular endothelium via E-selectin/E-selectin ligand interactions under shear flow theoretically promote extravasation and contribute to the development of metastases. However, it is unknown if CTCs from PCa patients interact with E-selectin expressed on endothelium, initiating a route for tumor metastases. Here we report that CTCs derived from PCa patients showed interactions with E-selectin and E-selectin expressing endothelial cells. To examine E-selectin-mediated interactions of PCa cell lines and CTCs derived from metastatic PCa patients, we used fluorescently-labeled anti-prostate specific membrane antigen (PSMA) monoclonal antibody J591-488 which is internalized following cell-surface binding. We employed a microscale flow device consisting of E-selectin-coated microtubes and human umbilical vein endothelial cells (HUVECs) on parallel-plate flow chamber simulating vascular endothelium. We observed that J591-488 did not significantly alter the rolling behavior in PCa cells at shear stresses below 3 dyn/cm(2). CTCs obtained from 31 PCa patient samples showed that CTCs tether and stably interact with E-selectin and E-selectin expressing HUVECs at physiological shear stress. Interestingly, samples collected during disease progression demonstrated significantly more CTC/E-selectin interactions than samples during times of therapeutic response (p=0.016). Analysis of the expression of sialyl Lewis X (sLe(x)) in patient samples showed that a small subset comprising 1.9-18.8% of CTCs possess high sLe(x) expression. Furthermore, E-selectin-mediated interactions between prostate CTCs and HUVECs were diminished in the presence of anti-E-selectin neutralizing antibody. ...
Keywords	Medicine ; R ; Science ; Q
Subject code	610 ; 570
Language	English
Publishing date	2013-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A phase II trial of the epothilone B analog ixabepilone (BMS-247550) in patients with metastatic melanoma.

Patrick A Ott / Anne Hamilton / Amanda Jones / Naomi Haas / Tsiporah Shore / Sandra Liddell / Paul J Christos / L Austin Doyle / Michael Millward / Franco M Muggia / Anna C Pavlick

PLoS ONE, Vol 5, Iss 1, p e

2010 Volume 8714

Abstract: Ixabepilone (BMS-247550), an epothilone B analog, is a microtubule stabilizing agent which has shown activity in several different tumor types and preclinical models in melanoma. In an open label, one-arm, multi-center phase II trial the efficacy and ... ...

Abstract	Ixabepilone (BMS-247550), an epothilone B analog, is a microtubule stabilizing agent which has shown activity in several different tumor types and preclinical models in melanoma. In an open label, one-arm, multi-center phase II trial the efficacy and toxicity of this epothilone was investigated in two different cohorts: chemotherapy-naïve (previously untreated) and previously treated patients with metastatic melanoma.Eligible patients had histologically-confirmed stage IV melanoma, with an ECOG performance status of 0 to 2. Ixabepilone was administered at a dose of 20 mg/m(2) on days 1, 8, and 15 during each 28-day cycle. The primary endpoint was response rate (RR); secondary endpoints were time to progression (TTP) and toxicity. Twenty-four patients were enrolled and 23 were evaluable for response. Initial serum lactate dehydrogenase (LDH) levels were elevated in 6/11 (55%) of the previously treated and in 5/13 (38%) of the previously untreated patients. No complete or partial responses were seen in either cohort. One patient in the previously treated group developed neutropenia and fatal septic shock. Seventeen patients (8 in the previously untreated group and 9 in the previously treated group) progressed after 2 cycles, whereas six patients (3 in each group) had stable disease after 2-6 cycles. Median TTP was 1.74 months in the previously untreated group (95% CI = 1.51 months, upper limit not estimated) and 1.54 months in the previously treated group (95% CI = 1.15 months, 2.72 months). Grade 3 and/or 4 toxicities occurred in 5/11 (45%) of previously untreated and in 5/13 (38%) of previously treated patients and included neutropenia, peripheral neuropathy, fatigue, diarrhea, and dyspnea.Ixabepilone has no meaningful activity in either chemotherapy-naïve (previously untreated) or previously treated patients with metastatic melanoma. Further investigation with ixabepilone as single agent in the treatment of melanoma is not warranted.Clinical Trials.gov NCT00036764.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2010-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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