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1.
J Clin Apher ; 35(1): 59-61, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31696530

RESUMEN

Heparin-induced thrombocytopenia (HIT) can occur following exposure to heparin and is characterized by thrombocytopenia with increased risk for thrombosis. This condition is mediated by formation of immunoglobulin G antibodies against platelet factor 4/heparin complexes that can subsequently lead to platelet activation. Herein, we detail the clinical and laboratory findings, treatments, and outcomes of two patients who developed HIT and thrombosis after undergoing collection of hematopoietic progenitor cells by apheresis (HPC-A) for autologous HPC transplant. Given that heparin may be used during HPC-A collections, these cases emphasize the importance of prompt consideration of HIT in patients that develop thrombocytopenia and thrombosis following HPC-A collection with heparin anticoagulation.

2.
Cult Health Sex ; : 1-17, 2019 Dec 05.
Artículo en Inglés | MEDLINE | ID: mdl-31805826

RESUMEN

This study used a sexual scripting framework to analyse data from the Online College Social Life Survey to examine the role of individual, (e.g. gender, race and alcohol use), relational (partner type, condom use behaviours), and contextual factors (sex ratios and fraternity/sorority affiliation) influencing 4,292 first-year college students' hookup experiences. Results suggest that hookups are relatively "safe", with the the majority involving non-penetrative sexual behaviour, condom use, and familiar partners. However, alcohol use affected hookup behaviours and lower levels of condom use were associated with heavy alcohol use, even with less well known partners. Findings point to the importance of interventions that reinforce first-year students' positive behaviours and present them with protective behavioural strategies to use in the context of alcohol, and with repeat or well-known partners to reduce risk and have enjoyable, consensual sexual experiences.

3.
Lab Chip ; 19(6): 1027-1034, 2019 03 13.
Artículo en Inglés | MEDLINE | ID: mdl-30729974

RESUMEN

We developed a multiplexed point-of-care immunodiagnostic assay for antibody detection in human sera made through the vertical stacking of functional paper layers. In this multiplexed vertical flow immunodiagnostic assay (xVFA), a colorimetric signal is generated by gold nanoparticles captured on a spatially-multiplexed sensing membrane containing specific antigens. The assay is completed in 20 minutes, following which the sensing membrane is imaged by a cost-effective mobile-phone reader. The images are sent to a server, where the results are rapidly analyzed and relayed back to the user. The performance of the assay was evaluated by measuring Lyme-specific antibodies in human sera as model target antibodies. The presented platform is rapid, simple, inexpensive, and allows for simultaneous and quantitative measurement of multiple antibodies and/or antigens making it a suitable point-of-care platform for disease diagnostics.


Asunto(s)
Inmunoensayo/métodos , Papel , Pruebas en el Punto de Atención , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/inmunología , Antígenos/química , Antígenos/inmunología , Borrelia burgdorferi/inmunología , Borrelia burgdorferi/metabolismo , Teléfono Celular , Procesamiento Automatizado de Datos , Oro/química , Humanos , Inmunoensayo/instrumentación , Enfermedad de Lyme/diagnóstico , Nanopartículas del Metal/química
6.
Matern Child Health J ; 22(9): 1233-1239, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30008042

RESUMEN

Background HIV-positive women in the United States can have healthy pregnancies and avoid transmitting HIV to their children. Yet, little is known about the extent to which HIV care providers' reproductive health practices match women's pregnancy desires. Accordingly, we explored young HIV-positive women's pregnancy desires and reproductive health behaviors and examined reproductive health information offered by HIV care clinics. Methods A mixed-method analysis was conducted using data from a 14-site Adolescent Medicine Trials Network (ATN) study. We conducted descriptive statistics on data from 25 HIV-positive women (e.g., demographics, pregnancy desires, and sexual- and health-related behaviors). Qualitative interviews with 58 adolescent and adult clinic providers were analyzed using the constant comparative method. Results About half of the women reported using reproductive health care services (i.e., contraception and pregnancy tests) (n = 12) and wanted a future pregnancy (n = 13). Among women who did not desire a future pregnancy (n = 5), three used dual methods and two used condoms at last sexual encounter. Qualitative themes related to clinics' approaches to reproductive health (e.g., "the emphasis…is to encourage use of contraceptives") and the complexity of merging HIV and reproductive care (e.g., "We [adolescent clinic] transition pregnant moms from our care back and forth to adult care"). Discussion Despite regular HIV-related medical appointments, HIV-positive women may have unaddressed reproductive health needs (e.g., pregnancy desire with providers focused on contraceptive use). Findings from this study suggest that increased support for young HIV-positive women's reproductive health is needed, including supporting pregnancy desires (to choose when, how, and if, to have children).


Asunto(s)
Actitud del Personal de Salud , Conducta Anticonceptiva , Servicios de Planificación Familiar/estadística & datos numéricos , Infecciones por VIH/complicaciones , Infecciones por VIH/psicología , Conducta Reproductiva , Salud Reproductiva , Serodiagnóstico del SIDA , Adolescente , Anticonceptivos , Toma de Decisiones , Servicios de Planificación Familiar/métodos , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Embarazo , Investigación Cualitativa , Adulto Joven
7.
J Adolesc Health ; 63(2): 157-165, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29887488

RESUMEN

PURPOSE: Youth living with HIV (YLHIV) in the United States (U.S.) account for nearly one-third of new HIV infections and face significant barriers to care engagement; only 25% are virally suppressed. Healthcare transition (HCT) from pediatric/adolescent to adult-oriented care can be particularly disruptive. Accordingly, we prospectively examined HCT processes at 14 distinct geographical sites across the U.S. METHODS: We collected Audio Computer-Assisted Self-Interviews data and abstracted electronic medical records from 135 HCT-eligible YLHIV at baseline and 9-month follow-up. Descriptive analyses and multilevel modeling were conducted. Data also included qualitative interviews with 28 adolescent and 30 adult providers across 14 adolescent and 20 adult clinics, respectively. Interviews were analyzed using the constant comparative method; this analysis focused on specific HCT recommendations. RESULTS: At baseline, youth were primarily age 24 (78.8%), male (76.8%), black (78.0%), identified as a sexual minority (62.9%), had attended an HIV appointment in the past 3 months (90.2%), had Medicaid for insurance (65.2%), and were always or mostly always adherent to their antiretroviral therapy (65.9%). At the 9-month follow-up only 37% of YLHIV successfully transitioned to adult care. Both individual-level (insurance status and disclosure-related stigma) and clinic-level (adolescent clinic best practices) factors were significant. Adolescent and adult clinic staff offered recommendations to support HCT; these focused primarily on clinical changes. CONCLUSIONS: This study highlights the complex set of individual- and clinic-level factors associated with HCT. Addressing these key factors is essential for developing streamlined, comprehensive, and context-specific HCT protocols to support continuous care engagement for YLHIV.


Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud , Transición a la Atención de Adultos , Adulto , Femenino , Infecciones por VIH/etnología , Humanos , Entrevistas como Asunto , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Estudios Prospectivos , Factores Sexuales , Estigma Social , Estados Unidos , Adulto Joven
8.
Adv Healthc Mater ; 7(12): e1800122, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29700986

RESUMEN

Engineering physiologically relevant in vitro models of human organs remains a fundamental challenge. Despite significant strides made within the field, many promising organ-on-a-chip models fall short in recapitulating cellular interactions with neighboring cell types, surrounding extracellular matrix (ECM), and exposure to soluble cues due, in part, to the formation of artificial structures that obstruct >50% of the surface area of the ECM. Here, a 3D cell culture platform based upon hydrophobic patterning of hydrogels that is capable of precisely generating a 3D ECM within a microfluidic channel with an interaction area >95% is reported. In this study, for demonstrative purposes, type I collagen (COL1), Matrigel (MAT), COL1/MAT mixture, hyaluronic acid, and cell-laden MAT are formed in the device. Three potential applications are demonstrated, including creating a 3D endothelium model, studying the interstitial migration of cancer cells, and analyzing stem cell differentiation in a 3D environment. The hydrophobic patterned-based 3D cell culture device provides the ease-of-fabrication and flexibility necessary for broad potential applications in organ-on-a-chip platforms.


Asunto(s)
Técnicas de Cultivo de Célula , Dispositivos Laboratorio en un Chip , Técnicas Analíticas Microfluídicas , Técnicas de Cultivo de Célula/instrumentación , Técnicas de Cultivo de Célula/métodos , Diferenciación Celular , Movimiento Celular , Humanos , Células MCF-7 , Técnicas Analíticas Microfluídicas/instrumentación , Técnicas Analíticas Microfluídicas/métodos
9.
J Urban Health ; 95(4): 576-583, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29633227

RESUMEN

Criminal justice practices in the USA disproportionately affect sexual and racial/ethnic minority men, who are at higher risk of incarceration. Previous research demonstrates associations between incarceration and sexual risk behaviors for men who have sex with men (MSM). However, little of this work focuses on young MSM (YMSM), particularly HIV-infected YMSM, despite nearly one-third reporting engagement in sexual risk behaviors, such as transactional sex. We therefore explored the association between incarceration and transactional sex among HIV-infected YMSM. We recruited 97 HIV-infected YMSM across 14 clinical sites in urban centers from August 2015 to February 2016. We used multivariate logistic regression to examine the relationship between incarceration and transactional sex among YMSM. The majority was 24 years old (78%) and racial/ethnic minority (95%); over half were not in school and reported an annual income of < $12,000. In the multivariate model, having ever been incarcerated (aOR = 3.20; 95% CI 1.07-9.63) was independently associated with a history of transactional sex. Being 24 years vs. younger (aOR = 9.68; 95% CI 1.42-65.78) and having ever been homeless (aOR = 3.71, 95% CI 1.18-11.65) also remained independently associated with a history of transactional sex. This analysis fills a gap in the literature by examining the relationship between incarceration and transactional sex among HIV-infected YMSM. Facilitating youths' engagement with social services available in their HIV clinic may serve as a key strategy in promoting health. Public health efforts need to address social-structural factors driving disproportionate rates of arrest and incarceration and related harms among this population.


Asunto(s)
Grupos Étnicos/estadística & datos numéricos , Infecciones por VIH , Homosexualidad Masculina/estadística & datos numéricos , Prisioneros/estadística & datos numéricos , Asunción de Riesgos , Conducta Sexual/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Adolescente , Adulto , Humanos , Masculino , Estados Unidos , Adulto Joven
10.
Am J Ther ; 25(2): e270-e272, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29293474

RESUMEN

The treatment of refractory immune-mediated thrombocytopenia purpura (ITP) can be challenging. This case report describes treatment of refractory ITP with bortezomib, a proteasome inhibitor. This strategy has been successful in relapsing thrombotic thrombocytopenic purpura but is a novel therapeutic approach for ITP. Further research use of proteasome inhibition in refractory ITP may be warranted.


Asunto(s)
Bortezomib/uso terapéutico , Inhibidores de Proteasoma/uso terapéutico , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Femenino , Humanos , Factores Inmunológicos/uso terapéutico , Persona de Mediana Edad , Receptores de Trombopoyetina/agonistas , Recurrencia , Resultado del Tratamiento
11.
Artículo en Inglés | MEDLINE | ID: mdl-31414077

RESUMEN

Background: Emerging research has begun to examine the breastfeeding experiences among racial/ethnic minority women. However, limited research to date has explored the potential factors that impact Latina mothers' breastfeeding through a multi-level lens. We examined the context of breastfeeding among Latina mothers in an exploratory study. Methods: We conducted semi-structured interviews with a convenience sample of 9 Latina mothers. Guided by the social-ecological model, thematic content analysis was used. Results: Latina mothers described individual- (e.g., knowledge of breastfeeding), interpersonal- (e.g., social support and norms), institutional- (e.g., healthcare system), and community-level (e.g., cultural norms) influences on their breastfeeding. Mothers recommended provision of bilingual and bicultural health professionals, information on US breastfeeding norms, and Latino-friendly informational materials in other languages. Conclusions: Considering the multi-level factors that shape Latina mothers' breastfeeding is essential to develop and implement culturally tailored initiatives and facilitate access to breastfeeding support to improve maternal and infant health.

12.
AIDS Patient Care STDS ; 31(10): 421-427, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28981334

RESUMEN

It is important for both individual- and population-level health that HIV-infected individuals progress through the Care Continuum. However, HIV-infected youth frequently disengage from care during transition from pediatric/adolescent to adult care; only 50% remain in adult care after 1 year. Understanding how providers define and approach a successful healthcare transition can improve the delivery of HIV-related services during critical years of HIV treatment. We conducted 58 staff interviews across 14 Adolescent Trials Network clinics (n = 30) and 20 adult clinics (n = 28). We used the constant comparative method to examine how providers defined and approached youths' successful transition. Providers identified four components critical to successful transition: (1) clinical outcomes (e.g., medication adherence and viral suppression); (2) youth knowing how to complete treatment-related activities (e.g., refilling prescriptions and making appointments); (3) youth taking responsibility for treatment-related activities and their overall health (e.g., "when they stop reaching out to the adolescent [clinic] to solve all their problems."); and (4) youth feeling a connection and trust toward the adult clinic (e.g., "they feel safe here"), with some providers even prioritizing connectedness over clinical outcomes (e.g., "Even if they're not taking meds but are connected [to care], …that's a success."). The identification of key components of successful transition can guide focused interventions and resources to improve youth maintenance in the HIV Care Continuum as they transition to adult care. Identifying what facilitates successful transitions, and the gaps that interventions can target, will help to ensure HIV-infected youth remain healthy across their lifespan.


Asunto(s)
Conducta del Adolescente , Continuidad de la Atención al Paciente/organización & administración , Infecciones por VIH/tratamiento farmacológico , Personal de Salud/psicología , Cooperación del Paciente , Transición a la Atención de Adultos/organización & administración , Adolescente , Adulto , Instituciones de Atención Ambulatoria/organización & administración , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , Encuestas de Atención de la Salud , Humanos , Entrevistas como Asunto , Masculino , Cumplimiento de la Medicación , Estados Unidos
13.
Cancer Med ; 6(9): 2142-2152, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28776955

RESUMEN

Notch signaling is minimally active in neuroendocrine (NE) cancer cells. While histone deacetylase inhibitors (HDACi) suppress NE cancer growth by inducing Notch, the molecular mechanism underlying this interplay has not yet been defined. NE cancer cell lines BON, H727, and MZ-CRC-1 were treated with known HDACi Thailadepsin-A (TDP-A) and valproic acid (VPA), and Notch1 mRNA expression was measured with RT-PCR. Truncated genomic fragments of the Notch1 promotor region fused with luciferase reporter were used to identify the potential transcription factor (TF) binding site. The key regulatory TF was identified with the electrophoretic mobility shift assay (EMSA). The effect of HDACi on Notch1 level was determined before and after silencing the TF. TDP-A and VPA induced Notch1 mRNA in a dose-dependent manner. A functional DNA motif at -80 to -52 from the Notch1 start codon responsible for the HDACi-dependent Notch1 induction was identified. Mutation of this core sequence failed to induce luciferase activity despite HDACi treatment. EMSA showed the greatest gel shift with AP-1 in nuclear extracts. Knockdown of AP-1 significantly attenuated the effect of HDACi on Notch1 induction. Interestingly, AP-1 transfection did not alter Notch1 level, suggesting that AP-1 is necessary but insufficient for HDACi activation of Notch1. Therefore, AP-1 is the TF that binds to a specific transcription-binding site within the Notch1 promotor region to trigger Notch1 transcription. Elucidating the HDACi activation mechanism may lead to the development of novel therapeutic options against NE cancers and facilitate the identification of clinical responders and prevent adverse effects.


Asunto(s)
Antineoplásicos/farmacología , Carcinoma Neuroendocrino/genética , Inhibidores de Histona Desacetilasas/farmacología , Receptor Notch1/genética , Factor de Transcripción AP-1/genética , Línea Celular Tumoral , Depsipéptidos/farmacología , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Humanos , Mutación , Regiones Promotoras Genéticas , Transducción de Señal , Ácido Valproico/farmacología
14.
J Adolesc Health ; 61(4): 434-439, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28754584

RESUMEN

PURPOSE: The HIV Care Continuum highlights the need for HIV-infected youth to be tested, linked, and maintained in lifelong care. Care engagement is important for HIV-infected youth in order for them to stay healthy, maintain a low viral load, and reduce further transmission. One point of potential interruption in the care continuum is during health care transition from adolescent- to adult-centered HIV care. HIV-related health care transition research focuses mainly on youth and on adolescent clinic providers; missing is adult clinic providers' perspectives. METHODS: We examined health care transition processes through semi-structured interviews with 28 adult clinic staff across Adolescent Trials Network sites. We also collected quantitative data related to clinical characteristics and transition-specific strategies. RESULTS: Overall, participants described health care transition as a "warm handoff" and a collaborative effort across adolescent and adult clinics. Emergent transition themes included adult clinical care culture (e.g., patient responsibility), strategies for connecting youth to adult care (e.g., adolescent clinic staff attending youth's first appointment at adult clinic), and approaches to evaluating transition outcomes (e.g., data sharing). Participants provided transition improvement recommendations (e.g., formalized protocols). CONCLUSIONS: Using evidence-based research and a quality improvement framework to inform comprehensive and streamlined transition protocols can help enhance the capacity of adult clinics to collaborate with adolescent clinics to provide coordinated and uninterrupted HIV-related care and to improve continuum of care outcomes.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Continuidad de la Atención al Paciente/normas , Infecciones por VIH/terapia , Mejoramiento de la Calidad/normas , Transición a la Atención de Adultos/normas , Adolescente , Adulto , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Estados Unidos , Adulto Joven
15.
AIDS Care ; 29(10): 1227-1234, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28599596

RESUMEN

HIV-infected adolescents have disproportionately low rates of care retention and viral suppression. Approximately half disengage from care while transitioning to adult clinics, in part due to fragmented care systems and lack of streamlined protocols. We conducted 58 qualitative interviews with social service and health care providers across 14 Adolescent Trials Network clinics (n = 28) and 20 adult clinics that receive transitioning adolescents (n = 30) from August 2015-June 2016. We used the constant comparative approach to examine processes, barriers, and facilitators of adult care transition. Transition barriers coalesced around three levels. Structural: insurance eligibility, transportation, and HIV-related stigma; Clinical: inter-clinic communication, differences in care cultures, and resource/personnel limitations; and Individual: adolescents' transition readiness and developmental capacity. Staff-initiated solutions (e.g., grant-funded transportation) were often unsustainable and applied individual-level solutions to structural-level barriers. Comprehensive initiatives, which develop collaborative policies and protocols that support providers' ability to match the solution and barrier level (i.e., structural-to-structural), are sorely needed. These initiatives should also support local systematic planning to facilitate inter-clinic structures and communication. Such approaches will help HIV-infected adolescents transition to adult care and improve long-term health outcomes.


Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Disparidades en Atención de Salud , Estigma Social , Apoyo Social , Transición a la Atención de Adultos , Adolescente , Adulto , Instituciones de Atención Ambulatoria , Actitud del Personal de Salud , Infecciones por VIH/psicología , Personal de Salud , Accesibilidad a los Servicios de Salud , Humanos , Solución de Problemas , Estados Unidos
17.
J Am Coll Health ; 65(1): 32-40, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27610821

RESUMEN

OBJECTIVE: To describe first-year college student-athletes' friendship contexts and test whether their perceptions of alcohol use and approval by different types of friends are associated with their own alcohol use. PARTICIPANTS: First-year student-athletes (N = 2,622) from 47 colleges and universities participating in National Collegiate Athletic Association (NCAA) sports during February-March 2013. METHODS: Student-athletes completed online surveys during the baseline assessment of an alcohol and other drug prevention program evaluation. Analyses tested whether perceptions of friends' alcohol use (descriptive norms) and perceptions of friends' approval of alcohol use (injunctive norms) predicted their alcohol use. RESULTS: Both use and approval perceptions by upperclassmen, same-team, and most influential friends significantly predicted alcohol use. By contrast, only perceived use by first-year, nonteam, and less influential friends significantly predicted alcohol use. CONCLUSIONS: Athletics departments' alcohol policies and prevention programming for first-year student-athletes should address the potential influence of different types of friends on alcohol use.


Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Atletas/psicología , Grupo Paritario , Percepción , Estudiantes/psicología , Adolescente , Femenino , Amigos/psicología , Humanos , Masculino , Encuestas y Cuestionarios , Universidades/organización & administración , Adulto Joven
18.
Depress Res Treat ; 2016: 4972854, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27703808

RESUMEN

Background. Little is known about the role of discrimination on depression among Latino sexual and gender identity minorities. This manuscript examined the relationship between ethnic/racial discrimination and sexual discrimination on clinically significant depressive symptoms among Latino sexual minority men (i.e., gay and bisexual men and other men who have sex with men) and Latina transgender women. Methods. A community-based participatory research partnership recruited participants (N = 186; 80.6% cisgender men) in North Carolina to a social network-based HIV intervention. Using baseline data, we quantified the amount of perceived discrimination and conducted mixed-effects logistic regression analyses to examine correlates of clinically significant depressive symptoms. Results. A high percentage of participants reported ethnic/racial discrimination (73.7%) and sexual discrimination (53.8%). In the multivariable models, ethnic/racial discrimination, sexual discrimination, masculinity, fatalism, and social support were significantly associated with clinically significant depressive symptoms. Discussion. Improving mental health requires multilevel interventions that address pertinent individual, interpersonal, and system level factors.

19.
Blood Coagul Fibrinolysis ; 27(7): 761-769, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27467981

RESUMEN

The Hemostasis and Thrombosis Research Society (HTRS) Registry was used to monitor the postapproval use of recombinant factor VIIa. The objective of this manuscript is to provide key insights on the demographics of patients with acquired hemophilia in the HTRS Registry. Acquired hemophilia patient registration in HTRS captured age; sex; comorbidities and predisposing conditions; first bleeding location; laboratory parameters; exposure to blood products, factor, and bypassing agents; and initiation of immune suppression/tolerance therapy. Overall, 166 patients with acquired hemophilia were registered in HTRS (83 women, 73 men, median age 70 years); the majority were non-Hispanic whites (61.4%). The most common comorbidities were autoimmune disease (28.4%) and malignancy (14.5%). The most common first site of bleeding was subcutaneous (27.1%); this was more common in whites (29.1%) than blacks (12.5%) and in non-Hispanics (26.4%) than Hispanics (11.8%). Blood product exposure was reported for 33.1% of patients; the most commonly reported product was packed red blood cells (28%). Of the 57 patients with outcome data available for immune tolerance therapy, 26 patients (46%) reported successful treatment, 13 reported unsuccessful treatment (23%), and 18 (32%) were receiving active treatment at the time of registration. The HTRS Registry final analysis provides the only current comprehensive look at acquired hemophilia in the US population, including details on underlying autoimmune diseases and malignancies. Pertinent to recognition and diagnosis of the disease, subcutaneous bleeding as a presenting bleeding symptom was more common in white and non-Hispanic individuals.


Asunto(s)
Hemofilia A/diagnóstico , Hemostasis/genética , Trombosis/genética , Anciano , Anciano de 80 o más Años , Comorbilidad , Demografía , Femenino , Humanos , Masculino , Sistema de Registros , Estudios Retrospectivos , Estados Unidos
20.
Am J Hematol ; 91(8): 787-92, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-27152483

RESUMEN

Choosing Wisely (CW) is a medical stewardship initiative led by the American Board of Internal Medicine Foundation in collaboration with professional medical societies in the United States. In an effort to learn from and leverage the work of others, the American Society of Hematology CW Task Force developed a method to identify and prioritize CW recommendations from other medical societies of high relevance and importance to patients with blood disorders and their physicians. All 380 CW recommendations were reviewed and assessed for relevance and importance. Relevance was assessed using the MORE(TM) relevance scale. Importance was assessed with regard to six guiding principles: harm avoidance, evidence, aggregate cost, relevance, frequency and impact. Harm avoidance was considered the most important principle. Ten highly relevant and important recommendations were identified from a variety of professional societies. Recommendations focused on decreasing unnecessary imaging, blood work, treatments and transfusions, as well as on increasing collaboration across disciplines and considering value when recommending treatments. Many CW recommendations have relevance beyond the society of origin. The methods developed by the ASH CW Task Force could be easily adapted by other Societies to identify additional CW recommendations of relevance and importance to their fields. Am. J. Hematol. 91:787-792, 2016. © 2016 Wiley Periodicals, Inc.


Asunto(s)
Hematología/métodos , Guías de Práctica Clínica como Asunto/normas , Directrices para la Planificación en Salud , Hematología/normas , Sociedades Médicas , Estados Unidos
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