All Publications

  • Building trust and partnership with Black pediatric patients and their families: A scoping review. Academic pediatrics Garcia, R. S., Hollis, T., Baratta, J., King, Z., Faulks, M., Ricketts, M., Brown-Johnson, C., Shankar, M., Guerin, A., Wong, C., Zulman, D. M., Floyd, B. D. 2023


    Systemic racism embedded within the U.S. healthcare system results in disproportionately worse health outcomes for Black pediatric patients and their families/caregivers. One meaningful mechanism through which these health disparities persist is through discriminatory treatment and anti-Black bias from clinicians. Strengthening care provided to Black pediatric patients and their families/caregivers requires that clinicians adopt culturally tailored communication strategies that promote health equity and counter racism. We conducted a scoping review of evidence-based communication practices in the medical literature that improve care for Black pediatric patients. We mapped the specific practices to the Presence 5 for Racial Justice framework and identified cross-cutting themes to describe practices across the five domains. There are three cross-cutting themes that underlie the recommended practices: (1) promote unbiased implementation of clinician communication strategies (e.g., providing equitable recommendations for preventive care); (2) tailor care to Black pediatric patients (e.g., explore the importance of the family unit); and (3) address racism experienced by Black pediatric patients and their families/caregivers (e.g., acknowledge any previous negative experiences with the healthcare system). This review highlights communication practices that clinicians can adopt to build trusting relationships, empower Black families, and promote racial justice in clinical care. Future opportunities include expanding to system level change and validating these practices with patients and clinicians.

    View details for DOI 10.1016/j.acap.2023.08.016

    View details for PubMedID 37659602

  • Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis Wong, Y., Nguyen, V. H., Yang, H., Li, J., Le, M., Wu, W., Han, N., Fong, K., Chen, E., Wong, C., Rui, F., Xu, X., Xue, Q., Hu, X., Leow, W., Goh, B., Cheung, R. C., Wong, G., Wong, V., Yu, M., Nguyen, M. ELSEVIER. 2023: S1096-S1097
  • Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis. Clinical and molecular hepatology Wong, Y. J., Nguyen, V. H., Yang, H. I., Li, J., Le, M. H., Wu, W. J., Han, N. X., Fong, K. Y., Chen, E., Kumar, R., Wong, C., Rui, F., Xu, X., Xue, Q., Hu, X. Y., Leow, W. Q., Goh, G. B., Cheung, R., Wong, G., Wong, V. W., Yu, M. W., Nguyen, M. H. 2023


    Chronic hepatitis B (CHB) and fatty liver (FL) often co-exist, but natural history data of this dual condition (CHB-FL) are sparse. Via a systematic review, conventional meta-analysis (MA) and individual patient-level data MA (IPDMA), we compared liver-related outcomes and mortality between CHB-FL and CHB-no FL patients.We searched 4 databases from inception to December 2021 and pooled study-level estimates using a random-effects model for conventional MA. For IPDMA, we evaluated outcomes after balancing the two study groups with inverse probability treatment weighting (IPTW) on age, sex, cirrhosis, diabetes, ALT, HBeAg, HBV DNA, and antiviral treatment.We screened 2,157 articles and included 19 eligible studies (17,955 patients: 11,908 CHB-no FL; 6,047 CHB-FL) in conventional MA, which found severe heterogeneity (I2=88%-95%) and no significant differences in HCC, cirrhosis, mortality, or HBsAg seroclearance incidence (P=0.27-0.93). IPDMA included 13,262 patients: 8,625 CHB-no FL and 4,637 CHB-FL patients who differed in several characteristics. The IPTW cohort included 6,955 CHB-no FL and 3,346 CHB-FL well-matched patients. CHB-FL patients (vs. CHB-no FL) had significantly lower HCC, cirrhosis, mortality and higher HBsAg seroclearance incidence (all P≤0.002), with consistent results in subgroups. CHB-FL diagnosed by liver biopsy had a higher 10-year cumulative HCC incidence than CHB-FL diagnosed with non-invasive methods (63.6% vs. 4.3%, P<0.0001). On Cox regression, CHB-FL was associated with lower HCC, cirrhosis, mortality and higher HBsAg seroclearance incidence (hazard ratio=0.68, 0.61, 0.38, 1.35, respectively, all P≤0.004).IPDMA data with well-matched CHB patient groups showed that FL (vs. no FL) was associated with significantly lower HCC, cirrhosis, and mortality risk and higher HBsAg seroclearance probability.

    View details for DOI 10.3350/cmh.2023.0004

    View details for PubMedID 37157776

  • "The More I Know ... the More I Like It": A Systematic Review Evaluating Public- and Patient-Facing Educational Interventions About Palliative Care Singh, N., Smith, G. M., Sossenheimer, P. H., Heidari, S. N., Hui, F., Hannah, J., Romano, P., Wong, C. ELSEVIER SCIENCE INC. 2023: E579
  • Characteristics and Outcomes of Elderly Hepatocellular Carcinoma Patients following Surgical Resection: Systematic Review and Meta-analysis DIGESTIVE DISEASES Garcia, E. M., Nerurkar, S. N., Tan, E. X., Tan, S. S., Peck, E., Quek, S. Z., Teh, R., Teng, M., Tran, A., Yeo, E., Le, M., Wong, C., Cheung, R., Huang, D. Q. 2023


    Due to ageing of the global population, hepatocellular carcinoma (HCC) is increasingly common among elderly patients, but outcomes after curative hepatic resection are unclear. Using a metanalytic approach, we aimed to estimate overall survival (OS), recurrence free survival (RFS) and complication rates in elderly HCC patients undergoing resection.We searched PubMed, Embase, and Cochrane databases from inception to Nov 10, 2020 for studies reporting outcomes in elderly (age ≥ 65 years) patients with HCC undergoing curative surgical resection. Pooled estimates were generated using a random-effects model.We screened 8,598 articles and included 42 studies (7,778 elderly patients). The mean age was 74.45 years (95% CI 72.89-76.02), 75.54% were male (95% CI 72.53-78.32) and 66.73% had cirrhosis (95% CI 43.93-83.96). The mean tumor size was 5.50 cm (95% CI 4.71-6.29) and 16.01% had multiple tumors (95% CI 10.74-23.19). The 1-year (86.02% versus 86.66%, p=0.84) and 5-year OS (51.60% versus 53.78%) between non-elderly versus elderly patients were similar. Likewise, there were no differences in the 1-year (67.32% versus 73.26%, p=0.11) and 5-year RFS (31.57% versus 30.25%, p=0.67) in non-elderly versus elderly patients. There was a higher rate of minor complications (21.95% versus 13.71%, p=0.03) among elderly patients compared with non-elderly patients, but no difference in major complications (p=0.43) Conclusion: This data shows that overall survival, recurrence and major complications after liver resection for HCC are comparable between elderly and non-elderly patients, and may inform clinical management of HCC in this population.

    View details for DOI 10.1159/000530101

    View details for Web of Science ID 001023703800001

    View details for PubMedID 36913917

  • Global treatment rate and barriers to DAA therapy: A systematic review and meta-analysis of 146 studies and 1,760,352 HCV patients. Liver international : official journal of the International Association for the Study of the Liver Nguyen, V. H., Huang, D. Q., Le, M. H., Jin, M., Lee, E. Y., Henry, L., Nerurkar, S. N., Ogawa, E., Thin, K. N., Teng, M. L., Goh, K. S., Kai, J. C., Wong, C., Tan, D. J., Thuy, L. T., Hai, H., Enomoto, M., Cheung, R., Nguyen, M. H. 2023


    Global data on the treatment rate with direct-acting antivirals (DAAs) for chronic hepatitis C (CHC) are sparse. We aimed to evaluate the CHC treatment rate and barriers to treatment in the DAA era.We searched PubMed, EMBASE, and Cochrane from inception to August 5, 2021, for relevant articles. Patients treated with DAAs without interferon (IFN) therapy were categorized as IFN-free DAAs. Patients receiving DAA with IFN or unclear IFN status were categorized as DAA/IFN.We identified and analyzed data from 146 studies (1,760,352 CHC patients). DAA/IFN treatment rate was 16.0% (95% CI: 9.9-23.3, 49 studies, 886,535 patients). IFN-free DAA treatment rate was 52.3% (95% CI: 46.2 - 58.4, 123 studies, 1,276,754 patients): 45.4% in North America, 64.2% in South America (1 study), 90.4% in Africa (most data from Egypt), 54.4% in Europe, 60.7% in Australia, and 60.5% in Asia, p < 0.0001); 49% with hepatitis B co-infection, and 32.3% with hepatocellular carcinoma (HCC). Treatment was not a priority in 22.8% of patients in Europe and 16.7% in Australia, compared to only 4.8% in North America and 2.1% in Asia (P<0.0001). Poor adherence to clinic follow-up was the cause of no treatment in 74.7% of patients in Australia, 37.0% in North America, 7.9% in Europe, and 14.3% in Asia (P<0.0001).Though a marked improvement from IFN/DAA, the treatment rate with IFN-free DAA remains suboptimal (52.3% overall, 32.3% in HCC patients). Non-adherence to clinical follow-up and lack of disease awareness were treatment barriers.

    View details for DOI 10.1111/liv.15550

    View details for PubMedID 36825358

  • Effectiveness of psychosocial interventions for pediatric patients with scoliosis: a systematic review World Journal of Pediatric Surgery van Niekerk, M., Richey, A., Vorhies, J., Wong, C., Tileston, K. 2023; 6 (e000513)

    View details for DOI 10.1136/wjps-2022-000513

  • Characteristics and outcomes of hepatocellular carcinoma patients with macrovascular invasion following surgical resection: a meta-analysis of 40 studies and 8,218 patients. Hepatobiliary surgery and nutrition Huang, D. Q., Tran, A., Tan, E. X., Nerurkar, S. N., Teh, R., Teng, M. L., Yeo, E. J., Zou, B., Wong, C., Esquivel, C. O., Bonham, C. A., Nguyen, M. H. 2022; 11 (6): 848-860


    Guidelines recommend that hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) and/or hepatic vein tumor thrombosis (HVTT) should undergo systemic therapy. However, recent data suggest that surgical resection may be beneficial in selected cases, but outcomes are heterogenous. We aimed to estimate pooled overall survival (OS), recurrence free survival (RFS) and complication rates in HCC patients with macrovascular invasion (MVI) following surgical resection.In this systematic review and meta-analysis, two investigators independently searched PubMed, Embase, and Cochrane databases from inception to Nov 10, 2020, without language restrictions, for studies reporting outcomes of adult HCC patients with MVI who underwent liver resection with curative intent.We screened 8,598 articles and included 40 studies involving 8,218 patients. Among all patients with MVI, the pooled median OS was 14.39 months [95% confidence interval (CI): 10.99-18.84], 1-year OS was 54.47% (95% CI: 46.12-62.58%) and 3-year OS was 23.20% (95% CI: 16.61-31.42%). Overall, 1- and 3-year RFS were 27.70% (95% CI: 21.00-35.57%) and 10.06% (95% CI: 6.62-15.01%), respectively. Among patients with PVTT, median OS was 20.41 months in those with segmental/2nd order involvement compared to 12.91 months if 1st order branch was involved and 6.41 months if the main trunk was involved. The pooled rate of major complications was 6.17% (95% CI: 3.53-10.56%).Overall median survival was 14.39 months for HCC patients with MVI following resection. Median survival was higher in PVTT with segmental/2nd order involvement at 20.41 versus 6.41 months if the main trunk was involved.

    View details for DOI 10.21037/hbsn-21-419

    View details for PubMedID 36523924

    View details for PubMedCentralID PMC9745615

  • CHARACTERISTICS AND OUTCOMES OF ELDERLY HEPATOCELLULAR CARCINOMA PATIENTS FOLLOWING SURGICAL RESECTION: A META-ANALYSIS OF 44 STUDIES AND 33,948 PATIENTS Garcia, E. M., Nerurkar, S., Tan, X., Tan, S., Peck, E., Quek, S., Teh, R., Teng, M., Tran, A., Yeo, E., Le, M., Wong, C., Cheung, R., Huang, D. WILEY. 2022: S474-S475
  • Characteristics and outcomes of hepatocellular carcinoma patients with macrovascular invasion following surgical resection: a meta-analysis of 40 studies and 8,218 patients HEPATOBILIARY SURGERY AND NUTRITION Huang, D. Q., Tran, A., Tan, E. X., Nerurkar, S. N., Teh, R., Teng, M. P., Yeo, E., Zou, B., Wong, C., Esquivel, C. O., Bonham, C., Nguyen, M. H. 2022
  • Global and regional long-term survival following resection for HCC in the recent decade: A meta-analysis of 110 studies. Hepatology communications Reveron-Thornton, R. F., Teng, M. L., Lee, E. Y., Tran, A., Vajanaphanich, S., Tan, E. X., Nerurkar, S. N., Ng, R. X., Teh, R., Tripathy, D. P., Ito, T., Tanaka, T., Miyake, N., Zou, B., Wong, C., Toyoda, H., Esquivel, C. O., Bonham, C. A., Nguyen, M. H., Huang, D. Q. 2022


    Surgical resection for HCC remains a major curative treatment option, but it is unclear whether there are differences in outcomes by region and whether outcomes have improved over time. We aimed to estimate pooled overall survival (OS), recurrence-free survival (RFS), and complication rates in patients with hepatocellular carcinoma (HCC) following curative surgical resection and to compare outcomes by region and by time period. In this systematic review and meta-analysis, we searched Pubmed, Embase, and Cochrane databases from inception to May 15, 2020. We selected studies reporting OS, RFS, and complications in adult patients with HCC undergoing curative surgical resection. Two authors independently searched the literature and extracted the data. We screened 6983 articles and included 110 eligible studies with 82,392 patients, with study periods spanning from 1980-2017. The global pooled 1-year and 5-year survival rates were 88.9% (95% confidence interval [CI] 87.1-90.4) and 56.2% (95% CI 52.8-59.6) for OS and 71.1% (95% CI 67.6-74.3) and 35.2% (95% CI 32.5-38.0) for RFS, respectively. Five-year OS was higher in Asia (57.03%) than in other regions (Europe 48.3%; North America 48.0%; and South America 49.5%); p=0.002. Five-year RFS was higher in patients with hepatitis B virus versus patients with hepatitis C virus (34.8% vs. 24.1%; p=0.02). There was no significant improvement in 5-year OS and RFS over time. The pooled rate for complications was 27.6% (95% CI 23.4-32.3), with 9.7% (95% CI 6.3-14.7) classified as major. One-year OS after surgical resection for HCC is excellent (~90%). However, 5-year OS (~55%) and RFS (~35%) are still poor, suggesting that long-term care is suboptimal. Greater efforts are required to improve survival through enhanced surveillance and preventing recurrence through antiviral therapy.

    View details for DOI 10.1002/hep4.1923

    View details for PubMedID 35234371

  • A Scoping Review of Palliative Care for Adults with Huntington's Disease: Current Practice and Future Directions JOURNAL OF PALLIATIVE MEDICINE El-Sourady, M., Martin, S., Wong, H., Carroll, T. 2021: 488-505


    Context: Huntington's disease (HD) is a neurodegenerative disorder characterized by mid-life onset, cognitive decline, and behavioral disturbance. Objective: We conducted a review of the end-of-life (EOL) experience of HD patients and their families. Methods: We searched 5 electronic databases. Eligible studies were published in English and contained outcomes related to PC, end-of-life (EOL), advance directives (ADs), symptom management, or hospice use for HD adults. Results: We screened 1566 studies, assessed 244 studies, and included 27 studies. Symptom Prevalence: Decedent data showed greater likelihood of pneumonia, choking, nutritional deficiencies, and skin ulcers. HD patients in hospice experienced pain, anxiety, nausea, and dyspnea. Psychiatric symptoms included dysphoria, agitation, irritability, apathy, and anxiety. Psychosis is associated with worse cognition, function, and behavioral disturbance. Symptom Management: Electroconvulsive therapy (ECT) and venlafaxine improved depression. Suicidal ideation improved with talking, self-management, medication, and discussing EOL wishes. Tetrabenazine improved chorea. Experience as Illness Progressed: HD patients require home care within two years of diagnosis. Only one study reported use of palliative care services (4%). HD patients are admitted to the hospital late in disease course and are often discharged to long-term care facilities (LTCF). Advance Care Planning: Two studies created tools to navigate EOL decisions. Most HD patients had EOL wishes; only familiarity with HD predicted having EOL wishes. Few had ADs or discussed EOL wishes with their families. Clinicians drive EOL discussions. Views on physician-assisted death (PAD) and euthanasia varied widely. Conclusions: Research is needed to further assess the PC needs of HD patients and to provide care recommendations.

    View details for DOI 10.1089/jpm.2021.0308

    View details for Web of Science ID 000741768500001

    View details for PubMedID 34847736

  • META-ANALYSIS: REGIONAL DIFFERENCES IN OUTCOMES OF SURGICAL RESECTION FOR HEPATOCELLULAR CARCINOMA Teng, M., Reveron-Thornton, R., Lee, E. Y., Tran, A., Vajanaphanich, S., Tan, X., Nerurkar, S. N., Ng, R., Teh, R., Prasad, D., Ito, T., Tanaka, T., Miyake, N., Zou, B., Wong, C., Toyoda, H., Esquivel, C. O., Bonham, A., Nguyen, M. H., Huang, D. WILEY. 2021: 859A
  • LONG-TERM OVERALL AND RECURRENCE-FREE SURVIVAL FOLLOWING CURATIVE SURGICAL RESECTION FOR HEPATOCELLULAR CARCINOMA IN THE RECENT DECADE: A META-ANALYSIS OF 110 STUDIES AND 82,392 PATIENTS Reveron-Thornton, R., Teng, M., Lee, E. Y., Tran, A., Vajanaphanich, S., Tan, X., Nerurkar, S. N., Ng, R., Teh, R., Prasad, D., Ito, T., Tanaka, T., Miyake, N., Zou, B., Wong, C., Toyoda, H., Esquivel, C. O., Bonham, A., Nguyen, M. H., Huang, D. WILEY. 2021: 655A-656A
  • Outcomes of Specialty Palliative Care Interventions for Patients With Hematologic Malignancies: A Systematic Review JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Elliott, E., Watson, T., Singh, D., Wong, C., Lo, S. S., AAHPM Res Comm Writing Grp 2021; 62 (4): 863-875


    The outcomes of specialty palliative care (PC) interventions for patients with hematologic malignancies (HMs) is under-investigated.We performed a systematic review to evaluate the effect of PC interventions on patient- and caregiver- reported outcomes and healthcare utilization among adults with HMs (leukemia, myeloma, and lymphoma).From database inception through September 10, 2020, we systematically searched PubMed, CINAHL, Embase, Scopus, Web of Science, and Cochrane Reviews using terms representing HMs and PC. Eligible studies investigated adults aged 18 years and older, were published in the English language, and contained original, quantitative, or qualitative data related to patient- and/or caregiver-centered outcomes and healthcare utilization.We screened 5345 studies;16 met inclusion criteria and found that specialty PC led to improved symptom management, decreased likelihood of inpatient death, decreased healthcare utilization, decreased cost of healthcare, and improved caregiver-reported outcomes. Patients with HM have a high need for PC which, though increasing over time, is often provided late in the clinical disease course.Specialty PC interventions improve healthcare outcomes for patients with HMs and should be implemented early and often. There remains a need for additional studies investigating PC use exclusively in patients with HMs.

    View details for DOI 10.1016/j.jpainsymman.2021.03.014

    View details for Web of Science ID 000704370200024

    View details for PubMedID 33774128

  • Effects of integrated economic and health interventions with women's groups on health-related knowledge, behaviours and outcomes in low-income and middle-income countries: a systematic review protocol. BMJ open Desai, S., Mehta, K. M., Singh, R. J., Westley, A. K., Dirisu, O., Wong, C., De Hoop, T., Darmstadt, G. L. 2021; 11 (7): e046856


    INTRODUCTION: Economic groups, such as microfinance or self-help groups are widely implemented in low-income and middle-income countries (LMICs). Women's groups are voluntary groups, which aim to improve the well-being of members through activities, such as joint savings, credit, livelihoods development and/or health activities. Health interventions are increasingly added on to existing women's economic groups as a public health intervention for women and their families. Here, we present the protocol for a mixed-methods systematic review we will conduct of the evidence on integrated economic and health interventions on women's groups to assess whether and how they improve health-related knowledge, behaviour and outcomes in LMICs.METHODS AND ANALYSIS: We will search seven electronic databases for published literature, along with manual searches and consultation. The review will include (1) randomised trials and non-randomised quasiexperimental studies of intervention effects of integrated economic and health interventions delivered through women's groups in LMICs, and (2) sibling studies that examine factors related to intervention content, context, implementation processes and costs. We will appraise risk of bias and study quality using standard tools. High and moderate quality studies will be grouped by health domain and synthesised without meta-analysis. Qualitative evidence will be thematically synthesised and integrated into the quantitative synthesis using a matrix approach.ETHICS AND DISSEMINATION: This protocol was reviewed and deemed exempt by the institutional review board at the American Institutes for Research. Findings will be shared through peer-reviewed publication and disseminated with programme implementers and policymakers engaged with women's groups.PROSPERO REGISTRATION NUMBER: CRD42020199998.

    View details for DOI 10.1136/bmjopen-2020-046856

    View details for PubMedID 34253668

  • A systematic review of communication about Complementary and Integrative Health (CIH) in global biomedical settings. Patient education and counseling Ho, E. Y., Bylund, C. L., Wollney, E., Peterson, E. B., Wong, H., Koenig, C. J. 2021


    OBJECTIVES: A systematic review to analyze communication rates of complementary and integrative health (CIH) and analyze how communication terms, such as "disclosure," are measured and operationalized.METHODS: We searched seven databases for studies published between 2010 and 2018 with quantitative measurements of patients' communication of CIH to a biomedical clinician. We analyzed communication terms used to describe patients reporting CIH usage. We also examined the conceptual and operational definitions of CIH provided and whether those terms were explicitly operationalized. We aggregated the percentage, rate, or ratio of CIH users that communicated about CIH with their clinicians by disease type and geographical region.RESULTS: 7882 studies were screened and 89 included in the review. Studies used a wide range of conceptual and operational definitions for CIH, as well as 23 different terms to report communication related to reporting CIH usage. Usage varied by disease type and geographical region.CONCLUSIONS: Studies of CIH and CIH communication may measure different kinds of social and communicative phenomena, which makes comparison across international studies challenging.PRACTICE IMPLICATIONS: Future studies should employ standardized, replicable measures for defining CIH and for reporting CIH communication. Clinicians can incorporate questions about prior, current, and future CIH use during the medical visit.

    View details for DOI 10.1016/j.pec.2021.05.015

    View details for PubMedID 34030929

  • Interventions Incorporating Interdisciplinary Teaming to Improve Chronic Pain Management in Primary Care: A Systematic Review Giannitrapani, K., Connell, N., Prathivadi, P., Zupanc, S., Wong, H., Lorenz, K. CHURCHILL LIVINGSTONE. 2021: 609
  • Scoping review of traumatic hemothorax: Evidence and knowledge gaps, from diagnosis to chest tube removal. Surgery Choi, J., Villarreal, J., Andersen, W., Min, J. G., Touponse, G., Wong, C., Spain, D. A., Forrester, J. D. 2021


    BACKGROUND: Traumatic hemothorax is a common injury that invites diagnostic and management strategy debates. Evidence-based management has been associated with improved care efficiency. However, the literature abounds with long-debated, re-emerging, and new questions. We aimed to consolidate up-to-date evidence on traumatic hemothoraces, focusing on clinical conundra debated in literature.METHODS: We conducted a scoping review of 21 clinical conundra in traumatic hemothorax diagnosis and management according to PRISMA-ScR guidelines. Experimental and observational studies evaluating patients (aged ≥18 years) with traumatic hemothoraces were identified through database searches (PubMed, EMBASE, Web of Science, Cochrane Library; database inception to Sep, 26 2020) and bibliography reviews of selected articles. Three reviewers screened and selected articles using standardized forms.RESULTS: We screened 1,440 articles for eligibility, of which 71 met criteria for synthesis. The review comprises 6 sections: (1) Presumptive antibiotics before tube thoracostomy; (2) Initial diagnostic and intervention decisions; (3) Chest tubes; (4) Retained hemothoraces; (5) Delayed hemothoraces; and (6) Chest tube removal). The 21 conundra across these sections follow the format of a question, our recommendation based on interpretation of available evidence, and succinct rationale. Rationale sections detail knowledge gaps and opportunities for future research.CONCLUSION: Even practices engrained into surgical dogma, such as obtaining chest x-rays after inserting or removing chest tubes and mandating operation for patients who develop chest tube output above a certain threshold, deserve re-evaluation. Some knowledge gaps require rigorous future investigation; sound clinical judgment can likely supplement others.

    View details for DOI 10.1016/j.surg.2021.03.030

    View details for PubMedID 33888318

  • Distal Femur Replacement versus Open Reduction and Internal Fixation for Treatment of Periprosthetic Distal Femur Fractures: Systematic Review and Meta-Analysis. Journal of orthopaedic trauma Wadhwa, H. n., Salazar, B. P., Goodnough, L. H., Van Rysselberghe, N. L., DeBaun, M. R., Wong, H. N., Gardner, M. J., Bishop, J. A. 2021


    To compare complications and functional outcomes of treatment with primary distal femoral replacement (DFR) versus open reduction and internal fixation (ORIF).PubMed, Embase, and Cochrane databases were searched for English language studies up to May 19, 2020, identifying 913 studies.Studies that assessed complications of periprosthetic distal femur fractures with primary DFR or ORIF were included. Studies with sample size ≤5, mean age <55, nontraumatic indications for DFR, ORIF with non-locking plates, native distal femoral fractures, or revision surgeries were excluded. Selection adhered to PRISMA criteria.Study quality was assessed using previously reported criteria. There were 40 Level IV studies, 17 Level III studies, and 1 Level II study.Fifty-eight studies with 1,484 patients were included in the meta-analysis. Complications assessed (Incidence Rate Ratio (IRR) (95%CI): 0.78 (0.59-1.03)) and reoperation or revision (IRR (95%CI): 0.71 (0.49-1.04)) were similar between the DFR and ORIF cohorts. Mean knee range of motion (ROM) was greater in the ORIF cohort (DFR: 90.47 vs. ORIF: 100.36, p < 0.05). Mean Knee Society Score (KSS) (DFR: 79.41 vs. ORIF: 82.07, p = 0.35) and return to preoperative ambulatory status were similar (IRR (95%CI): 0.82 (0.48-1.41)).In comparing complications among patients treated for periprosthetic distal femur fracture with DFR or ORIF, there was no difference between the groups. There were also no differences in functional outcomes, although knee ROM was greater in the ORIF group. This systematic review and meta-analysis highlights the need for future prospective trials evaluating the outcomes of these divergent treatment strategies.Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

    View details for DOI 10.1097/BOT.0000000000002141

    View details for PubMedID 34001801

  • The Impact of Specialty Palliative Care in Pediatric Oncology: A Systematic Review JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Kaye, E. C., Weaver, M. S., DeWitt, L., Byers, E., Stevens, S. E., Lukowski, J., Shih, B., Zalud, K., Applegarth, J., Wong, H., Baker, J. N., Ullrich, C. K., AAHPM Res Comm 2020; 61 (5): 1060-+
  • End-of-Life Care, Palliative Care Consultation, and Palliative Care Referral in the Emergency Department: A Systematic Review. Journal of pain and symptom management Wilson, J. G., English, D. P., Owyang, C. G., Chimelski, E. A., Grudzen, C. R., Wong, H., Aslakson, R. A. 2019


    CONTEXT: There is growing interest in providing palliative care (PC) in the emergency department (ED), but relatively little is known about the efficacy of ED-based PC interventions. A 2016 systematic review on this topic found no evidence that ED-based PC interventions affect patient outcomes or healthcare utilization, but new research has emerged since the publication of that review.OBJECTIVE: This systematic review provides a concise summary of current literature addressing the impact of ED-based PC interventions on patient- or family-reported outcomes, healthcare utilization, and survival.METHODS: We searched Pubmed, Embase, Web of Science, Scopus and CINAHL from inception until September 1, 2018 and reviewed references. Eligible articles evaluated the effects of PC interventions in the ED on patient- or family-reported outcomes, healthcare utilization, or survival.RESULTS: We screened 3091 abstracts and 98 full text articles with 13 articles selected for final inclusion. Two articles reported the results of a single RCT, while the remaining 11 studies were descriptive or quasi-experimental cohort studies. Over half of the included articles were published after the previous systematic review on this topic. Populations studied included older adults, patients with advanced malignancy, and ED patients screening positive for unmet palliative care needs. Most interventions involved referral to hospice or PC, or PC provided directly in the ED. Compared to usual care, ED-PC interventions improved quality of life, though this improvement was not observed when comparing ED-PC to inpatient-PC. ED-PC interventions expedited PC consultation; most studies reported a concomitant reduction in hospital length-of-stay and increase in hospice utilization, but some data were conflicting. Short-term mortality rates were high across all studies, but ED-PC interventions did not decrease survival time compared to usual care.CONCLUSION: Existing data support that PC in the ED is feasible, may improve quality of life, and does not appear to affect survival.

    View details for DOI 10.1016/j.jpainsymman.2019.09.020

    View details for PubMedID 31586580

  • Palliative Care Opportunities Among Adults with Congenital Heart Disease - A Systematic Review. Journal of pain and symptom management Ludmir, J., Steiner, J. M., Wong, H., Kloosterboer, A., Leong, J., Aslakson, R. A. 2019


    CONTEXT: Little is known about advance care planning (ACP) and palliative care needs among adults with congenital heart disease (ACHD).OBJECTIVES: To identify and synthesize studies concerning palliative care among ACHD patients.METHODS: We searched five electronic databases (PubMed, Embase, SCOPUS, Web of Science, and CINAHL) using the keywords palliative care and congenital heart disease. Inclusion criteria were adults (age >18) with congenital heart disease and publications in English through March 3, 2019.RESULTS: Our search yielded 2872 studies, and after removal of duplicates, we screened 2319 abstracts and identified 7 for inclusion. Study findings were grouped into three domains: ACP, symptomatology, and End-of-Life care. Among the 5 cross-sectional studies, only 1-28% of ACHD patients recalled participating in ACP discussions with their doctors but 69-78% reported a strong interest and desire to participate in ACP. In one study, 46% (n=67) of patients had elevated anxiety symptoms (Hospital Anxiety and Depression Scale (HADS-A) ≥ 8) and 11% (n=15) had elevated depressive symptoms (HADS-A ≥ 8). ACHD patients who had a documented goals of care conversation prior to cardiac decompensation had a lower incidence of resuscitation and aggressive treatments at end-of-life (12% (n=3) vs 100% (n=12), p<0.001).CONCLUSION: While few ACHD patients complete advance directives, our findings support that many ACHD patients recognize the value of initiating end-of-life and goals of care conversations early on in the course of illness. Future studies investigating communication and implementation strategies of ACP as well as the symptom experience of patients with ACHD are needed.

    View details for DOI 10.1016/j.jpainsymman.2019.07.025

    View details for PubMedID 31404639

  • Patient-Reported Outcomes for Cancer Patients Receiving Checkpoint Inhibitors: Opportunities for Palliative Care-A Systematic Review JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Hall, E. T., Singhal, S., Dickerson, J., Gabster, B., Wong, H., Aslakson, R. A., Schapira, L., Ast, K., Carroll, T., Dzeng, E., Harrison, K. L., Kaye, E. C., LeBlanc, T. W., Lo, S. S., McKenna, K., Nageswaran, S., Powers, J., Rotella, J., Ullrich, C., Vickey, T., AAHPM Res Comm Writing Grp 2019; 58 (1): 137-+
  • Efficacy and toxicity of particle radiotherapy in WHO grade II and grade III meningiomas: a systematic review. Neurosurgical focus Wu, A., Jin, M. C., Meola, A., Wong, H., Chang, S. D. 2019; 46 (6): E12


    OBJECTIVEAdjuvant radiotherapy has become a common addition to the management of high-grade meningiomas, as immediate treatment with radiation following resection has been associated with significantly improved outcomes. Recent investigations into particle therapy have expanded into the management of high-risk meningiomas. Here, the authors systematically review studies on the efficacy and utility of particle-based radiotherapy in the management of high-grade meningioma.METHODSA literature search was developed by first defining the population, intervention, comparison, outcomes, and study design (PICOS). A search strategy was designed for each of three electronic databases: PubMed, Embase, and Scopus. Data extraction was conducted in accordance with the PRISMA guidelines. Outcomes of interest included local disease control, overall survival, and toxicity, which were compared with historical data on photon-based therapies.RESULTSEleven retrospective studies including 240 patients with atypical (WHO grade II) and anaplastic (WHO grade III) meningioma undergoing particle radiation therapy were identified. Five of the 11 studies included in this systematic review focused specifically on WHO grade II and III meningiomas; the others also included WHO grade I meningioma. Across all of the studies, the median follow-up ranged from 6 to 145 months. Local control rates for high-grade meningiomas ranged from 46.7% to 86% by the last follow-up or at 5 years. Overall survival rates ranged from 0% to 100% with better prognoses for atypical than for malignant meningiomas. Radiation necrosis was the most common adverse effect of treatment, occurring in 3.9% of specified cases.CONCLUSIONSDespite the lack of randomized prospective trials, this review of existing retrospective studies suggests that particle therapy, whether an adjuvant or a stand-alone treatment, confers survival benefit with a relatively low risk for severe treatment-derived toxicity compared to standard photon-based therapy. However, additional controlled studies are needed.

    View details for DOI 10.3171/2019.3.FOCUS1967

    View details for PubMedID 31153145

  • Opportunities for Palliative Care in Patients with Burn Injury - A Systematic Review. Journal of pain and symptom management Cook, A. C., Langston, J. A., Jaramillo, J. D., Edwards, K. n., Wong, H. N., Aslakson, R. A. 2019


    Patients with significant burn injuries likely have palliative care needs.We performed a systematic review of existing evidence concerning the palliative care needs of burn patients.Through November 26, 2018, we systematically searched PubMed, CINAHL, Embase, Web of Science, and Scopus, using terms representing burn injuries and the eight domains of quality palliative care as outlined by the National Consensus Project for Quality Palliative Care. Eligible articles involved burn injured patients treated with an intervention targeting at least one of the eight domains.Our searches yielded 7,532 unique records which led to 238 manuscripts for full review and 88 studies which met inclusion criteria. Seventy-five studies addressed the domain "Physical Aspects of Care" and merit a separate systematic review; 13 studies were included in our final review. Four of the 7 domains - processes of care, psychologic symptoms, social aspects, and end-of-life - were addressed by studies but three domains - spiritual, cultural, or ethics - were unaddressed. Included studies highlight potential benefits from peri-discharge self-care education programs, peer support and group therapy in improving quality-of-life. In patients with severe injuries, end-of-life decision making protocols were associated with increased utilization of comfort-focused treatments.Most existing palliative care-related research in burn patients addresses interventions for physical symptoms with minimal literature concerning other domains. Opportunities exist for further research of palliative care in burn populations with emphasis on: addressing interventions for all domains and better standardizing the language and outcomes for the palliative care interventions.

    View details for DOI 10.1016/j.jpainsymman.2019.11.014

    View details for PubMedID 31775021

  • Opportunities to Improve Utilization of Palliative Care among Adults with Cystic Fibrosis: A Systematic Review. Journal of pain and symptom management Marmor, M. n., Jonas, A. n., Mirza, A. n., Rad, E. n., Wong, H. n., Aslakson, R. A. 2019


    Individuals with Cystic Fibrosis (CF) frequently survive into adulthood and many have multi-faceted symptoms that impair quality of life.We conducted a systematic review to investigate opportunities to improve utilization of palliative care among adults with CF.We searched PubMed, Embase, Scopus, Web of Science and CINAHL databases from inception until September 27, 2018, and reviewed references manually. Eligible articles were published in English, involved adults age 18 years and older with CF and contained original data regarding patient outcomes related to presence of advanced care planning (ACP), symptom experience, and preferred and/or received end-of-life care.We screened 652 article abstracts and 32 full text articles; 12 studies met inclusion criteria. All studies were published between 2000 and 2018. Pertinent findings include that while 43% to 65% of adults with CF had contemplated completing ACP, the majority only completed ACP during their terminal hospital admission. Patients also reported high prevalence of untreated symptoms, with adequate symptom control reported in 45% among those with dyspnea, 22% among those with pain and 51% among those with anxiety and/or depression. Prevalence of in-hospital death ranged from 62% to 100%, with a third dying in the intensive care unit (ICU). The majority received antibiotics and preventative treatments during their terminal hospitalization. Finally, treatment from a palliative care specialist was associated with a higher prevalence of patient completion of advanced directives, decreased likelihood of in-ICU death and decreased use of mechanical ventilation at end-of-life.Adults with CF often have untreated symptoms and many opportunities exist for palliative care specialists to improve ACP completion and quality of end-of-life care.

    View details for DOI 10.1016/j.jpainsymman.2019.08.017

    View details for PubMedID 31437475

  • Age-prevalence of Otarine Herpesvirus-1, a tumor-associated virus, and possibility of its sexual transmission in California sea lions VETERINARY MICROBIOLOGY Buckles, E. L., Lowenstine, L. J., DeLong, R. L., Melin, S. R., Vittore, R. K., Wong, H., Ross, G. L., St Leger, J. A., Greig, D. J., Duerr, R. S., Gulland, F. D., Stott, J. L. 2007; 120 (1-2): 1-8


    Otarine Herpesvirus-1 (OtHV-1) is a gammaherpesvirus routinely detected in urogenital tumor tissues of adult sea lions dying during rehabilitation, To investigate the epidemiology of this virus and guide the development of a mathematical model of its role in the multifactorial etiology of cancer in California sea lions, polymerase chain reaction (PCR) amplification of an OtHV-1 specific fragment of the DNA polymerase gene was used to look for evidence of OtHV-1 infection in urogenital and pharyngeal swabs and peripheral blood mononuclear cells (PBMC) of sea lions of different ages. Samples were also examined from pregnant females and their late term in utero or aborted fetuses to investigate potential for vertical transmission. Prevalence of infection in 72 adult females was 22%, whereas it was 46% in 52 adult males, and was significantly lower in 120 juvenile animals (6%). OtHV-1 DNA was most often detected in the lower reproductive tract of the adult animals, especially the males, and rarely in the pharynx or urogenital tract of juvenile animals. These data suggest sexual transmission may an important route of transmission. Additional studies are required to confirm this mode of transmission. Additionally, the virus was detected in a single prematurely born pup, suggesting the possibility of perinatal transmission. No indication of a PBMC associated viremia was evident in adults using standard PCR or in juveniles using standard and real time PCR.

    View details for DOI 10.1016/j.vetmic.2006.10.002

    View details for Web of Science ID 000244374400001

    View details for PubMedID 17208394

  • Outbreaks of short-incubation ocular and respiratory illness following exposure to indoor swimming pools ENVIRONMENTAL HEALTH PERSPECTIVES Bowen, A. B., Kile, J. C., Otto, C., Kazerouni, N., Austin, C., Blount, B. C., Wong, H., Beach, M. J., Fry, A. M. 2007; 115 (2): 267-271


    Chlorination destroys pathogens in swimming pool water, but by-products of chlorination can cause human illness. We investigated outbreaks of ocular and respiratory symptoms associated with chlorinated indoor swimming pools at two hotels.We interviewed registered guests and companions who stayed at hotels X and Y within 2 days of outbreak onset. We performed bivariate and stratified analyses, calculated relative risks (RR), and conducted environmental investigations of indoor pool areas.Of 77 guests at hotel X, 47 (61%) completed questionnaires. Among persons exposed to the indoor pool area, 22 (71%) of 31 developed ocular symptoms [RR = 24; 95% confidence interval (CI), 1.5-370], and 14 (45%) developed respiratory symptoms (RR = 6.8; 95% CI, 1.0-47) with a median duration of 10 hr (0.25-24 hr). We interviewed 30 (39%) of 77 registered persons and 59 unregistered companions at hotel Y. Among persons exposed to the indoor pool area, 41 (59%) of 69 developed ocular symptoms (RR = 24; 95% CI, 1.5-370), and 28 (41%) developed respiratory symptoms (RR = 17; 95% CI, 1.1-260) with a median duration of 2.5 hr (2 min-14 days). Four persons sought medical care. During the outbreak, the hotel X's ventilation system malfunctioned. Appropriate water and air samples were not available for laboratory analysis. CONCLUSIONS AND RELEVANCE TO PROFESSIONAL PRACTICE: Indoor pool areas were associated with illness in these outbreaks. A large proportion of bathers were affected; symptoms were consistent with chloramine exposure and were sometimes severe. Improved staff training, pool maintenance, and pool area ventilation could prevent future outbreaks.

    View details for DOI 10.1289/ehp.9555

    View details for Web of Science ID 000243946800037

    View details for PubMedID 17384776

    View details for PubMedCentralID PMC1817713

  • Otarine herpesvirus-1, not papillomavirus, is associated with endemic tumours in California sea lions (Zalophus californianus) JOURNAL OF COMPARATIVE PATHOLOGY Buckles, E. L., Lowenstine, L. J., Funke, C., Vittore, R. K., Wong, H., St Leger, J. A., Greig, D. J., Duerr, R. S., Gulland, F. D., Stott, J. L. 2006; 135 (4): 183-189


    The purpose of this study was to determine if Otarine Herpesvirus-1 (OtHV-1) is associated with the presence of urogenital carcinomas in California sea lions. Polymerase chain reaction (PCR) analysis with primers specific for OtHV-1 was used to compare the prevalence of OtHV-1 infection in 15 sea lions affected by urogenital carcinoma with that of age-matched and juvenile tumour-free animals, and animals with tumours of non-urogenital origin. The herpesvirus was more prevalent (100%) and more widespread in the 15 animals with urogenital carcinoma than in 25 control animals, and was most often found in the urogenital tissue (vagina and prostate) and in the draining lymph nodes. Moreover, OtHV-1 DNA was not found in any juvenile animal, or in the neoplastic tissues of animals with non-urogenital tumours. Papillomavirus-specific PCR analysis of urogenital carcinoma tissues detected papillomavirus sequences in only one carcinomatous tissue. Further studies are needed to determine if OtHV-1 contributes to oncogenesis in the California sea lion; these data show, however, that OtHV-1 is associated with urogenital carcinomas, is preferentially present in urogenital tissues, and may be sexually transmitted. Papillomaviruses, which are known to contribute to urogenital tumours in other species, did not appear to be associated with the sea lion carcinomas.

    View details for DOI 10.1016/j.jcpa.2006.06.007

    View details for Web of Science ID 000242695400003

    View details for PubMedID 17034810