Victoria Leigh Williams · University of Pennsylvania · PhdFit
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Victoria Leigh Williams
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University of Pennsylvania · Rehabilitation Medicine
Victoria Leigh Williams, MD, is an Adjunct Assistant Professor of Dermatology at the University of Pennsylvania's Perelman School of Medicine. She specializes in HIV Dermatology, Albinism, and Tropical Dermatology, with additional expertise in Global Health, Health Informatics, and E-Health. Dr. Williams completed her undergraduate studies in Psychology at The University of Texas at Austin in 2006 and earned her MD from Baylor College of Medicine in 2011. Her professional focus includes clinical research and practice in dermatology, particularly in the context of infectious diseases and global health settings.
Background Surgical site infections (SSIs) following neck of femur fracture surgery are associated with increased morbidity, mortality, and healthcare costs. Identifying risk factors for SSIs is essential for improving patient outcomes. Methods We conducted a prospective cohort study at Morriston Hospital, Swansea, United Kingdom, analysing neck of femur fracture surgeries performed between 2019 and 2024. Data were collected on ASA (American Society of Anesthesiologists) grade, Abbreviated Mental Test (AMT) score, duration of operation, time to theatre, skin closure method, grade of surgeon, and operation type. Statistical analysis was performed using univariate (Chi-squared and Mann-Whitney U) and multivariate logistic regression analyses. Results A total of 1,737 cases were included. The overall SSI rate was 4.3%, with a reduction from 9.43% in 2019 to 1.93% in 2024. Skin closure method influenced infection rates, with a notable reduction in SSIs following the transition from clips (88.3% in 2019 to 5.8% in 2024) to Monocryl (11.3% to 93.3%). On univariate analysis, significant associations were found between SSI incidence and closure method (p = 0.022), time to theatre (p < 0.0001), and operative duration (p < 0.0001). On multivariate analysis, higher AMT scores were found to be protective against infection (p < 0.0001 for AMT 8, and p = 0.023 for AMT 9). Additionally, hemiarthroplasty and intramedullary nailing were protective against infection, both with p < 0.0001. Conclusion Findings suggest that the skin closure method plays a role in SSI risk following neck of femur fracture surgery. Further prospective studies are needed to validate these findings and explore additional risk factors. This study contributes to optimising surgical techniques and improving patient outcomes.
BACKGROUND: Cardiovascular disease (CVD) is a leading cause of mortality among breast cancer survivors, and racial disparities exist between Black and White women. Therefore, the purpose of this study was to assess breast cancer survivors' perceptions of heart health resources and communication received during active treatment with potentially cardiotoxic therapies and to evaluate whether differences in perceptions are associated with race. METHODS: This qualitative analysis included semi-structured interviews with breast cancer survivors who received potentially cardiotoxic treatment(s). Survivors were asked to recall conversations with their healthcare providers regarding cancer treatment, the risk of CVD during and following treatment, and discussions of heart healthy behaviors that could be employed during treatment. Audio recorded interviews were transcribed, and codes were developed using Dedoose Qualitative Software. RESULTS: Of the 17 participants, 9 women were White and 8 were Black. A majority of participants were married (58.8%), reported an annual household income of at least $60,000, had a Bachelor's degree or higher (70.6%), and had a mastectomy (70.6%). Participants had an average age of 50.9 years (SD = 11.85). Approximately 88% (100% White women, 75% Black women) recalled receiving heart health information either prior to or during treatment. The majority also received trastuzumab (88.2%). Four themes were identified from the interviews. Key results showed that Black survivors were more likely to share positive experiences when their family members were a part of their treatment conversations and that White women were more likely to have positive experiences throughout their treatment. CONCLUSIONS: This qualitative analysis did not show striking differences in perceived care experiences between Black and White survivors. However, there were notable differences in community support, such as the inclusion of family members in treatment conversations and the receipt and timing of heart health information. Enhancing healthcare communication with a particular focus on culturally diverse populations is needed.
Abstract Background: Black breast cancer survivors are up to three times more likely to develop cancer therapy-related cardiac dysfunction (CTRCD) when compared to White survivors. Reasons behind this disparity are not fully understood, and studies examining these disparities have been limited. One contributor may be variations in communications about CTRCD risk and risk prevention strategies between providers and patients by race and ethnicity. This study assessed racial differences in Black versus White breast cancer patients with provider communication regarding cardiotoxic treatments. Methods: Study participants were recruited from a comprehensive cancer center. Eligibility included identifying as a Black/African American or White woman, a diagnosis of stage I-III breast cancer, and receipt of anthracyclines and/or trastuzumab. Semi-structured interviews were conducted with survivors. Interviews were audio-recorded, transcribed, and were reconciled using Dedoose. Results: Interviews were conducted with 16 survivors (8 Black, 8 White) with a median age at diagnosis of 53 years. Prior to starting treatment, 100% of white survivors reported that a provider discussed CTRCD risk, however only 75% black survivors reported CTRCD discussion. Although all women received information on prevention strategies including exercise and nutrition, there were differences in timing of information delivered. Black women desired to have information at the beginning of treatment, but no White women mentioned a desire to receive information earlier. A greater proportion of White women reported engaging in prevention strategies such as exercising and eating healthy during treatment. In terms of knowledge gained, 75% of White Women reported being satisfied with the information given regarding cardiotoxic risk and prevention whereas only 45% of Black women reported being satisfied.As 65% of Black women (vs. White) reported being less than satisfied with the information given, Black women were also more likely to recommend access to additional resources. For example, one Black woman suggested that “they [care team] should get a cardiologist to be a part of the team when they first go. Conclusion & Implications: Fewer Black women reported being satisfied with their medical visits regarding CTRCD risk and prevention strategies. Racial differences in assessments of these experiences highlight opportunities to develop culturally-tailored communication interventions to reduce racial disparities in CTRCD; however, future research is needed to assess interpersonal aspects of care during the receipt of cardiotoxic treatment. Citation Format: Ashley Turner, America Vijil, Sara Gómez-Trillos, Victoria Williams, Paulette Omeaku, Susan Hong, Arnethea L. Sutton. “They should get a cardiologist to be a part of the team when you first go”: A qualitative analysis of racial differences in the cancer care experience amongst breast cancer patients receiving cardiotoxic therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6297.
<sec> <title>BACKGROUND</title> In resource-limited countries, access to specialized health care services such as dermatology is limited. Clinical decision support systems (CDSSs) offer innovative solutions to address this challenge. However, the implementation of CDSSs is commonly associated with unique challenges. VisualDx—an exemplar CDSS—was recently implemented in Botswana to provide reference materials in support of the diagnosis and management of dermatological conditions. To inform the sustainable implementation of VisualDx in Botswana, it is important to evaluate the intended users’ perceptions about the technology. </sec> <sec> <title>OBJECTIVE</title> This study aims to determine health care workers’ acceptance of VisualDx to gauge the feasibility of future adoption in Botswana and other similar health care systems. </sec> <sec> <title>METHODS</title> The study’s design was informed by constructs of the Technology Acceptance Model. An explanatory, sequential, mixed methods study involving surveys and semistructured interviews was conducted. The REDCap (Research Electronic Data Capture; Vanderbilt University) platform supported web-based data capture from March 2021 through August 2021. In total, 28 health care workers participated in the study. Descriptive statistics were generated and analyzed using Excel (Microsoft Corp), and thematic analysis of interview transcripts was performed using Delve software. </sec> <sec> <title>RESULTS</title> All survey respondents (N=28) expressed interest in using mobile health technology to support their work. Before VisualDx, participants referenced textbooks, journal articles, and Google search engines. Overall, participants’ survey responses showed their confidence in VisualDx (18/19, 95%); however, some barriers were noted. Frequently used VisualDx features included generating a differential diagnosis through manual entry of patient symptoms (330/681, 48.5% of total uses) or using the artificial intelligence feature to analyze skin conditions (150/681, 22% of total uses). Overall, 61% (17/28) of the survey respondents were also interviewed, and 4 thematic areas were derived. </sec> <sec> <title>CONCLUSIONS</title> Participants’ responses indicated their willingness to accept VisualDx. The ability to access information quickly without internet connection is crucial in resource-constrained environments. Selected enhancements to VisualDx may further increase its feasibility in Botswana. Study findings can serve as the basis for improving future CDSS studies and innovations in Botswana and similar resource-limited countries. </sec>
OBJECTIVE: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can be monophasic or relapsing, with early relapse being a feature. However, the relevance of early relapse on longer-term relapse risk is unknown. Here, we investigate whether early relapses increase longer-term relapse risk in patients with MOGAD. METHODS: A retrospective analysis of 289 adult- and pediatric-onset patients with MOGAD followed for at least 2 years in 6 specialized referral centers. "Early relapses" were defined as attacks within the first 12 months from onset, with "very early relapses" defined within 30 to 90 days from onset and "delayed early relapses" defined within 90 to 365 days. "Long-term relapses" were defined as relapses beyond 12 months. Cox regression modeling and Kaplan-Meier survival analysis were used to estimate the long-term relapse risk and rate. RESULTS: Sixty-seven patients (23.2%) had early relapses with a median number of 1 event. Univariate analysis revealed an elevated risk for long-term relapses if any "early relapses" were present (hazard ratio [HR] = 2.11, p < 0.001), whether occurring during the first 3 months (HR = 2.70, p < 0.001) or the remaining 9 months (HR = 1.88, p = 0.001), with similar results yielded in the multivariate analysis. In children with onset below aged 12 years, only delayed early relapses were associated with an increased risk of long-term relapses (HR = 2.64, p = 0.026). INTERPRETATION: The presence of very early relapses and delayed early relapses within 12 months of onset in patients with MOGAD increases the risk of long-term relapsing disease, whereas a relapse within 90 days appears not to indicate a chronic inflammatory process in young pediatric-onset disease. ANN NEUROL 2023;94:508-517.
JMIR Formative Research · 2023-08-08 · 10 citations
articleOpen accessSenior author
BACKGROUND: In resource-limited countries, access to specialized health care services such as dermatology is limited. Clinical decision support systems (CDSSs) offer innovative solutions to address this challenge. However, the implementation of CDSSs is commonly associated with unique challenges. VisualDx-an exemplar CDSS-was recently implemented in Botswana to provide reference materials in support of the diagnosis and management of dermatological conditions. To inform the sustainable implementation of VisualDx in Botswana, it is important to evaluate the intended users' perceptions about the technology. OBJECTIVE: This study aims to determine health care workers' acceptance of VisualDx to gauge the feasibility of future adoption in Botswana and other similar health care systems. METHODS: The study's design was informed by constructs of the Technology Acceptance Model. An explanatory, sequential, mixed methods study involving surveys and semistructured interviews was conducted. The REDCap (Research Electronic Data Capture; Vanderbilt University) platform supported web-based data capture from March 2021 through August 2021. In total, 28 health care workers participated in the study. Descriptive statistics were generated and analyzed using Excel (Microsoft Corp), and thematic analysis of interview transcripts was performed using Delve software. RESULTS: All survey respondents (N=28) expressed interest in using mobile health technology to support their work. Before VisualDx, participants referenced textbooks, journal articles, and Google search engines. Overall, participants' survey responses showed their confidence in VisualDx (18/19, 95%); however, some barriers were noted. Frequently used VisualDx features included generating a differential diagnosis through manual entry of patient symptoms (330/681, 48.5% of total uses) or using the artificial intelligence feature to analyze skin conditions (150/681, 22% of total uses). Overall, 61% (17/28) of the survey respondents were also interviewed, and 4 thematic areas were derived. CONCLUSIONS: Participants' responses indicated their willingness to accept VisualDx. The ability to access information quickly without internet connection is crucial in resource-constrained environments. Selected enhancements to VisualDx may further increase its feasibility in Botswana. Study findings can serve as the basis for improving future CDSS studies and innovations in Botswana and similar resource-limited countries.
