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Poulson MR, Geary A, Papageorge M, Laraja A, Sacks O, Hall J, Kenzik KM. The effect of medicare and screening guidelines on colorectal cancer outcomes. J Natl Med Assoc 2023; 115:90-98. [PMID: 36470707 DOI: 10.1016/j.jnma.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/17/2022] [Accepted: 09/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colorectal cancer screening has been shown effective at reducing stage at presentation, but there is differential uptake of screening based on insurance status. We sought to determine the population-level effect of Medicare and screening guidelines on colorectal screening by race and region. METHODS Data on Black and white patients with colorectal cancer were obtained from the SEER database. Regression discontinuity was used to assess the causal effect of near-universal health insurance (represented by age 65) and United States Preventive Services Task Force guidelines (age 50) on the proportion of people presenting at advanced stage. This was stratified by race and region. RESULTS In the Southern United States, Black patients saw a significant decrease in advanced stage at presentation at age 65 (coefficient -0.12, p = 0.003), while white patients did not (coefficient -0.03, p = 0.09). At age 50, neither Black (coefficient 0.09, p = 0.10) nor white patients (coefficient -0.04, p = 0.1) saw a significant decrease in advanced stage. In the Western U.S., neither Black (coefficient 0.02, p = 0.72) or white patients (coefficient -0.02, p = 0.09) saw a significant decrease in advanced stage at age 65; however, both Black (coefficient -0.20, p = 0.008) and white patients (coefficient -0.05, p = 0.03) saw a significant decrease at age 50. CONCLUSIONS Our data highlight the significant impact that near-universal insurance has on reducing colorectal cancer stage at presentation in areas with poor baseline insurance coverage, particularly for Black patients. To reduce disparities in advanced stage at presentation for colorectal cancer, state-level insurance coverage should be addressed.
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Affiliation(s)
- Michael R Poulson
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Alaina Geary
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Marianna Papageorge
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Alexander Laraja
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Olivia Sacks
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jason Hall
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Kelly M Kenzik
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama-Birmingham, Birmingham, AL, USA.
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Geary A, Arinze N, Shean K, King E, Merrill AL. A 41-Year-Old Woman with a Cold Foot. NEJM Evid 2022; 1:EVIDmr2200106. [PMID: 38319258 DOI: 10.1056/evidmr2200106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
A 41-Year-Old Woman with a Cold FootA 41-year-old woman presented for evaluation of a painful and cold right foot. How do you approach the evaluation, and what is the diagnosis?
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Affiliation(s)
- Alaina Geary
- from the General Surgery Residency Program and Vascular Surgery Fellowship Program, Boston Medical Center
| | - Nkiruka Arinze
- from the General Surgery Residency Program and Vascular Surgery Fellowship Program, Boston Medical Center
| | - Katie Shean
- from the General Surgery Residency Program and Vascular Surgery Fellowship Program, Boston Medical Center
| | - Elizabeth King
- from the General Surgery Residency Program and Vascular Surgery Fellowship Program, Boston Medical Center
| | - Andrea L Merrill
- from the General Surgery Residency Program and Vascular Surgery Fellowship Program, Boston Medical Center
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3
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Poulson MR, Geary A, Annesi C, Dechert T, Kenzik K, Hall J. The Impact of Income and Social Mobility on Colorectal Cancer Outcomes and Treatment: A Cross-sectional Study. Ann Surg 2022; 275:546-550. [PMID: 34954755 DOI: 10.1097/sla.0000000000005347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the impact of income mobility on racial disparities in colorectal cancer. BACKGROUND There are well-documented disparities in colorectal cancer treatment and outcomes between Black and White patients. Socioeconomic status, insurance, and other patient-level factors have been shown important, but little has been done to show the discriminatory factors that lead to these outcomes. METHODS Data were obtained from the Surveillance Epidemiology and End-Results database for Black and White patients with colorectal cancer between 2005 and 2015. County level measures of Black (BIM) and White income mobility (WIM) were obtained from the Opportunity Atlas as a measure of intergenerational poverty and social mobility. Regression models were created to assess the relative risk of advanced stage at diagnosis (Stage IV), surgery for localized disease (Stage I/II), and cancer-specific mortality. RESULTS There was no significant association of BIM or WIM on advanced stage at diagnosis in Black or White patients. An increase of $10,000 of BIM was associated with a 9% decrease in hazards of death for both Black (hazard ratio 0.91, 95% confidence interval 0.86,0.95) and White (0.91, 95%CI 0.90,0.93) patients, while the same increase in WIM was associated with no significant difference in hazards among Black patients (hazard ratio 0.99, 95% confidence interval 0.97,1.02). There were no predicted racial differences in hazards of death at high levels of BIM. CONCLUSIONS Increased Black income mobility significantly improves survival for both Black and White patients. Interventions aimed at increasing economic and social mobility could significantly decrease mortality in both Black and White patients while alleviating disparities in outcomes.
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Affiliation(s)
- Michael R Poulson
- Department of Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Alaina Geary
- Department of Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | | | - Tracey Dechert
- Department of Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston, MA
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Jason Hall
- Department of Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
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4
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Jones M, Okano S, Looke D, Kennedy G, Pavilion G, Clouston J, Van Kuilenburg R, Geary A, Joubert W, Eastgate M, Mollee P. Catheter-associated bloodstream infection in patients with cancer: comparison of left- and right-sided insertions. J Hosp Infect 2021; 118:70-76. [PMID: 34656663 DOI: 10.1016/j.jhin.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is limited research on the relationship between side of insertion of central venous catheter (CVAD) and bloodstream infection risk in patients with cancer. AIM To conduct an exploratory analysis of data from a randomized control trial (RCT) and data from a prospective cohort study to compare infection rates for right- and left-sided insertions. METHODS The study populations were patients aged >14 years with cancer from two tertiary hospitals in Brisbane, Australia. The primary endpoint was catheter-associated bloodstream infection (CABSI) adjudicated by blinded assessors. For the RCT, randomized intention-to-treat comparisons were conducted between left- and right-side allocated insertion for early (≤14 days) and late (>14 days) infection using Cox proportional hazards regression. The RCT data were also combined with cohort study data collected from one of the hospitals prior to the RCT and non-randomized comparisons conducted between left- and right-sided insertions. FINDINGS In 634 randomly allocated CVADs there were 141 CABSIs. Analysis showed strong evidence of right-side allocated insertions having an increased risk of early infection by 2.5 times (95% confidence interval (CI): 1.3-4.7); however, there was no evidence of increased risk for late infection (hazard ratio: 1.06; 95% CI: 0.71-1.59). Results from analysis of the RCT and cohort study data combined (2786 CVADs and 385 CABSIs) were similar. CONCLUSION There appears to be an increased risk of CABSI in patients with cancer for CVAD inserted into the right-side for around two weeks after line insertion. The mechanism underpinning the increased risk is unknown.
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Affiliation(s)
- M Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia.
| | - S Okano
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - D Looke
- School of Medicine, University of Queensland, Brisbane, Australia; Department of Infectious Diseases, Princess Alexandra Hospital, Brisbane, Australia
| | - G Kennedy
- School of Medicine, University of Queensland, Brisbane, Australia; Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - G Pavilion
- Department of Interventional Radiology, Princess Alexandra Hospital, Brisbane, Australia
| | - J Clouston
- Department of Interventional Radiology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - R Van Kuilenburg
- Department of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - A Geary
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - W Joubert
- Department of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - M Eastgate
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - P Mollee
- School of Medicine, University of Queensland, Brisbane, Australia; Department of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
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5
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Affiliation(s)
- Luise I Pernar
- Boston University School of Medicine, USA; Department of Surgery, Boston Medical Center, USA.
| | - Alaina Geary
- Boston University School of Medicine, USA; Department of Surgery, Boston Medical Center, USA
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Poulson M, Geary A, Annesi C, Allee L, Kenzik K, Sanchez S, Tseng J, Dechert T. National Disparities in COVID-19 Outcomes between Black and White Americans. J Natl Med Assoc 2021; 113:125-132. [PMID: 32778445 PMCID: PMC7413663 DOI: 10.1016/j.jnma.2020.07.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is very limited comprehensive information on disparate outcomes of black and white patients with COVID-19 infection. Reports from cities and states have suggested a discordant impact on black Americans, but no nationwide study has yet been performed. We sought to understand the differential outcomes for black and white Americans infected with COVID-19. METHODS We obtained case-level data from the Centers for Disease Control and Prevention on 76,442 white and 48,338 non-Hispanic Black patients diagnosed with COVID-19, ages 0 to >80+, outlining information on hospitalization, ICU admission, ventilation, and death outcomes. Multivariate Poisson regressions were used to estimate the association of race, treating white as the reference group, controlling for sex, age group, and the presence of comorbidities. RESULTS Black patients were generally younger than white, were more often female, and had larger numbers of comorbidities. Compared to white patients with COVID-19, black patients had 1.4 times the risk of hospitalization (RR 1.42, p < 0.001), and almost twice the risk of requiring ICU care (RR 1.68, p < 0.001) or ventilatory support (RR 1.81, p < 0.001) after adjusting for covariates. Black patients saw a 1.36 times increased risk of death (RR 1.36, p < 0.001) compared to white. Disparities between black and white outcomes increased with advanced age. CONCLUSION Despite the initial descriptions of COVID-19 being a disease that affects all individuals, regardless of station, our data demonstrate the differential racial effects in the United States. This current pandemic reinforces the need to assess the unequal effects of crises on disadvantaged populations to promote population health.
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Affiliation(s)
- Michael Poulson
- Department of Surgery, Boston University/Boston Medical Center; Boston University School of Medicine
| | - Alaina Geary
- Department of Surgery, Boston University/Boston Medical Center; Boston University School of Medicine
| | | | - Lisa Allee
- Department of Surgery, Boston University/Boston Medical Center
| | - Kelly Kenzik
- Department of Surgery, Boston University/Boston Medical Center; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sabrina Sanchez
- Department of Surgery, Boston University/Boston Medical Center; Boston University School of Medicine
| | - Jennifer Tseng
- Department of Surgery, Boston University/Boston Medical Center; Boston University School of Medicine
| | - Tracey Dechert
- Department of Surgery, Boston University/Boston Medical Center; Boston University School of Medicine.
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7
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Poulson M, Neufeld M, Geary A, Kenzik K, Sanchez SE, Dechert T, Kimball S. Intersectional Disparities Among Hispanic Groups in COVID-19 Outcomes. J Immigr Minor Health 2020; 23:4-10. [PMID: 33090300 PMCID: PMC7579850 DOI: 10.1007/s10903-020-01111-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 01/03/2023]
Abstract
Previous geographically limited studies have shown differential impact of COVID-19 on Hispanic individuals. Data were obtained from the Centers for Disease Control and Prevention. We performed multivariate Poisson regression assessing risk of hospitalization and death in Hispanic White (HW), Hispanic Black (HB), and Hispanic Multiracial/Other (HM) groups compared to non-Hispanic Whites (NHW). The relative risk of hospitalization was 1.35, 1.58, and 1.50 (p < 0.001) for HW, HB, and HM individuals respectively when compared to NHW. Relative risk of death was 1.36, 1.72, 1.68 (p < 0.001) times higher in HW, HB, and HM compared to NHW. HW, HB, and HM individuals also had significantly increased risk of requiring mechanical ventilation and ICU admission when compared to NHW. Hispanic individuals are more likely to be hospitalized and die from COVID-19 infection than White, which underscores the need for more precise data and policies aimed at unique Hispanic groups to decrease disparities.
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Affiliation(s)
- Michael Poulson
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Miriam Neufeld
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Alaina Geary
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston, USA.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sabrina E Sanchez
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Tracey Dechert
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Sarah Kimball
- Boston University School of Medicine, Boston, USA. .,Immigrant and Refugee Health Center, Boston Medical Center, 801 Massachusetts Ave, 6th Floor, Boston, MA, 02119, USA.
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8
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Geary A, Poulson M, Madiedo A, Fernando Hall J. Effect of Social Mobility on Racial Disparities in Colorectal Cancer Outcomes. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Geary A, Wang V, Cooper J, Roberts K, Yoo J. Analysis of Electronic Residency Application Service (ERAS) Data Can Improve House Staff Diversity. J Surg Res 2020; 257:246-251. [PMID: 32862052 DOI: 10.1016/j.jss.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/29/2020] [Accepted: 08/02/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Training diverse house staff, including those who are underrepresented in medicine, is vital to provide high-quality patient care for the communities that we serve. In 2018, the Accreditation Council for Graduate Medical Education announced new common program requirements for systematic efforts to recruit and retain a diverse workforce. However, questions remain about how to implement such efforts. MATERIALS AND METHODS Electronic Residency Application Service (ERAS) data from eight residency programs spanning two recruitment cycles (2017-2018, 2018-2019) was reviewed. The number of candidates at each stage in the process (applicant, invited to interview, interviewed, and matched) was examined by self-identified race or ethnicity. These data were presented to residency program directors at our Graduate Medical Education committee meeting before the next recruitment cycle. Data were analyzed following the 2019-20 residency match. Odds ratios and Pearson's chi-squared test were used to assess statistical significance. RESULTS A total of 10,445 and 10,982 medical students applied to our 8 core residency programs in 2017 and 2018, respectively. Medical students who applied and self-identified as Asian, Black or African American, and Hispanic or Latino or Spanish origin had lower odds of being invited to interview than those who self-identified as White. After data presentation, the odds of inviting Black or African American applicants to interview increased significantly. The odds of attending an interview once invited were the same across groups. CONCLUSIONS Sharing ERAS data patterns with residency program directors was associated with a significant year over year change in interviewee diversity. Structured analysis of institutional ERAS data can provide insight into the resident selection process and may be a useful tool to improve house staff diversity.
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Affiliation(s)
- Alaina Geary
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Victoria Wang
- Departments of Obstetrics and Gynecology, Surgery and Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Jeffrey Cooper
- Departments of Obstetrics and Gynecology, Surgery and Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Kari Roberts
- Departments of Obstetrics and Gynecology, Surgery and Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - James Yoo
- Department of Surgery, Harvard Medical School, Boston, Massachusetts.
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Abstract
This study assessed the clinical effectiveness of the Nimbus 3 alternating pressure mattress replacement system (APMRS) on pressure ulcer healing and comfort in subjects > or = 65 years, with at least a Grade 2 ulcer and some mobility problems. Twelve patients in a hospital setting were randomly allocated to the Nimbus 3 or another APMRS, and 20 residents in a nursing home setting to the Nimbus 3 or an alternating pressure mattress overlay. Wound surface area (WSA) (cm2) was recorded twice weekly and comfort once weekly. In the hospital setting, there were no significant differences between groups in the reduction in WSA per day. In the nursing home setting, though subjects on Nimbus 3 had significantly more pressure ulcers at baseline, there were no significant differences between groups in the reduction in WSA per day. Nimbus 3 was statistically more comfortable than control surfaces. The study's sample size has not shown the products were different with regard to clinical effectiveness. However, it might serve as a pilot for a larger, multi-centre RCT aimed at establishing the efficacy of a pressure-relieving (PR) device on pressure ulcer healing.
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Affiliation(s)
- D Evans
- University of Central England in Birmingham, Birmingham, UK
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Land L, Evans D, Geary A, Taylor C. A clinical evaluation of an alternating-pressure mattress replacement system in hospital and residential care settings. J Tissue Viability 2000; 10:6-11. [PMID: 10839090 DOI: 10.1016/s0965-206x(00)80014-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
An observational study was carried out to compare wound healing on alternating-pressure mattress replacement systems (APMRS) and other surfaces in an elderly population in acute and residential care settings. Subjects were assessed for the reduction in their pressure ulcers at approximately two weeks and per day, and a visual analogue scale was used to record the patients' comfort. Seven and ten subjects were allocated to the Nimbus III APMRS (Huntleigh Healthcare Ltd) in the hospital and residential care settings respectively. There was no significant difference in the healing of the subjects' sores in the two areas either at two weeks or per day. Five people were allocated to control surfaces in the hospital setting (mainly APMRS; Pegasus Airwave, Pegasus Egerton) and ten in the residential care setting (mainly alternating-pressure overlays; AlphaXcell, Huntleigh Healthcare Ltd). There was no significant difference in the healing of subjects' sores in the two areas, either at two weeks or per day. The trial APMRS was found to be equally comfortable in either setting, and in both settings the control surfaces were not regarded as significantly different in terms of comfort. These findings, from a small sample, promote discussion about the use of pressure-relieving equipment in settings where there are older people who may be at particular risk from pressure damage and where nursing interventions are less intensive and routine.
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Affiliation(s)
- L Land
- University of Central England in Birmingham, Faculty of Health and Community Care, Edgbaston
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Mooney SC, Hayes AA, MacEwen EG, Matus RE, Geary A, Shurgot BA. Treatment and prognostic factors in lymphoma in cats: 103 cases (1977-1981). J Am Vet Med Assoc 1989; 194:696-702. [PMID: 2925488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The records of 103 cats with lymphoma that underwent chemotherapy were reviewed. Diagnosis was confirmed by cytologic or histopathologic examination of appropriate tissue specimens. Sixty-four cats (62%) had a complete response to chemotherapy (median survival time, 7 months); 21 cats (20%) had a partial response (median survival time, 2.5 months); and 18 cats had a minimal response (median survival time, 1.5 months). Seventy-seven cats (75%) died of recurrent or progressive lymphoma, 9 cats died of feline leukemia-related anemia, 13 cats died of unrelated causes, and 4 cats were alive. Stage of disease was significantly (P = 0.009) related to response to treatment, and stage of disease and FeLV status were both significantly (P = 0.002 and P less than 0.001, respectively) related to survival.
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Affiliation(s)
- S C Mooney
- Donaldson-Atwood Cancer Clinic, Animal Medical Center, New York, NY 10021
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Abstract
The concentration of oestrone sulphate in whey obtained from 66 pregnant dairy goats was measured by direct radioimmunoassay. The mean time at which pregnancy was first detected was day 41 of gestation. Levels remained low (37 pmol/l-0.96 nmol/l, mean = 167 pmol/l) until week 5 of gestation when they rose rapidly. The test had an accuracy of 95.6%, was able to distinguish true from pseudopregnancy, and suggested that pregnancy in females carrying multiple fetuses could be detected earlier, possibly as a result of the fetal-placental origin of oestrone sulphate.
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