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Preston M, Morris A, Villegas R, Huston J, Heloury Y, Grover SR. Response to letter to the editor: Lost in Transition. J Pediatr Urol 2024:S1477-5131(24)00101-3. [PMID: 38443193 DOI: 10.1016/j.jpurol.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Affiliation(s)
- M Preston
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia.
| | - A Morris
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia
| | - R Villegas
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia
| | - J Huston
- The Royal Children's Hospital, Urology, 50 Flemington Road, Parkville, Australia
| | - Y Heloury
- The Royal Children's Hospital, Urology, 50 Flemington Road, Parkville, Australia
| | - S R Grover
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia; The Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, Australia
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Bower N, Morris A, O'Connor J, Sponagle M, Bahr R, Gilbert R, Mohamed A, Bower J. Clinical value of whole body 18F-FDG PET/CT imaging in patients with cutaneous melanoma: A multi-center cohort study. J Med Imaging Radiat Sci 2024:S1939-8654(24)00010-9. [PMID: 38403520 DOI: 10.1016/j.jmir.2024.01.012] [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: 10/20/2023] [Revised: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND 18F-FDG-PET/CT is a valuable tool in the staging and surveillance of cutaneous melanoma; however, recent studies prompt debate on the clinical significance of imaging patients below the lesser trochanter. This study explored two research questions. In patients with a known primary cutaneous melanoma within the standard field of view (SFOV, between the orbits and lesser trochanter), what is the prevalence of metastasis to sites solely within the lower extremities? and, In patients with a known primary cutaneous melanoma within the SFOV what demographic and clinical factors are associated with sole metastasis to the lower extremities? METHODS A retrospective, multi-centered, observational study of consecutive case reports was conducted. Subjects included 619 patients who underwent extended field of view (EFOV) 18F-FDG-PET/CT (from vertex to toes) for staging and/or follow-up of cutaneous melanoma. Data was collected at three primary healthcare centers in Canada (Nova Scotia, Alberta, and British Columbia). Inclusion criteria were patients >18 years of age, confirmed primary cutaneous melanoma, and a known location of the primary within the SFOV. Patients with primary cutaneous melanoma lesions in lower extremities and previous other cancers were excluded. To determine the prevalence of lesions located below the lesser trochanter, the proportion of such lesions were computed, and 95% confidence intervals ensured a precise estimation of the proportion. RESULTS 2512 patient charts were reviewed with 619 meeting the inclusion criteria, 298 of these were females. Six percent had metastases in both the lower extremities and sites within the SFOV. The number of subjects who had no metastasis within their SFOV was 361 (58.3%). The number of subjects who presented with confirmed metastasis in the lower extremities without concurrent metastasis in the SFOV region was one (0.58%). Despite a large initial study sample, the number of patients with metastasis in the lower extremities was insufficient to allow correlation of factors associated with risk of spread to the lower extremities. CONCLUSION Lower extremity 18F-FDG-PET/CT provided additional, relevant clinical data in a sole patient. This finding supports prior research suggesting the prevalence is rare. Future studies should seek to define demographic and clinical factors that predict such rare occurrences, where follow up would be warranted. This study highlights feasibility challenges associated with such investigation.
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Affiliation(s)
- Nichole Bower
- School of Health Sciences Dalhousie University, Nova Scotia Health, 1276 South Park Street. Halifax, NS B3H 2Y9.
| | - Amy Morris
- School of Health & Public Safety, Nuclear Medicine Technology Program, Southern Alberta Institute of Technology, 1301 16 Ave, NW, Calgary, AB, T2M 0L4; Nuclear Medicine & PET/CT, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada, 1403 29 St. NW, Calgary, AB, T2N 2T9
| | - Janet O'Connor
- Department of Diagnostic Imaging, Nuclear Medicine and PET/CT, Thunder Bay Regional Health Sciences Centre, 980 Oliver Rd, Thunder Bay, ON P7B 6V4
| | - Melissa Sponagle
- School of Health Sciences Dalhousie University, Nova Scotia Health, 1276 South Park Street. Halifax, NS B3H 2Y9
| | - Rebekah Bahr
- Functional Imaging, PET/CT, BC Cancer- Vancouver Center, 600 W.10th Ave, Vancouver, BC V5Z4E6
| | - Robert Gilbert
- School of Health Sciences Dalhousie University, Nova Scotia Health, 1276 South Park Street. Halifax, NS B3H 2Y9
| | - Abdolell Mohamed
- Department of Diagnostic Radiology, Faculty of Medicine, Dalhousie University, Affiliated Scientist, QEII Health Sciences Centre, Nova Scotia Health, 1276 South Park St. Halifax, NS B3H 2Y9
| | - Jonathan Bower
- Department of Diagnostic Imaging Information Systems, Nova Scotia Health, 1276 South Park St, Halifax, NS B3H 2Y9
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Preston M, Morris A, Villegas R, Huston J, Heloury Y, Grover SR. Surgical timing and complications, with body image, quality of life, sexual function and genital sensation in patients with congenital adrenal hyperplasia. J Pediatr Urol 2024:S1477-5131(24)00018-4. [PMID: 38286725 DOI: 10.1016/j.jpurol.2024.01.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
INTRODUCTION The aim of this project was to document the long-term outcomes relating to sexual function, genital sensation, body image and quality of life, in an Australian cohort of adolescent and adult women with congenital adrenal hyperplasia (CAH) who have undergone feminising genitoplasty in infancy, childhood or adolescence. MATERIALS AND METHODS Identification and follow-up of women with CAH aged 12-40 years who had their first feminising genitoplasty or ongoing management at a single tertiary referral center with multidisciplinary care (n = 80). Medical records were reviewed for Prader stage, and operative outcomes. The prospective component of the study included tracing indivudals aged 12-40 years (n = 69), of whom 34 were contactable. Twenty-one responded to the invitation to participate in the study, completing some or all of a series of validated standardized questionnaires and/or participation in examination of external genital with sensation testing. Results were compared to a control population of similar age distribution (n = 23). RESULTS The median Prader stage was 3, median age at surgery was four months, median hospital stay of three days with 80 % of surgery undertaken by one surgeon. There was one major and eight minor complications. Re-operation rates were low. There was no difference between participants and controls in terms of sexual function, quality of life, or body image outcomes including genital appearance. Participants had increased sensitivity to soft touch on genital sensation testing compared to controls. Most participants (71 %) reported that early timing of surgery was 'good', four (19 %) felt their surgery was too late, one felt their surgery was too early, and one was unsure. Most were happy with the outcome of their surgery. DISCUSSION Outcomes after feminising genitoplasty are mixed and influenced not only by the surgery itself, but also the ongoing management of the condition alongside each patient's own cultural and social context. At present there is no comparative data available on the sexual, mental, body image and quality of life outcomes of young females with CAH who have had their operation delayed until adulthood. Our study is limited by low participant response rate, and difficulty recruiting 1:1 control population for all participants, but nevertheless provides some insight into the outcomes of these patients for which limited data is available. CONCLUSION In the population studied feminising genitoplasty in infancy and childhood had overall positive outcomes. This occurred in a tertiary center with expert multidisciplinary individualised care.
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Affiliation(s)
- M Preston
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia.
| | - A Morris
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia
| | - R Villegas
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia
| | - J Huston
- The Royal Children's Hospital, Urology, 50 Flemington Road, Parkville, Australia
| | - Y Heloury
- The Royal Children's Hospital, Urology, 50 Flemington Road, Parkville, Australia
| | - S R Grover
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia; The Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, Australia
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Parlatini V, Frangou L, Zhang S, Epstein S, Morris A, Grant C, Zalewski L, Jewell A, Velupillai S, Simonoff E, Downs J. Emotional and behavioral outcomes among youths with mental disorders during the first Covid lockdown and school closures in England: a large clinical population study using health care record integrated surveys. Soc Psychiatry Psychiatr Epidemiol 2024; 59:175-186. [PMID: 37353579 PMCID: PMC10799796 DOI: 10.1007/s00127-023-02517-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/06/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE Emotional and behavioral problems in children and young people (CYP) have increased over the pandemic. Those with pre-existing mental disorders are more vulnerable but have been understudied. We investigated emotional and behavioral outcomes in this population; differences across diagnostic groups; and social, educational, and clinical determinants. METHODS We invited 5386 caregivers and CYP (aged 5-17) under child mental health services pre-pandemic to complete an online survey on CYP's emotional/behavioral symptoms and pandemic-related circumstances, and integrated responses with clinicodemographic information extracted from electronic health records. We compared four parent-rated outcomes (total emotional/behavioral scores and emotional/behavioral changes as compared to before the pandemic) across the three most common diagnostic groups in our population (Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and emotional disorders (EmD)). We then estimated the association of clinicodemographic and pandemic-related characteristics with emotional/behavioral outcomes. RESULTS A total of 1741 parents (32.3%) completed the survey. Parents of CYP with ADHD or ASD reported more behavioral difficulties (t(591) = 5.618 (0.001); t(663) = 6.527 (0.001)); greater emotional deterioration (t(591) = 2.592 (0.009); t(664) = 4.670 (< 0.001); and greater behavioral deterioration (t(594) = 4.529 (< 0.001); t(664) = 5.082 (< 0.001)) as compared to the EmD group. Those with ASD and EmD showed more emotional difficulties than ADHD (t(891) = - 4.431 (< 0.001); t(590) = - 3.254 (0.001)). Across diagnoses, poor parental mental health and challenges with education were most strongly associated with worse outcomes. CONCLUSIONS Within our clinical population, CYP with ADHD/ASD were the most adversely affected during lockdown. Enhancing clinical service provision that tackles parental stress and supports education may help mitigate the impact of future restrictions.
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Affiliation(s)
- V Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - L Frangou
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - S Zhang
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - S Epstein
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - A Morris
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - C Grant
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- Department of Epidemiology and Public Health, University College London, London, UK
| | - L Zalewski
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - A Jewell
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - S Velupillai
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - J Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, 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Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Camp J, Morris A, Wilde H, Smith P, Rimes KA. Gender- and Sexuality-Minoritised Adolescents in DBT: A Reflexive Thematic Analysis of Minority-Specific Treatment Targets and Experience. Cogn Behav Therap 2023; 16:s1754470x23000326. [PMID: 38125010 PMCID: PMC7615396 DOI: 10.1017/s1754470x23000326] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Gender- and sexuality-minoritised (GSM) adolescents are at increased risk of self-harm and suicidal behaviours compared to their cisgender and heterosexual peers. This increased risk is thought to be explained in part by exposure to stigma and societal oppression. Dialectical Behaviour Therapy (DBT) is an evidence-based intervention for self-harm and suicidal behaviour that may have advantages for supporting GSM young people in distress. No study has yet sought to understand what GSM-associated difficulties may be important to consider in DBT for adolescents, or the experiences of GSM young people in a standard DBT programme. Therefore, this study aimed to understand the experiences of GSM young people in DBT and what difficulties and dilemmas associated with their gender and sexuality diversity were thought by them to be important to target in DBT. Qualitative interviews were conducted with 14 GSM young people in a comprehensive DBT programme and were analysed using Reflexive Thematic Analysis. The analysis was supported by two further GSM young people who had finished DBT. The findings were split into three overarching themes (Identity, Impact of Others, and Space for Sexual and Gender Identity in DBT), each with themes within. The identity-based theme included "identity confusion and acceptance"; the relationship-based themes included "cis-Heterosexism" and "community connectedness"; and the space within DBT themes included "negotiating focus and targeting in DBT" and "creating safety in DBT". Findings are discussed in relation to implications and recommendations for therapists working with GSM young people within and outside of DBT.
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Affiliation(s)
- J Camp
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - A Morris
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - H Wilde
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - P Smith
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
| | - K A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
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Morris A, Hanes DA, Kaplan H. Long Term Outcomes of Radiation (RT)-Monotherapy vs. Combined RT + Endocrine Therapy (RT+ET) in Low-Risk Early-Stage Breast Cancer Patients 70 Years or Older after Breast-Conserving Surgery (BCS). Int J Radiat Oncol Biol Phys 2023; 117:S5-S6. [PMID: 37784514 DOI: 10.1016/j.ijrobp.2023.06.212] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Combined Radiation and Endocrine Therapy (RT+ET) and ET Monotherapy are acceptable adjuvant strategies based on randomized trial data. Less is known about RT Monotherapy as a form of treatment de-escalation. Radiation delivery has become safer and more convenient. This study compares long-term outcomes in patients who opted for RT-Monotherapy versus combined RT+ET. MATERIALS/METHODS This retrospective study included female patients from Swedish Cancer Institute breast cancer registry (Seattle, WA), aged ≥70 years with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) T1N0 breast cancer treated with BCS between 1995 and 2015. Patients with positive surgical margins, multifocality, histologic grade 3 and LVI were excluded. Patients were classified into 4 groups: (1) RT+ET (reference); (2) RT Monotherapy; (3) ET Monotherapy; and (4) neither RT nor ET (NT). Choice of therapy was determined by the treating physician and the patient. The primary endpoints were local recurrence (LR), distant metastasis (DM), disease specific survival (DSS), overall survival (OS), and second breast cancer events (SBCEs). Competing risk models were used to estimate cumulative incidence at varying lengths of follow-up and sub distribution hazard ratios (HR) between treatment groups. Significance was set at P ≤ .05. RESULTS We analyzed 496 patients with a median age of 76 years and median follow-up of 9.6 years. 62% (N = 307) of patients received combined RT+ET, 30% (N = 148) RT Monotherapy, 4% (N = 20) ET alone and 4% (N = 21) no therapy, NT group. Only the RT monotherapy and combined RT+ET groups were large enough for a meaningful statistical analysis. RT monotherapy conferred non-inferior disease control compared to combined RT+ET. Recurrence events were extremely low. Incidence of SBCEs was not significantly different between treatments. CONCLUSION For this favorable patient population, RT monotherapy was associated with equivalent long-term outcomes compared to combined RT+ET therapy. Recurrence rates stayed extremely low with long-term FU. RT monotherapy may be a reasonable de-escalation option for this older low risk patient population. Further prospective trials are needed to help refine treatment strategies that allow for more choices in treatment de-escalation.
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Affiliation(s)
- A Morris
- Swedish Cancer Institute, Seattle, WA
| | - D A Hanes
- Providence Health & Services, Portland, OR
| | - H Kaplan
- Swedish Cancer Institute, Seattle, WA
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Brown E, Jr GAF, Shelton A, Johnson T, Chen C, Shaheen S, Holden TL, Dao VA, Bien JYE, King D, Vitzthum L, Kirilcuk N, Morris A, Kin C, Dawes A, Sheth V, Chang DT, Pollom E. A Technology-Informed Approach to Clinical Trial Equity. Int J Radiat Oncol Biol Phys 2023; 117:e8. [PMID: 37786184 DOI: 10.1016/j.ijrobp.2023.06.664] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Despite efforts to increase participation of diverse communities in clinical trials, ethnic/racial minorities remain underrepresented. One such determinant may be lack of access to a comprehensive cancer center that conducts clinical research. Historically, our institution has had low accrual from rural regions further away from our cancer center, with Hispanic or Latino (HL) patients (pts) being especially underrepresented in our clinical research. In this study, we explored the impact of a clinical trial that allowed pts to receive chemotherapy (chemo) with their local oncologist. We hypothesize that allowing pts to receive chemo locally will lead to higher rates of enrollment from populations under-represented in clinical trials. MATERIALS/METHODS We conducted a study for pts with rectal cancer to undergo short-course radiation followed by 4 months of chemo with the option to pursue watch and wait if pts achieve a clinical complete response. Radiation was administered at our institution while pts could receive standard-of-care chemo closer to home with their local oncologist. For pts who received chemo locally, the research coordinator and co-investigators held video visits with the pts prior to each chemo infusion to review adverse events (AE), labs, and chemo dosing. We compared demographic data of pts on this trial with that of pts enrolled across all adult therapeutic oncologic clinical trials over the same time period at our institution. Distance to our institution was calculated based on pts' primary residence zip code. Protocol compliance with AE reporting for pts who received chemo locally was assessed by chart review. RESULTS Between May 2020 and January 2023, 24/35 enrolled pts completed both radiation and chemo on trial. 13/24 pts (54%) received chemo locally. Of the 24 pts, 16 were White (67%), 7 Asian (29%), 1 Native Hawaiian/ Pacific Islander (4%). Of all enrolled patients, 4 were HL (16.7%), compared to our institutional average of 16.5%. All enrolled HL pts received their chemo locally. The average distance traveled by non-HL pts from their home to our institution was 87.7 miles (range 5.1 - 308). In contrast, HL pts traveled an average of 147.8 miles (range 110 - 249), 68% further than their non-HL counterparts. There was 100% compliance with AE reporting among those pts who received their chemo locally. CONCLUSION Although the percentage of HL participation in our study was consistent with our institutional average, all HL pts enrolled on the trial received treatment locally and lived substantially further from our institution than non-HL. By allowing pts to receive this part of treatment locally, we provided pts who live further away an opportunity to engage in clinical research without the associated financial and time toxicities related with traveling for treatment. By decentralizing clinical trials and leveraging telemedicine, we can promote the participation of under-represented groups in clinical trials.
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Affiliation(s)
- E Brown
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA
| | - G A Fisher Jr
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - A Shelton
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - T Johnson
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - C Chen
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - S Shaheen
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - T L Holden
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - V A Dao
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - J Y E Bien
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA
| | - D King
- Department of Medical Oncology/Hematology, Northwell Health Cancer Institute, New Hyde Park, NY
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA
| | - N Kirilcuk
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - A Morris
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - C Kin
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - A Dawes
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - V Sheth
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA
| | - D T Chang
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, MI
| | - E Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA
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Steinberg R, Nayak A, Wang J, Okoh A, Morris A, Cowger J, Nohria A. Associations Between Pre-Implant Cancer and Left Ventricular Assist Device Outcomes: An Intermacs Registry Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1589] [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: 04/05/2023] Open
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Magua W, Okoh A, Pranav P, Wang J, Karadkhele G, Cole R, Daneshmand M, Gupta D, Larsen C, Morris A. Belatacept-Based Immunosuppression in Heart Transplant Recipients: National Trends with Outcomes from a Single Center. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.564] [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: 04/05/2023] Open
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Hofmeyer M, Haas G, Kransdorf E, Ewald G, Morris A, Owens A, Lowes B, Stoller D, Tang W, Garg S, Trachtenberg B, Shah P, Pamboukian S, Sweitzer N, Wheeler M, Wilcox J, Katz S, Pan S, Jimenez J, Smart F, Wang J, Gottlieb S, Judge D, Moore C, Huggins G, Jordan E, Kinnamon D, Ni H, Hershberger R. Genetic Signature of Dilated Cardiomyopathy Severity: The DCM Precision Medicine Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1674] [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: 04/05/2023] Open
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Shetty NS, Parcha V, Pampana A, Kalra R, Pandey A, Morris A, Prabhu S, Arora G, Arora P. Incident heart failure risk reclassification with race-$$$independent estimated glomerular filtration rate: an NHLBI pooled cohorts analysis. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00016-2] [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: 01/28/2023]
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Varadarajan I, Pierce E, Scheuing L, Morris A, El Chaer F, Keng M. Post-Hematopoietic Cell Transplantation Relapsed Acute Lymphoblastic Leukemia: Current Challenges and Future Directions. Onco Targets Ther 2023; 16:1-16. [PMID: 36685611 PMCID: PMC9849790 DOI: 10.2147/ott.s274551] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/14/2022] [Indexed: 01/15/2023] Open
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) represents an important and potentially curative treatment option for adult patients with acute lymphoblastic leukemia. Relapse continues to remain the most important factor influencing overall survival post allo-HCT. We discuss early identification, clinical manifestations, and management of relapsed disease. Routine evaluation of measurable residual disease (MRD) and change in donor chimerism play a crucial role in early detection. Pivotal clinical trials have led to FDA approval of multiple novel agents like blinatumomab and inotuzumab. Combining targeted therapy with cellular immunotherapy serves as the backbone for prolonging overall survival in these patients. Donor lymphocyte infusions have traditionally been used in relapsed disease with suboptimal outcomes. This review provides insight into use of cellular therapy in MRD positivity and decreasing donor chimerism. It also discusses various modalities of combining cellular therapy with novel agents and discussing the impact of chimeric antigen receptor T-cell therapy in the setting of post allo-HCT relapse both as consolidative therapy and as a bridge to second transplant.
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Affiliation(s)
- Indumathy Varadarajan
- Department of Medicine, Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| | - Eric Pierce
- Department of Medicine, Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| | - Lisa Scheuing
- Department of Medicine, Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| | - Amy Morris
- Department of Pharmacy Services, University of Virginia, Charlottesville, VA, USA
| | - Firas El Chaer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| | - Michael Keng
- Department of Medicine, Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA,Correspondence: Michael Keng, Division of Hematology & Oncology, University of Virginia Comprehensive Cancer Center, West Complex Room 6009, 1300 Jefferson Park Ave, PO Box 800716, Charlottesville, VA, 22908, USA, Tel +1 434 924 4257, Fax +1 434- 243 6068, Email
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Hudson-Phillips S, Patel N, Akthar H, Morris A, Noor L. Accuracy of pre-operative axillary US and biopsy in breast cancer patients. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01424-1] [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: 11/19/2022]
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Blouin GC, Derosier C, Man Y, Morris A, Roberts DA. Outcomes of a quality improvement project aimed at improving delivery of new anticancer drug education to nursing in an academic-community hybrid model. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.050] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
50 Background: Educating staff on new anticancer medications is imperative for patient safety. Infusion nurses at Dana Farber Cancer Institute (DFCI) satellite infusion centers were surveyed on their comfort level administering newer oncology drugs. Results revealed only 57% of nurses were “extremely comfortable or somewhat comfortable,” while 32% of nurses were “somewhat uncomfortable or very uncomfortable.” This project aimed to increase percentage of nurses at the satellites indicating they are “extremely comfortable” or “somewhat comfortable” from baseline of 57% to ≥75%. Methods: An interdisciplinary team including pharmacy, medical oncology, and nursing was formed to analyze workflows around new drug onboarding, staff education, and satellite communication. The team utilized Plan-Do-Study-Act (PDSA) cycle methodology. Tools included process maps and fishbone to identify areas of improvement. Intervention development tools included a Pareto chart and a priority matrix. Results were analyzed using statistical process control charts. Results: PDSA cycle 1 consisted of making the pharmacy driven education sheet, At-A-Glance (AAG), more accessible for new drugs. AAGs for drugs approved by the FDA in the previous 18 months were posted on the DFCI pharmacy intranet page. Nurses were educated on how to access AAG weekly. For PDSA cycle 2, the survey was modified to target individual nurses administering new drugs rather than all nurses. A “Nursing consideration” section was added to the AAG template and workflow developed; Navigation and review of AAG was added to nursing competency. Monthly nursing/pharmacy huddles were established to optimize communication. These interventions increased the percentage of nurses indicating they are “extremely comfortable” or “somewhat comfortable” to ≥75% which was sustainable through PDSA cycle 2 (see Table). Conclusions: Making an easy-to-use nursing education resource accessible improved nursing comfort level. There were challenges with nursing survey due to COVID-19 surge and staff shortages. Routine huddles are essential for sustainability.[Table: see text]
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Affiliation(s)
| | | | - Yun Man
- Dana-Farber Cancer Institute, Boston, MA
| | - Amy Morris
- University of Virginia, Charlottesville, VA
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Morris A, Yau Y, Howell P, Parsek M, Hoffman L, Nguyen D, Rooney A, Coburn B, McDonald N, DiGiandomenico A, Wozniak D, Waters V. 570 Visualization of Pseudomonas aeruginosa biofilms in sputum of children with cystic fibrosis who fail eradication therapy. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01260-7] [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: 11/06/2022]
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al Bahri T, Bhoombla N, Rao BM, Titu L, Chatha S, Field C, Gandhi T, Gulati R, Jha R, Jones Sam MT, Karim S, Patel R, Saunders M, Sharma K, Abid S, Heath E, Kurup D, Patel A, Ali M, Cresswell B, Felstead D, Jennings K, Kaluarachchi T, Lazzereschi L, Mayson H, Miah JE, Reinders B, Rosser A, Thomas C, Williams H, Al-Hamid Z, Alsadoun L, Chlubek M, Fernando P, Gaunt E, Gercek Y, Maniar R, Ma R, Matson M, Moore S, Morris A, Nagappan PG, Ratnayake M, Rockall L, Shallcross O, Sinha A, Tan KE, Virdee S, Wenlock R, Donnelly HA, Ghazal R, Hughes I, Liu X, McFadden M, Misbert E, Mogey P, O'Hara A, Peace C, Rainey C, Raja P, Salem M, Salmon J, Tan CH, Alves D, Bahl S, Baker C, Coulthurst J, Koysombat K, Linn T, Rai P, Sharma A, Shergill A, Ahmed M, Ahmed S, Belk LH, Choudhry H, Cummings D, Dixon Y, Dobinson C, Edwards J, Flint J, Franco Da Silva C, Gallie R, Gardener M, Glover T, Greasley M, Hatab A, Howells R, Hussey T, Khan A, Mann A, Morrison H, Ng A, Osmond R, Padmakumar N, Pervaiz F, Prince R, Qureshi A, Sawhney R, Sigurdson B, Stephenson L, Vora K, Zacken A, Cope P, Di Traglia R, Ferarrio I, Hackett N, Healicon R, Horseman L, Lam LI, Meerdink M, Menham D, Murphy R, Nimmo I, Ramaesh A, Rees J, Soame R, Dilaver N, Adebambo D, Brown E, Burt J, Foster K, Kaliyappan L, Knight P, Politis A, Richardson E, Townsend J, Abdi M, Ball M, Easby S, Gill N, Ho E, Iqbal H, Matthews M, Nubi S, Nwokocha JO, Okafor I, Perry G, Sinartio B, Vanukuru N, Walkley D, Welch T, Yates J, Yeshitila N, Bryans K, Campbell B, Gray C, Keys R, Macartney M, Chamberlain G, Khatri A, Kucheria A, Lee STP, Reese G, Roy choudhury J, Tan WYR, Teh JJ, Ting A, Kazi S, Kontovounisios C, Vutipongsatorn K, Amarnath T, Balasubramanian N, Bassett E, Gurung P, Lim J, Panjikkaran A, Sanalla A, Alkoot M, Bacigalupo V, Eardley N, Horton M, Hurry A, Isti C, Maskell P, Nursiah K, Punn G, Salih H, Epanomeritakis E, Foulkes A, Henderson R, Johnston E, McCullough H, McLarnon M, Morrison E, Cheung A, Cho SH, Eriksson F, Hedges J, Low Z, May C, Musto L, Nagi S, Nur S, Salau E, Shabbir S, Thomas MC, Uthayanan L, Vig S, Zaheer M, Zeng G, Ashcroft-Quinn S, Brown R, Hayes J, McConville R, French R, Gilliam A, Sheetal S, Shehzad MU, Bani W, Christie I, Franklyn J, Khan M, Russell J, Smolarek S, Varadarassou R, Ahmed SK, Narayanaswamy S, Sealy J, Shah M, Dodhia V, Manukyan A, O'Hare R, Orbell J, Chung I, Forenc K, Gupta A, Agarwal A, Al Dabbagh A, Bennewith R, Bottomley J, Chu TSM, Chu YYA, Doherty W, Evans B, Hainsworth P, Hosfield T, Li CH, McCullagh I, Mehta A, Thaker A, Thompson B, Virdi A, Walker H, Wilkins E, Dixon C, Hassan MR, Lotca N, Tong KS, Batchelor-Parry H, Chaudhari S, Harris T, Hooper J, Johnson C, Mulvihill C, Nayler J, Olutobi O, Piramanayagam B, Stones K, Sussman M, Weaver C, Alam F, Al Rawi M, Andrew F, Arrayeh A, Azizan N, Hassan A, Iqbal Z, John I, Jones M, Kalake O, Keast M, Nicholas J, Patil A, Powell K, Roberts P, Sabri A, Segue AK, Shah A, Shaik Mohamed SA, Shehadeh A, Shenoy S, Tong A, Upcott M, Vijayasingam D, Anarfi S, Dauncey J, Devindaran A, Havalda P, Komninos G, Mwendwa E, Norman C, Richards J, Urquhart A, Allan J, Cahya E, Hunt H, McWhirter C, Norton R, Roxburgh C, Tan JY, Ali Butt S, Hansdot S, Haq I, Mootien A, Sanchez I, Vainas T, Deliyannis E, Tan M, Vipond M, Chittoor Satish NN, Dattani A, De Carvalho L, Gaston-Grubb M, Karunanithy L, Lowe B, Pace C, Raju K, Roope J, Taylor C, Youssef H, Munro T, Thorn C, Wong KHF, Yunus A, Chawla S, Datta A, Dinesh AA, Field D, Georgi T, Gwozdz A, Hamstead E, Howard N, Isleyen N, Jackson N, Kingdon J, Sagoo KS, Schizas A, Yin L, Aung E, Aung YY, Franklin S, Han SM, Kim WC, Martin Segura A, Rossi M, Ross T, Tirimanna R, Wang B, Zakieh O, Ben-Arzi H, Flach A, Jackson E, Magers S, Olu abara C, Rogers E, Sugden K, Tan H, Veliah S, Walton U, Asif A, Bharwada Y, Bowley D, Broekhuizen A, Cooper L, Evans N, Girdlestone H, Ling C, Mann H, Mehmood N, Mulvenna CL, Rainer N, Trout I, Gujjuri R, Jeyaraman D, Leong E, Singh D, Smith E, Anderton J, Barabas M, Goyal S, Howard D, Joshi A, Mitchell D, Weatherby T, Badminton R, Bird R, Burtle D, Choi NY, Devalia K, Farr E, Fischer F, Fish J, Gunn F, Jacobs D, Johnston P, Kalakoutas A, Lau E, Loo YNAF, Louden H, Makariou N, Mohammadi K, Nayab Y, Ruhomaun S, Ryliskyte R, Saeed M, Shinde P, Sudul M, Theodoropoulou K, Valadao-Spoorenberg J, Vlachou F, Arshad SR, Janmohamed AM, Noor M, Oyerinde O, Saha A, Syed Y, Watkinson W, Ahmadi H, Akintunde A, Alsaady A, Bradley J, Brothwood D, Burton M, Higgs M, Hoyle C, Katsura C, Lathan R, Louani A, Mandalia R, Prihartadi AS, Qaddoura B, Sandland-Taylor L, Thadani S, Thompson A, Walshaw J, Teo S, Ali S, Bawa JH, Fox S, Gargan K, Haider SA, Hanna N, Hatoum A, Khan Z, Krzak AM, Li T, Pitt J, Tan GJS, Ullah Z, Wilson E, Cleaver J, Colman J, Copeland L, Coulson A, Davis P, Faisal H, Hassan F, Hughes JT, Jabr Y, Mahmoud Ali F, Nahaboo Solim ZN, Sangheli A, Shaya S, Thompson R, Cornwall H, De Andres Crespo M, Fay E, Findlay J, Groves E, Jones O, Killen A, Millo J, Thomas S, Ward J, Wilkins M, Zaki F, Zilber E, Bhavra K, Bilolikar A, Charalambous M, Elawad A, Eleni A, Fawdon R, Gibbins A, Livingstone D, Mala D, Oke SE, Padmakumar D, Patsalides MA, Payne D, Ralphs C, Roney A, Sardar N, Stefanova K, Surti F, Timms R, Tosney G, Bannister J, Clement NS, Cullimore V, Kamal F, Lendor J, McKay J, Mcswiggan J, Minhas N, Seneviratne K, Simeen S, Valverde J, Watson N, Bloom I, Dinh TH, Hirniak J, Joseph R, Kansagra M, Lai CKN, Melamed N, Patel J, Randev J, Sedighi T, Shurovi B, Sodhi J, Vadgama N, Abdulla S, Adabavazeh B, Champion A, Chennupati R, Chu K, Devi S, Haji A, Schulz J, Testa F, Davies P, Gurung B, Howell S, Modi P, Pervaiz A, Zahid M, Abdolrazaghi S, Abi Aoun R, Anjum Z, Bawa G, Bhardwaj R, Brown S, Enver M, Gill D, Gopikrishna D, Gurung D, Kanwal A, Kaushal P, Khanna A, Lovell E, McEvoy C, Mirza M, Nabeel S, Naseem S, Pandya K, Perkins R, Pulakal R, Ray M, Reay C, Reilly S, Round A, Seehra J, Shakeel NM, Singh B, 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G, Raheel F, Rajaseharan A, Ramgopal A, Risbrooke C, Selvaratnam K, Sethunath G, Tabassum R, Taylor J, Thakker A, Wijesingha N, Wybrew R, Yasin T, Ahmed Osman A, Alfadhel S, Carberry E, Chen JY, Drake I, Glen P, Jayasuriya N, Kawar L, Myatt R, Sinan LOH, Siu SSY, Tjen V, Adeboyejo O, Bacon H, Barnes R, Birnie C, D'Cunha Kamath A, Hughes E, Middleton S, Owen R, Schofield E, Short C, Smith R, Wang H, Willett M, Zimmerman M, Balfour J, Chadwick T, Coombe-Jones M, Do Le HP, Faulkner G, Hobson K, Shehata Z, Beattie M, Chmielewski G, Chong C, Donnelly B, Drusch B, Ellis J, Farrelly C, Feyi-Waboso J, Hibell I, Hoade L, Ho C, Jones H, Kodiatt B, Lidder P, Ni Cheallaigh L, Norman R, Patabendi I, Penfold H, Playfair M, Pomeroy S, Ralph C, Rottenburg H, Sebastian J, Sheehan M, Stanley V, Welchman J, Ajdarpasic D, Antypas A, Azouaghe O, Basi S, Bettoli G, Bhattarai S, Bommireddy L, Bourne K, Budding J, Cookey-Bresi R, Cummins T, Davies G, Fabelurin C, Gwilliam R, Hanley J, Hird A, Kruczynska A, 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Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Morris A, Henkel R, Siebert T. O-134 Predictive value of seminal oxidation-reduction potential (ORP) and sperm DNA fragmentation (SDF) analysis for reproductive outcomes of intracytoplasmic sperm injection (ICSI) cycles. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.034] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Do seminal oxidation-reduction potential (ORP) and sperm DNA fragmentation (SDF) predict ICSI cycle outcomes?
Summary answer
Both SDF and seminal ORP have strong prognostic value in predicting good fertilization (≥80%), blastocyst development (≥60%), clinical pregnancy and live birth.
What is known already
Seminal oxidative stress (OS) has been found to play an important role in various aetiologies of male infertility and is induced by the imbalance between reactive oxygen species (ROS) and antioxidants. OS is a major cause of sperm DNA fragmentation (SDF). It is well established that high levels of seminal OS and SDF are negatively associated with ART outcomes. Previous studies have associated high levels of SDF with an increase risk of miscarriage and a decrease in live birth rate.
Study design, size, duration
This prospective study included 144 couples who had a fresh autologous ICSI cycle between June 2018 and December 2020. There was no restriction to patients with severe male factor infertility. All cryopreservation and third party assisted reproductive techniques were excluded.
Participants/materials, setting, methods
This multi-centre study was performed at three ART Clinics in Cape Town, South Africa. All couples included in the study had fresh autologous ICSI cycles with freshly ejaculated semen. Seminal ORP testing was performed using the MiOXSYS system and SDF by means of a fluorescence microscopic TUNEL assay on freshly ejaculated semen samples that were used for ICSI. The ART outcomes evaluated were fertilization rate, blastocyst development rate, clinical pregnancy rate and live birth rate.
Main results and the role of chance
The study shows that seminal ORP significantly negatively correlates with fertilization rate (r=-0.267; P = 0.0012), blastocyst development rate (r=-0.389; P < 0.0001), pregnancy (r=-0.296; P = 0.0003) and live birth (r=-0.353; P < 0.0001). ROC curve analysis shows significant predictive power for ORP for fertilization (≥80%; AUC=0.652; P = 0.0012), blastocyst development rate (≥60%; AUC=0.762; P < 0.0001), pregnancy (AUC=0.677; P = 0.0002) and live birth (AUC=0.729; P < 0.0001). Comparable results were obtained for SDF. An average cut-off value for ORP of 0.55 mV/106 sperm/mL was calculated. The AUCs between the SDF and ORP results for all reproductive outcome parameters did not differ. For all reproductive outcome parameters, normal sperm morphology shows the lowest predictive power. ORP with male age as confounding factor had significant effects on odds ratios (OR) of fertilization (OR = 0.1446; CI: 0.048-0.430; P = 0.0001) and blastocyst development (OR = 0.2468; CI: 0.095-0.635; P = 0.0029), while it was not significant for pregnancy and life birth.
Multivariate logistic regression with fertilization, blastocyst development, pregnancy and live birth as dependent parameters and high/low seminal ORP, primary and secondary infertility, unexplained infertility, polycystic ovaries, endometriosis, tubal factor myomectomy, ovarian insufficiency and advanced maternal age as independent variables showed overall model fits (P < 0.0002) with a significant (P < 0.0084) influence of ORP on all reproductive outcome parameters.
Limitations, reasons for caution
Since only ICSI patients were included in this study, this might have contributed to the fact the cut-off value of ORP is lower than the published cut-off. A further limitation is the use of a fluorescence microscopic TUNEL assay which drastically limited the number of sperm evaluated.
Wider implications of the findings
This is the first study showing predictive value of seminal ORP for reproductive outcome including pregnancy and live birth. The method is easy and much quicker than current methods for the determination of SDF. Hence, it can be used a point of care method.
Trial registration number
Not applicable
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Affiliation(s)
- A Morris
- University of the Western Cape and Tygerberg Hospital, Medical Biosciences , Cape Town, South Africa
| | - R Henkel
- University of the Western Cape, Medical Biosciences , Cape Town, South Africa
| | - T.I Siebert
- Stellenbosch University, Obstetrics and Gynecology , Cape Town, South Africa
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Curry P, Chinoy H, Jani M, Plant D, Hyrich K, Morgan A, Wilson AG, Isaacs J, Morris A, Barton A, Bluett J. POS1229 THE IMPACT OF COVID-19 ON MEDICATION NON-ADHERENCE IN A RHEUMATOID AND PSORIATIC ARTHRITIS UK COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIn March 2020, as part of the UK’s COVID-19 prevention strategy, those identified as ‘clinically extremely vulnerable’, were advised to shield. This included a number of patients prescribed anti-rheumatic drugs, who were asked to continue their current treatment unless they developed symptoms of infection. Suboptimal treatment adherence (16.0%-81.0%) has been reported in patients with arthritic diseases, and is associated with psychological factors, including anxiety (1). Previous literature in non-UK cohorts has highlighted suboptimal adherence levels in immunosuppressed patients during the pandemic, although many were single centre studies (2,3).ObjectivesThe aim of this multi-centre study is to investigate the impact of the COVID-19 pandemic on adherence to anti-rheumatic medications in patients with established rheumatoid (RA) and psoriatic (PsA) arthritis in the UK who had recently commenced a biologic or targeted synthetic DMARD.MethodsBetween September 2020 and May 2021, RA and PsA patients prescribed biologic or targeted synthetic anti-rheumatic drugs from two multi-centre observational studies (BRAGGSS and OUTPASS) were sent a questionnaire on medication usage, adherence, and perceptions to establish the impact of COVID-19 on these parameters. Patients were asked about compliance during the COVID-19 pandemic using a 5-point Likert scale (always, often, sometimes, rarely, and never) and the reason for non-adherence. Adherence was defined as never missing or delaying a dose, unless medically advised. Descriptive summary statistics were calculated, and logistic regression and Pearson’s chi-squared tests were employed to investigate variables associated with self-reported non-adherence.ResultsIn total 159 questionnaires were returned (81.1% RA and 18.9% PsA). Methotrexate (53.5%) was the most frequently prescribed agent, followed by etanercept (25.2%), sulfasalazine (22.6%), hydroxychloroquine (21.4%) and adalimumab (19.5%). Furthermore, 68.6% of patients were prescribed ≥2 drugs. During the pandemic, 42.1% of patients reported missing or delaying a treatment dose for any reason. Adherence information was available for 97.5% of patients with 25.8% reporting non-adherence which was not medically advised. Methotrexate non-adherence was 27.1%, with similar levels reported for etanercept (20.0%), sulfasalazine (27.8%), hydroxychloroquine (35.3%) and adalimumab (29.0%). No drugs had significantly different adherence compared to methotrexate. Furthermore, there was no association between disease type or perception of disease control and adherence. Of non-adherent patients, 17.5% reported increased anxiety, fear, and increased risk due to the COVID-19 pandemic as an influencing factor. Meanwhile, 37.5% of non-adherent patients listed non-COVID-19 intentional reasons and 45.0% reported non-intentional reasons, with forgetting and running out of treatment listed most frequently.ConclusionIn a UK cohort self-reported non-adherence was reported in 25.8% of patients during the COVID-19 pandemic, despite medical advice, with reasons including increased anxiety due to COVID-19.References[1]Medication adherence and persistence in patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis: a systematic literature review. Patient Prefer Adherence. 2018;12:1483–503.[2]Vakirlis E, Bakirtzi K, Papadimitriou I, Vrani F, Sideris N, Lallas A, et al. Treatment adherence in psoriatic patients during COVID-19 pandemic: Real-world data from a tertiary hospital in Greece. J Eur Acad Dermatology Venereol. 2020;34(11):e673–5.[3]Polat Ekinci A, Pehlivan G, Gökalp MO. Surveillance of psoriatic patients on biologic treatment during the COVID-19 pandemic: A single-center experience. Dermatol Ther. 2020;(December 2020):19–22.Acknowledgementson behalf of the BRAGGSS consortiumDisclosure of InterestsPhilippa Curry: None declared, Hector Chinoy Speakers bureau: UCB, Biogen, Consultant of: Novartis, Eli Lilly, Orphazyme, Astra Zeneca, Grant/research support from: Eli Lilly, UCB, Meghna Jani: None declared, Darren Plant: None declared, Kimme Hyrich Consultant of: consultancy/honoraria from AbbVie, Grant/research support from: Pfizer, BMS, Ann Morgan Speakers bureau: Roche, Chugai, Consultant of: GSK, Roche, Chugai, AstraZeneka, Regeneron, Sanofi, Vifor, Grant/research support from: Roche, Kiniksa Pharmaceuticals, Anthony G Wilson: None declared, John Isaacs Speakers bureau: Abbvie, Gilead, Roche, UCB, Grant/research support from: GSK, Janssen, Pfizer, Andrew Morris: None declared, Anne Barton Grant/research support from: I have received grant funding from Pfizer, Galapagos, Scipher Medicine and Bristol Myers Squibb., James Bluett Grant/research support from: Pfizer Limited. JB has received travel/conference fees from UCB, Pfizer and Eli Lilly
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Tordoff M, Smith S, Rice GI, Morris A, Briggs T, Thomson W, Eyre S, Bowes J. POS0164 GENETIC ANALYSIS OF WHOLE EXOME SEQUENCING IN A COHORT OF CHILDREN WITH REFRACTORY JIA REVEALS GENETIC RISK FACTORS FOR RARE JUVENILE DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundJuvenile idiopathic arthritis (JIA) encompasses a group of heterogeneous rheumatic diseases of childhood onset. JIA can result in long term disability and remission is the main goal of treatment. However refractory disease can occur, which is defined as the absence of response to a standard disease therapy. A genetic basis for refractory disease has yet to be explored, where deleterious rare variants can complicate diagnosis or treatment outcome.ObjectivesTo investigate, through genetic analysis, whether children with JIA that is refractory carry rare genetic risk factors in genes linked to monogenic diseases.MethodsWhole exome sequencing of 99 children with JIA was performed with the Agilent SureSelect Human All ExonV6 kit. All quality control, variant filtering and annotation was performed in Varseq (version 2.2.1). Variants with a read depth <30 and genotype quality <80 were removed. Rarity and pathogenicity filters were then applied to remove variants with an allele frequency >1% (based on ExAC, gnomAD, gnomAD exome, NHLBI and 1KGp phase 3), classified as benign or likely benign on ClinVar, with a CADD PHRED score <15 and a REVEL score >0.7. Variants were annotated if they appeared in a gene from the primary immunodeficiency PanelApp (Martin et al., 2019), in a gene associated with an arthritis phenotype or in a gene that appeared on a paediatric monogenic gene list. The variants were then classified using ACMG guidelines (Richards et al., 2015) and benign, or likely benign, classified variants were removed.ResultsA total of 628 variants were identified and we found that 20 out of the 99 children screened were heterozygous for at least one recognised variant in a gene linked to a monogenic disease. Five of these children carried more than one recognised variant linked to monogenic genes. Here we provide a number of illustrative examples: three genes, ADAR, ATP7B and MVK, were prioritised based on prior evidence of associated disease. The variant p.Pro193Ala (gnomAD allele frequency (GAD) 2.2x10-3) of ADAR has previously been deemed pathogenic in a homozygous or compound heterozygous state for Aicardi-Goutières syndrome. Adenosine deaminases (ADARs) catalyse the hydrolytic deamination of adenosine to inosine in dsRNA and is suggested to act as a suppressor of type 1 interferon-stimulated genes. Within ATP7B, two distinct variants were detected; p.Gln1142His (GAD 1.6x10-5) and p.Ile1148Thr (GAD 4.0x10-5) have previously been reported as pathogenic, in combination with a third variant, for Wilson’s disease and were carried by one individual in this cohort. ATP7B encodes copper-transporting ATPase 2, which supplies copper to ceruloplasmin. Variant p.Val377Ile (GAD 1.6x10-3) of MVK was detected in eight individuals in this cohort, interestingly five of these individuals also carried at least one HLA-DRB1 stop-gained variant. This MVK mutation has been confirmed as pathogenic in a homozygous or compound heterozygous state for mevalonate kinase deficiency. MVK converts mevalonic acid into mevalonate-5-phosphate in the cholesterol synthesis pathway. Additionally, two stop-gained loss of function HLA-DRB1 variants, p.Tyr107Ter and p.Gln125Ter, were detected in five and 20 individuals, respectively, in this cohort. HLA-DRB1 is a recognised susceptibility locus for JIA.ConclusionScreening of a cohort of 99 children with JIA that have refractory disease has revealed that individuals carry deleterious variants in genes linked to monogenic forms of disease. These results highlight that the genetic basis for refractory disease needs to be further investigated. Carrying additional genetic risk factors to disease may complicate disease outcome and genetic screening of children with refractory JIA may improve treatment outcome in the future.AcknowledgementsI would like to acknowledge the CLUSTER consortium.Disclosure of InterestsNone declared
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Mort J, Wells L, DiBenedetto S, Morse E, Mautner B, Ghamsari F, Pierce E, Morris A, Keng MK, El Chaer F. Comparison of different treatment modalities for favorable risk acute myeloid leukemia: Standard-dose anthracycline versus high-dose anthracycline versus addition of gemtuzumab ozogamicin. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19016] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19016 Background: The standard remission induction regimen for medically fit patients with AML consists of a backbone of cytarabine & an anthracycline (“7+3” therapy). However, the choice & dose of the anthracycline varies between institutions & practitioner preference, particularly in patients with favorable risk cytogenetics. Gemtuzumab ozogamicin (GO) may improve outcomes in this patient population but is associated with increased toxicities. Methods: We performed a retrospective analysis on medically fit patients ≥ 18 yo with favorable risk AML from 2015-2020 treated with 7+3 at the University of Virginia. Patients were stratified based on standard dose (45 or 60 mg/m2 daunorubicin) (SD) vs higher dose (90 mg/m2 daunorubicin or 12 mg/m2 idarubicin) (HD) of anthracycline vs the addition of GO. Measures included rates of remission, EFS, RFS, and OS as well as rates of treatment-related complications. Results: In total, 58 patients were identified, of which 33 received induction with SD, 19 received HD, & 6 received GO. The majority (75%) of patients were < 60 years old & 93% had de novo AML. The rates of complete remission in the SD, HD & GO groups were 90.9%, 89.5% & 100%, respectively (p = 0.57). EFS at 2-years was 43.9%, 36.7%, & 66.7%, respectively (p = 0.85). RFS at 2-years was 53.0%, 39.0%, & 100%, respectively (p = 0.18). OS at 2-years was similar between all groups (58.9%, 56.9%, & 66.7%, p = 0.92). The rate & duration of cytopenias after induction were similar among all groups (median duration 29 days), however cytopenias were more common in the GO group following consolidation. The rates of major bleeding, admission to the intensive care unit (ICU), and new onset cardiomyopathy (EF < 50%) were higher in the GO group (major bleeding: 0% in SD, 5.3% in HD, 33.3% in GO; ICU admission: 12.1% in SD, 21.1% in HD, 33.3% in GO; cardiomyopathy: 12.1% in SD, 26.3% in HD, 33.3% in GO). The rate of infection, liver dysfunction, & acute renal injury were similar among all groups. No patients developed veno-occlusive disease. Conclusions: Patients receiving GO had a trend toward improved EFS & RFS, however with a similar OS at the expense of higher rates of cytopenias, major bleeding, ICU admission, & cardiotoxicity. Patients receiving HD had a trend toward worse outcomes than those who received SD. A major limitation of our study is the small sample size & single institution experience, however multi-institutional analysis is ongoing for further investigation.[Table: see text]
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Affiliation(s)
- Joseph Mort
- University of Virginia Health System, Charlottesville, VA
| | - Leah Wells
- University of Virginia, Charlottesville, VA
| | | | - Emily Morse
- University of Virginia Health System, Charlottesville, VA
| | - Ben Mautner
- University of Virginia Health System, Charlottesville, VA
| | - Farid Ghamsari
- University of Virginia School of Medicine, Charlottesville, VA
| | | | - Amy Morris
- University of Virginia, Charlottesville, VA
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FitzMaurice T, Morris A, Nazareth D, Walshaw M. WS10.02 People with cystic fibrosis on elexacaftor/tezacaftor/ivacaftor therapy demonstrate improved physical activity levels and cardiovascular fitness. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00208-9] [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: 11/29/2022]
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Mautner B, Pierce E, Mort J, DiBenedetto S, Wells L, Ghamsari F, Morse E, Morris A, Keng MK, El Chaer F. The risks of thrombotic and bleeding events in patients receiving PEGylated asparaginase for treatment of acute lymphoblastic leukemia. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19015] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19015 Background: The prognosis of adult patients with acute lymphoblastic leukemia (ALL) has improved with the adoption of pediatric-inspired chemotherapy regimens. PEGylated asparaginase (PEG-Asp) is essential to these regimens. Although PEG-Asp is associated with an increased risk of coagulopathy, venous thromboembolism, and depletion of antithrombin III (AT3), there is limited data evaluating the risk of thrombosis and bleeding and optimal antithrombotic interventions in these patients are unknown. Methods: We performed a single-center retrospective study of patients ≥ 18 years-old who received PEG-Asp for B- or T-ALL at the University of Virginia between 2015 and 2020. The primary outcomes were the incidence of thrombosis and bleeding events. All patients received prophylactic AT3 repletion for activity level <60% & cryoprecipitate for fibrinogen <100mg/dL. None received prophylactic anticoagulation. All received prednisone during induction at a median daily dose of 1 mg/kg. Results: We identified 57 patients who received PEG-Asp for ALL. Median age was 32 years (range 18-63). Five patients (8.8%) had a thrombotic event during induction versus five (16%) during post-induction. Four patients (7%) had a bleeding event during induction versus five (10%) during post-induction. The most common type of thrombosis was deep venous thrombosis, with the majority being catheter-associated. Pulmonary embolism and CNS thrombosis were less common. During induction, the median time to thrombotic event was 18 days after last PEG-Asp administration. 60% and 80% of patients received AT3 and cryoprecipitate, respectively. During post-induction, the median time to thrombotic event was 58 days after last PEG-Asp administration. 38% and 63% of the patients received AT3 and cryoprecipitate, respectively. There was one episode of major bleeding during induction and six during post-induction. Conclusions: Though the increase in thrombotic risk in adult patients receiving PEG-Asp is well-characterized, rates of reported thromboses vary widely. Studies examining bleeding risk associated with PEG-Asp regimens are even scarcer and with variable outcomes. There was a significant occurrence of both thrombotic and bleeding events associated with administration of PEG-Asp. More investigation into the relative thrombotic and bleeding risks associated with PEG-Asp is needed to determine optimal antithrombotic interventions in adult patients with ALL.[Table: see text]
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Affiliation(s)
- Ben Mautner
- University of Virginia Health System, Charlottesville, VA
| | | | - Joseph Mort
- University of Virginia Health System, Charlottesville, VA
| | | | - Leah Wells
- University of Virginia, Charlottesville, VA
| | - Farid Ghamsari
- University of Virginia School of Medicine, Charlottesville, VA
| | - Emily Morse
- University of Virginia Health System, Charlottesville, VA
| | - Amy Morris
- University of Virginia, Charlottesville, VA
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Fonseca De Freitas D, Agbedjro D, Kadra-Scalzo G, Francis E, Ridler I, Pritchard M, Shetty H, Segev A, Casetta C, Smart S, Morris A, Downs J, Christensen S, Bak N, Kinon B, Stahl D, Hayes R, Maccabe J. Correlates of late-onset antipsychotic treatment resistance. Eur Psychiatry 2022. [PMCID: PMC9567017 DOI: 10.1192/j.eurpsy.2022.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction There is emerging evidence of heterogeneity within treatment-resistance schizophrenia (TRS), with some people not responding to antipsychotic treatment from illness onset and a smaller group becoming treatment-resistant after an initial response period. It has been suggested that these groups have different aetiologies. Few studies have investigated socio-demographic and clinical differences between early and late onset of TRS. Objectives This study aims to investigate socio-demographic and clinical correlates of late-onset of TRS. Methods Using data from the electronic health records of the South London and Maudsley, we identified a cohort of people with TRS. Regression analyses were conducted to identify correlates of the length of treatment to TRS. Analysed predictors include gender, age, ethnicity, positive symptoms severity, problems with activities of daily living, psychiatric comorbidities, involuntary hospitalisation and treatment with long-acting injectable antipsychotics. Results We observed a continuum of the length of treatment until TRS presentation. Having severe hallucinations and delusions at treatment start was associated shorter duration of treatment until the presentation of TRS. Conclusions Our findings do not support a clear cut categorisation between early and late TRS, based on length of treatment until treatment resistance onset. More severe positive symptoms predict earlier onset of treatment resistance. Disclosure DFdF, GKS, EF and IR have received research funding from Janssen and H. Lundbeck A/S. RDH and HS have received research funding from Roche, Pfizer, Janssen and Lundbeck. SES is employed on a grant held by Cardiff University from Takeda Pharmaceutical Comp
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Pierce E, Mautner B, Mort J, Blewett A, Morris A, Keng M, El Chaer F. MRD in ALL: Optimization and Innovations. Curr Hematol Malig Rep 2022; 17:69-81. [PMID: 35616771 DOI: 10.1007/s11899-022-00664-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Measurable residual disease (MRD) is an important monitoring parameter that can help predict survival outcomes in acute lymphoblastic leukemia (ALL). Identifying patients with MRD has the potential to decrease the risk of relapse with the initiation of early salvage therapy and to help guide decision making regarding allogeneic hematopoietic cell transplantation. In this review, we discuss MRD in ALL, focusing on advantages and limitations between MRD testing techniques and how to monitor MRD in specific patient populations. RECENT FINDINGS MRD has traditionally been measured through bone marrow samples, but more data for evaluation of MRD via peripheral blood is emerging. Current and developmental testing strategies for MRD include multiparametric flow cytometry (MFC), next-generation sequencing (NGS), quantitative polymerase chain reaction (qPCR), and ClonoSeq. Novel therapies are incorporating MRD as an outcome measure to demonstrate efficacy, including blinatumomab, inotuzumab ozogamicin, and chimeric antigen receptor T (CAR-T) cell therapy. Understanding how to incorporate MRD testing into the management of ALL could improve patient outcomes and predict efficacy of new therapy options.
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Affiliation(s)
- Eric Pierce
- Department of Medicine, Division of Hematology and Oncology, University of Virginia Comprehensive Cancer Center, 1300 Jefferson Park Ave, PO Box 800716, Charlottesville, VA, 22908, USA
| | - Benjamin Mautner
- Department of Medicine, Division of Hematology and Oncology, University of Virginia Comprehensive Cancer Center, 1300 Jefferson Park Ave, PO Box 800716, Charlottesville, VA, 22908, USA
| | - Joseph Mort
- Department of Medicine, Division of Hematology and Oncology, University of Virginia Comprehensive Cancer Center, 1300 Jefferson Park Ave, PO Box 800716, Charlottesville, VA, 22908, USA
| | - Anastassia Blewett
- Department of Pharmacy Services, University of Virginia Comprehensive Cancer Center, 1300 Jefferson Park Ave, PO Box 800716, Charlottesville, VA, 22908, USA
| | - Amy Morris
- Department of Pharmacy Services, University of Virginia Comprehensive Cancer Center, 1300 Jefferson Park Ave, PO Box 800716, Charlottesville, VA, 22908, USA
| | - Michael Keng
- Department of Medicine, Division of Hematology and Oncology, University of Virginia Comprehensive Cancer Center, 1300 Jefferson Park Ave, PO Box 800716, Charlottesville, VA, 22908, USA
| | - Firas El Chaer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia Comprehensive Cancer Center, 1300 Jefferson Park Ave, PO Box 800716, Charlottesville, VA, 22908, USA.
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Mehra M, Nayak A, Morris A, Lanfear D, Nemeh H, Desai S, Bansal A, Guerrero-Miranda C, Hall S, Cleveland J, Goldstein D, Uriel N, Chen L, Bailey S, Anyanwu A, Heatley G, Chuang J, Estep J. Development and Validation of a Personalized Risk Score for Prediction of Patient-Specific Clinical Experiences with HeartMate 3 LVAD Implantation: An Analysis from the MOMENTUM 3 Trial Portfolio. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.050] [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: 11/30/2022] Open
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Urie R, Morris A, Farris D, Lombard E, Li J, Goldstein D, Shea L. Tissue Engineering Scaffolds for Minimally-Invasive Immunosurveillance of Acute Cellular Graft Rejection. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.297] [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: 11/29/2022] Open
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Incledon B, Incledon C, Gomeni R, Uchida CL, Morris A, Perry K, Kapuscinski J. Effect of Colonic Absorption on the Pharmacokinetic Properties of Delayed-Release and Extended-Release Methylphenidate: In Vivo, In Vitro, and Modeling Evaluations. Clin Pharmacol Drug Dev 2022; 11:966-975. [PMID: 35316579 PMCID: PMC9541386 DOI: 10.1002/cpdd.1089] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/06/2021] [Accepted: 02/13/2022] [Indexed: 11/07/2022]
Abstract
Most stimulants used to treat attention‐deficit/hyperactivity disorder are administered in the morning and absorbed in the upper gastrointestinal tract. DR/ER‐MPH (formerly HLD200), an evening‐dosed delayed‐release and extended‐release methylphenidate, is predicted to be absorbed in the proximal colon. The pharmacokinetic (PK) profile of DR/ER‐MPH is characterized by an 8‐ to 10‐hour delay in initial methylphenidate absorption and a subsequent gradual increase in plasma concentration, followed by a slow decline. To examine the relationship of absorption site to pharmacokinetics, the DR/ER‐MPH formulation was altered to release methylphenidate in the small intestine and distal colon. The 3 formulations were administered in an open‐label, 3‐way, crossover study in healthy adults (N = 18). Compared with the small intestine formulation, the PK profile of the proximal colon (DR/ER‐MPH) formulation exhibited a longer delay before initial methylphenidate absorption, decreased peak methylphenidate concentration, increased time to peak concentration, and decreased bioavailability; these characteristics were amplified in the distal colon formulation. Safety profiles fell within the expectations for methylphenidate products. Modeled PK profiles were similar between the small intestine formulation and a morning‐dosed extended‐release methylphenidate (both predicted to release methylphenidate in the upper gastrointestinal tract), providing additional evidence that the PK profile of DR/ER‐MPH is shaped by colonic absorption.
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Affiliation(s)
- Bev Incledon
- Ironshore Pharmaceuticals & Development, Inc.Camana BayGrand CaymanCayman Islands
| | - Chantal Incledon
- Ironshore Pharmaceuticals & Development, Inc.Camana BayGrand CaymanCayman Islands
| | | | | | | | - Kim Perry
- Innovative AnalyticsKalamazooMichiganUSA
| | - Jill Kapuscinski
- Ironshore Pharmaceuticals & Development, Inc.Camana BayGrand CaymanCayman Islands
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Morris A, Bamrungyat R, Scurry AN, Seitz A, Gallun F, Jiang F. Effects of Aging on Speech-in-Noise Discrimination. J Vis 2022. [PMID: 35120247 DOI: 10.1167/jov.22.3.13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The ability to discriminate speech in the presence of background noise decreases with age. The current study examined the effects of noise type and spatial separation between the target and masking speech on speech-in-noise (SiN) discrimination in older (22) and young (25) adults. Using Portable Automated Rapid Testing software implemented on an iPad, participants were asked to separate target speech from either interfering speech (informational masking) or 'garbled speech' that contained similar spectro-temporal aspects of sound, but no informational meaning (energetic masking) for three spatial separations (0°, 6°, and 45°). In addition, spectro-temporal modulation (STM) sensitivity, binaural sensitivity, and notched-noise masking thresholds were measured. Overall, older adults showed worse SiN performance compared to young controls for both types of masking at most of the spatial separations. In contrast to their worse sensitivity for binaural detection and notched-noise masking, older adults showed intact STM sensitivity. These findings add knowledge of how aging affects SiN discrimination and provide insight into training programs aimed at improving older adults' SiN performance.
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Affiliation(s)
- Amy Morris
- Department of Psychology, University of Nevada, Reno, USA
| | | | | | - Aaron Seitz
- Department of Psychology, University of California, Riverside, USA
| | - Frederick Gallun
- Oregon Hearing Research Center, Oregon Health & Science University, USA
| | - Fang Jiang
- Department of Psychology, University of Nevada, Reno, USA
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Pattock AM, Kim MM, Kersey CB, Liu L, Kirkpatrick JN, Adedipe A, Kessler R, Morris A, Nikravan S, Mazimba S, Kwon Y. Cardiac point-of-care ultrasound publication trends. Echocardiography 2022; 39:240-247. [PMID: 35034372 DOI: 10.1111/echo.15297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/18/2021] [Revised: 12/21/2021] [Accepted: 01/05/2022] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Cardiac point-of-care ultrasound (c-POCUS) is an increasingly implemented diagnostic tool with the potential to guide clinical management. We sought to characterize and analyze the existing c-POCUS literature with a focus on the temporal trends and differences across specialties. METHODS A literature search for c-POCUS and related terms was conducted using Ovid (MEDLINE and Embase) and Web of Science databases through 2020. Eligible publications were classified by publication type and topic, author specialty, geographical region of senior author, and journal specialty. RESULTS The initial search produced 1761 potential publications. A strict definition of c-POCUS yielded a final total of 574 cardiac POCUS manuscripts. A yearly increase in c-POCUS publications was observed. Nearly half of publications were original research (48.8%) followed by case report or series (22.8%). Most publications had an emergency medicine senior author (38.5%), followed by cardiology (20.8%), anesthesiology (12.5%), and critical care (12.5%). The proportion authored by emergency medicine and cardiologists has decreased over time while those by anesthesiology and critical care has generally increased, particularly over the last decade. First authorship demonstrated a similar trend. Articles were published in emergency medicine (24.4%) and cardiology journals (20.5%) with comparable frequency. CONCLUSION The annual number of c-POCUS publications has steadily increased over time, reflecting the increased recognition and utilization of c-POCUS. This study can help inform clinicians of the current state of c-POCUS and augment the discussion surrounding barriers to continued adoption across all specialties.
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Affiliation(s)
| | | | - Cooper B Kersey
- University of Washington, Department of Medicine, Seattle, Washington, USA
| | - Linda Liu
- University of Washington, Department of Medicine, Seattle, Washington, USA
| | | | - Adeyinka Adedipe
- University of Washington, Department of Emergency Medicine, Seattle, Washington, USA
| | - Ross Kessler
- University of Washington, Department of Emergency Medicine, Seattle, Washington, USA
| | - Amy Morris
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, Washington, USA
| | - Sara Nikravan
- University of Washington, Department of Anesthesiology and Pain Medicine, Seattle, Washington, USA
| | - Sula Mazimba
- University of Virginia, Division of Cardiovascular Medicine, Charlottesville, Virginia, USA
| | - Younghoon Kwon
- University of Washington, Division of Cardiology, Seattle, Washington, USA
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Morris A, Wu H, Morales C. Barriers to Care in Veterinary Services: Lessons Learned From Low-Income Pet Guardians' Experiences at Private Clinics and Hospitals During COVID-19. Front Vet Sci 2021; 8:764753. [PMID: 34746292 PMCID: PMC8564046 DOI: 10.3389/fvets.2021.764753] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/23/2021] [Indexed: 12/30/2022] Open
Abstract
This qualitative study aimed to explore the experiences of low-income pet guardians in accessing veterinary care during COVID-19. Participants were recruited through a purposive sampling method: 12 individuals who applied to and met the low-income threshold to access support for veterinary fees from the Vancouver Humane Society (VHS) were invited for semi-structured in-depth telephone interviews. Participants indicated that they experienced pandemic-related barriers related to and compounded by their low-income status. Their experiences fit into three categories: the barriers to accessing veterinary care pre-and peri-COVID-19, the emotional impact of compounding barriers related to accessing veterinary care during COVID-19, and the human-animal bond and resilience in the context of COVID-19. Drawing on the One Health, One Welfare approach, we argue that veterinary and animal services should evaluate and improve their support services, particularly programs developed for low-income pet guardians. Based on the participants' recommendations, we propose that veterinary and animal services prepare for future disaster situations by increasing their financial capacity to support people needing assistance, undergoing training to better work with people experiencing financial and emotional stress, and providing easily accessible resources to better distribute knowledge about animal needs and available financial assistance programming. The suggestions are intended to benefit animals, their guardians, and both veterinary and animal service sector workers.
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Affiliation(s)
- Amy Morris
- Vancouver Humane Society, Vancouver, BC, Canada
| | - Haorui Wu
- School of Social Work, Dalhousie University, Halifax, NS, Canada
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Jones C, Riley D, Morris A, Sen JM, Ferrari A, Humphrey J, VanHoose J, Schmidt N, Schlefman J, El Chaer FE, Keng MK. Reducing length of stay for patients with acute myeloid leukemia receiving inpatient high-dose cytarabine consolidation chemotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.257] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
257 Background: For patients receiving high dose cytarabine (HiDAC) at University of Virginia (UVA) Health between 10/2019 and 10/2020, median length of stay (LOS) from time of clinic appointment to hospital discharge was 119.35 hours. Standard treatment time should be 112 hours from premedication to end of chemotherapy. There are no national standards for duration of inpatient stay for planned chemotherapy, but only 50% of these patients were discharged after noon (over 3 hours post-chemotherapy completion). LOS that extends beyond the standard treatment time results in increased cost, overutilization of hospital resources, delayed admissions for future patients, and patient dissatisfaction. Methods: A multidisciplinary team comprised of licensed providers, pharmacists, and nurses was formed. The team focused on percentage of patients discharged by noon as a surrogate marker for LOS due to inconsistency of admission times; the aim was to increase patients discharged by noon to 65%. Reviewing the baseline data revealed an unstable process with a 3-sigma X-bar statistical process control chart. The team developed current and ideal process state maps, a Pareto chart, and a priority matrix to determine an action plan. The most common identified causes for delay in discharge included: lack of standardized discharge checklist, discharge order placed after 10 am, medications dispensed from the outpatient pharmacy after 11 am, licensed providers not prioritizing discharge patients, and medication reconciliation not completed prior to day of discharge. Results: From 10/2020 to 5/2021, the first PDSA cycle focused on standardizing the discharge process to correct the instability in the process. A discharge checklist was created based on the ideal process map, which allowed the providers to have a consistent process at discharge. 3-sigma Xbar chart demonstrated a now stable process and an increase of patients discharged by noon to 58%. During the second PDSA cycle starting in 6/2021, providers completed medication reconciliation the day before discharge, prioritized HiDAC discharges first during rounds, and ensured discharge orders were placed by completion of the last chemotherapy bag. Data collection is ongoing, and will be analyzed by August 2021. Future tests of change are planned to focus on the pharmacy medication delivery service. Hospital LOS has also decreased after the first PDSA cycle. Conclusions: Using quality improvement methodology, a multidisciplinary team developed an action plan for patients receiving HiDAC which to date has increased the percentage of patients discharging by noon and decreased length of stay. This outcome may lead to reduce hospitalization costs and increase bed availability for other oncology patients. Further PDSA cycles are scheduled and continuous evaluation of the process is ongoing.
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Affiliation(s)
| | | | - Amy Morris
- University of Virginia, Charlottesville, VA
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Vulfovich M, Salzberg MP, Louis-Jeune M, Pham K, King K, Jacques J, Lanier U, Morris A. Decreasing inpatient chemotherapy initiation delays at Memorial Regional Hospital. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.225] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
225 Background: Between June and December 2019, hematology-oncology patients admitted for elective chemotherapy at Memorial Regional Hospital had a median delay of 10 hours to initiate chemotherapy infusion from time of admission. This contributes to increased cost to the healthcare system and patient dissatisfaction. By September 2020, elective inpatient median time from admission to chemotherapy initiation at Memorial Regional Hospital will be reduced by 20%. Methods: Multidisciplinary team formed to evaluate the time from admission to initiation of chemotherapy for patients who are electively admitted for chemotherapy in 8 Central based on time stamps available in the electronic health records. Patients electively admitted by a non MCI oncologist were excluded. Data collections included time stamp between each process from admission to administration of 1st chemotherapy. Longest time lapse between each process was counted as an occurrence/contributor to delay. Top 80% contributors identified from Pareto chart allowed team to identify countermeasures. Priority Matrix of implementation in PDSA cycle based on highest impact and ease of implementation. Statistical process control chart was developed. Results: (see table). Conclusions: PDSA Cycle 1, obtaining labs 24-48 hours prior to admission, resulted in a 10% reduction in chemotherapy initiation time. PDSA Cycle 2, enhancing “ok to treat” communication, resulted in a further reduction of time to treatment. The combination of PDSA Cycle 1 & 2 resulted in a 40% reduction in time to chemotherapy initiation, exceeding the planned aim of 20%. Balance measures reflected no reduction in the mean number of overnight stays between baseline and PDSA Cycle 2 (4 nights) that could contribute to a decreased cost. Results and recommendations to adopt at all inpatient oncology departments within the healthcare system will be presented to leadership for support. Data automation through collaborative efforts with information technology is in process to assist with continuous monitoring. Future state, the quality improvement tools gained from ASCO QTP will be utilized to evaluate and improve workflow issues in the outpatient oncology setting. Nationally recognized organizations are encouraged to propose a benchmark for admission time to first chemotherapy administration based on the evaluation of current available data. Additional studies are needed to evaluate chemotherapy treatment delays in other settings.[Table: see text]
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Affiliation(s)
| | | | | | - Khang Pham
- Memorial Cancer Institute, Hollywood, FL
| | - Kelly King
- Memorial Cancer Institute, Hollywood, FL
| | | | | | - Amy Morris
- University of Virginia, Charlottesville, VA
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Wu H, Bains RS, Morris A, Morales C. Affordability, Feasibility, and Accessibility: Companion Animal Guardians with (Dis)Abilities' Access to Veterinary Medical and Behavioral Services during COVID-19. Animals (Basel) 2021; 11:ani11082359. [PMID: 34438816 PMCID: PMC8388706 DOI: 10.3390/ani11082359] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 06/17/2021] [Revised: 07/30/2021] [Accepted: 08/07/2021] [Indexed: 11/16/2022] Open
Abstract
The research aims to explore COVID-19 health and safety protocol impacts on companion animal guardians living with (dis)abilities relating to veterinary medical and behavioral service access. The COVID-19 global public health crisis has impacted almost all international communities; however, vulnerable and marginalized groups have been disproportionately affected. Within the human-companion animal domain, COVID-19-driven societal impacts (e.g., social, health, and economic) not only boomed with new companion animal guardians, but also negatively influenced guardians' access to veterinary services. Although studies have examined guardian-related COVID-19-specific challenges, there is a paucity of concentration on vulnerable populations, such as persons with disabilities (PWDs). Responding to this research deficit, this study recruited twelve companion animal guardians to participate in semi-structured in-depth interviews, and eight (67%) of the twelve participants self-identified as PWDs. From a PWD perspective, this research reveals three pandemic-triggered primary barriers, preventing PWDs from pursuing veterinary services: (1) service affordability, (2) assistance program feasibility, and (3) veterinary service accessibility. This article argues that PWD-driven approaches could improve existing assistance and support programs to address PWDs' unique requirements, promoting a healthy human-animal bond.
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Affiliation(s)
- Haorui Wu
- School of Social Work, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Natural Hazards Center, University of Colorado Boulder, Boulder, CO 80309, USA
- Correspondence: ; Tel.: +1-(902)-494-1188
| | | | - Amy Morris
- Vancouver Humane Society, Vancouver, BC V6P 5A2, Canada; (A.M.); (C.M.)
| | - Celeste Morales
- Vancouver Humane Society, Vancouver, BC V6P 5A2, Canada; (A.M.); (C.M.)
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36
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Chaarani B, Hahn S, Allgaier N, Adise S, Owens MM, Juliano AC, Yuan DK, Loso H, Ivanciu A, Albaugh MD, Dumas J, Mackey S, Laurent J, Ivanova M, Hagler DJ, Cornejo MD, Hatton S, Agrawal A, Aguinaldo L, Ahonen L, Aklin W, Anokhin AP, Arroyo J, Avenevoli S, Babcock D, Bagot K, Baker FC, Banich MT, Barch DM, Bartsch H, Baskin-Sommers A, Bjork JM, Blachman-Demner D, Bloch M, Bogdan R, Bookheimer SY, Breslin F, Brown S, Calabro FJ, Calhoun V, Casey BJ, Chang L, Clark DB, Cloak C, Constable RT, Constable K, Corley R, Cottler LB, Coxe S, Dagher RK, Dale AM, Dapretto M, Delcarmen-Wiggins R, Dick AS, Do EK, Dosenbach NUF, Dowling GJ, Edwards S, Ernst TM, Fair DA, Fan CC, Feczko E, Feldstein-Ewing SW, Florsheim P, Foxe JJ, Freedman EG, Friedman NP, Friedman-Hill S, Fuemmeler BF, Galvan A, Gee DG, Giedd J, Glantz M, Glaser P, Godino J, Gonzalez M, Gonzalez R, Grant S, Gray KM, Haist F, Harms MP, Hawes S, Heath AC, Heeringa S, Heitzeg MM, Hermosillo R, Herting MM, Hettema JM, Hewitt JK, Heyser C, Hoffman E, Howlett K, Huber RS, Huestis MA, Hyde LW, Iacono WG, Infante MA, Irfanoglu O, Isaiah A, Iyengar S, Jacobus J, James R, Jean-Francois B, Jernigan T, Karcher NR, Kaufman A, Kelley B, Kit B, Ksinan A, Kuperman J, Laird AR, Larson C, LeBlanc K, Lessov-Schlagger C, Lever N, Lewis DA, Lisdahl K, Little AR, Lopez M, Luciana M, Luna B, Madden PA, Maes HH, Makowski C, Marshall AT, Mason MJ, Matochik J, McCandliss BD, McGlade E, Montoya I, Morgan G, Morris A, Mulford C, Murray P, Nagel BJ, Neale MC, Neigh G, Nencka A, Noronha A, Nixon SJ, Palmer CE, Pariyadath V, Paulus MP, Pelham WE, Pfefferbaum D, Pierpaoli C, Prescot A, Prouty D, Puttler LI, Rajapaske N, Rapuano KM, Reeves G, Renshaw PF, Riedel MC, Rojas P, de la Rosa M, Rosenberg MD, Ross MJ, Sanchez M, Schirda C, Schloesser D, Schulenberg J, Sher KJ, Sheth C, Shilling PD, Simmons WK, Sowell ER, Speer N, Spittel M, Squeglia LM, Sripada C, Steinberg J, Striley C, Sutherland MT, Tanabe J, Tapert SF, Thompson W, Tomko RL, Uban KA, Vrieze S, Wade NE, Watts R, Weiss S, Wiens BA, Williams OD, Wilbur A, Wing D, Wolff-Hughes D, Yang R, Yurgelun-Todd DA, Zucker RA, Potter A, Garavan HP. Baseline brain function in the preadolescents of the ABCD Study. Nat Neurosci 2021; 24:1176-1186. [PMID: 34099922 PMCID: PMC8947197 DOI: 10.1038/s41593-021-00867-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/30/2021] [Indexed: 02/05/2023]
Abstract
The Adolescent Brain Cognitive Development (ABCD) Study® is a 10-year longitudinal study of children recruited at ages 9 and 10. A battery of neuroimaging tasks are administered biennially to track neurodevelopment and identify individual differences in brain function. This study reports activation patterns from functional MRI (fMRI) tasks completed at baseline, which were designed to measure cognitive impulse control with a stop signal task (SST; N = 5,547), reward anticipation and receipt with a monetary incentive delay (MID) task (N = 6,657) and working memory and emotion reactivity with an emotional N-back (EN-back) task (N = 6,009). Further, we report the spatial reproducibility of activation patterns by assessing between-group vertex/voxelwise correlations of blood oxygen level-dependent (BOLD) activation. Analyses reveal robust brain activations that are consistent with the published literature, vary across fMRI tasks/contrasts and slightly correlate with individual behavioral performance on the tasks. These results establish the preadolescent brain function baseline, guide interpretation of cross-sectional analyses and will enable the investigation of longitudinal changes during adolescent development.
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Affiliation(s)
- B Chaarani
- Department of Psychiatry, University of Vermont, Burlington, VT, USA.
| | - S Hahn
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - N Allgaier
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - S Adise
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - M M Owens
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - A C Juliano
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - D K Yuan
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - H Loso
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - A Ivanciu
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - M D Albaugh
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - J Dumas
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - S Mackey
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - J Laurent
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - M Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - D J Hagler
- University of California, San Diego, La Jolla, CA, USA
| | - M D Cornejo
- Institute of Physics UC, Pontificia Universidad Catolica de Chile, Pontificia, Chile
| | - S Hatton
- University of California, San Diego, La Jolla, CA, USA
| | - A Agrawal
- Department of Psychiatry, Washington University in Saint Louis, St. Louis, MO, USA
| | - L Aguinaldo
- University of California, San Diego, La Jolla, CA, USA
| | - L Ahonen
- University of Pittsburgh, Pittsburgh, PA, USA
| | - W Aklin
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - A P Anokhin
- Department of Psychiatry, Washington University in Saint Louis, St. Louis, MO, USA
| | - J Arroyo
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - S Avenevoli
- National Institute of Mental Health, Bethesda, MD, USA
| | - D Babcock
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - K Bagot
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - F C Baker
- SRI International, Menlo Park, CA, USA
| | - M T Banich
- University of Colorado, Boulder, CO, USA
| | - D M Barch
- Department of Psychiatry, Washington University in Saint Louis, St. Louis, MO, USA
| | - H Bartsch
- Haukeland University Hospital, Bergen, Norway
| | | | - J M Bjork
- Virginia Commonwealth University, Richmond, VA, USA
| | - D Blachman-Demner
- NIH Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
| | - M Bloch
- National Cancer Institute, Bethesda, MD, USA
| | - R Bogdan
- Department of Psychiatry, Washington University in Saint Louis, St. Louis, MO, USA
| | | | - F Breslin
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - S Brown
- University of California, San Diego, La Jolla, CA, USA
| | - F J Calabro
- University of Pittsburgh, Pittsburgh, PA, USA
| | - V Calhoun
- University of Colorado, Boulder, CO, USA
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | | | - L Chang
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - D B Clark
- University of Pittsburgh, Pittsburgh, PA, USA
| | - C Cloak
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - K Constable
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - R Corley
- University of Colorado, Boulder, CO, USA
| | | | - S Coxe
- Florida International University, Miami, FL, USA
| | - R K Dagher
- National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - A M Dale
- University of California, San Diego, La Jolla, CA, USA
| | - M Dapretto
- University of California, Los Angeles, CA, USA
| | | | - A S Dick
- Florida International University, Miami, FL, USA
| | - E K Do
- Virginia Commonwealth University, Richmond, VA, USA
| | - N U F Dosenbach
- Department of Psychiatry, Washington University in Saint Louis, St. Louis, MO, USA
| | - G J Dowling
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - S Edwards
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - T M Ernst
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - D A Fair
- Oregon Health & Science University, Portland, OR, USA
| | - C C Fan
- Department of Psychiatry, Washington University in Saint Louis, St. Louis, MO, USA
| | - E Feczko
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - J J Foxe
- University of Rochester, Rochester, NY, USA
| | | | | | | | | | - A Galvan
- University of California, Los Angeles, CA, USA
| | - D G Gee
- Yale University, New Haven, CT, USA
| | - J Giedd
- University of California, San Diego, La Jolla, CA, USA
| | - M Glantz
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - P Glaser
- Department of Psychiatry, Washington University in Saint Louis, St. Louis, MO, USA
| | - J Godino
- University of California, San Diego, La Jolla, CA, USA
| | - M Gonzalez
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - R Gonzalez
- Florida International University, Miami, FL, USA
| | - S Grant
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - K M Gray
- Medical University of South Carolina, Charleston, SC, USA
| | - F Haist
- University of California, San Diego, La Jolla, CA, USA
| | - M P Harms
- Department of Psychiatry, Washington University in Saint Louis, St. Louis, MO, USA
| | - S Hawes
- Florida International University, Miami, FL, USA
| | - A C Heath
- University of California, San Diego, La Jolla, CA, USA
| | - S Heeringa
- University of Michigan, Ann Arbor, MI, USA
| | | | - R Hermosillo
- Oregon Health & Science University, Portland, OR, USA
| | - M M Herting
- University of Southern California, Los Angeles, CA, USA
| | - J M Hettema
- Virginia Commonwealth University, Richmond, VA, USA
| | - J K Hewitt
- University of Colorado, Boulder, CO, USA
| | - C Heyser
- University of California, San Diego, La Jolla, CA, USA
| | - E Hoffman
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - K Howlett
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - R S Huber
- University of Utah, Salt Lake City, UT, USA
| | - M A Huestis
- Thomas Jefferson University, Philadelphia, PA, USA
| | - L W Hyde
- University of Michigan, Ann Arbor, MI, USA
| | - W G Iacono
- University of Minnesota, Minneapolis, MN, USA
| | - M A Infante
- University of California, San Diego, La Jolla, CA, USA
| | - O Irfanoglu
- National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - A Isaiah
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Iyengar
- National Endowment for the Arts, Washington DC, USA
| | - J Jacobus
- University of California, San Diego, La Jolla, CA, USA
| | - R James
- Virginia Commonwealth University, Richmond, VA, USA
| | - B Jean-Francois
- National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - T Jernigan
- University of California, San Diego, La Jolla, CA, USA
| | - N R Karcher
- Department of Psychiatry, Washington University in Saint Louis, St. Louis, MO, USA
| | - A Kaufman
- National Cancer Institute, Bethesda, MD, USA
| | - B Kelley
- National Institute of Justice, Washington DC, USA
| | - B Kit
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - A Ksinan
- Virginia Commonwealth University, Richmond, VA, USA
| | - J Kuperman
- University of California, San Diego, La Jolla, CA, USA
| | - A R Laird
- Florida International University, Miami, FL, USA
| | - C Larson
- University of Wisconsin, Milwaukee, WI, USA
| | - K LeBlanc
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - C Lessov-Schlagger
- Department of Psychiatry, Washington University in Saint Louis, St. Louis, MO, USA
| | - N Lever
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - D A Lewis
- University of Pittsburgh, Pittsburgh, PA, USA
| | - K Lisdahl
- University of Wisconsin, Milwaukee, WI, USA
| | - A R Little
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - M Lopez
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - M Luciana
- University of Minnesota, Minneapolis, MN, USA
| | - B Luna
- University of Pittsburgh, Pittsburgh, PA, USA
| | - P A Madden
- Department of Psychiatry, Washington University in Saint Louis, St. Louis, MO, USA
| | - H H Maes
- Virginia Commonwealth University, Richmond, VA, USA
| | - C Makowski
- University of California, San Diego, La Jolla, CA, USA
| | - A T Marshall
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - M J Mason
- University of Tennessee, Knoxville, TN, USA
| | - J Matochik
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | | | - E McGlade
- University of Utah, Salt Lake City, UT, USA
| | - I Montoya
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - G Morgan
- National Cancer Institute, Bethesda, MD, USA
| | - A Morris
- Oklahoma State University, Stillwater, OK, USA
| | - C Mulford
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - P Murray
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - B J Nagel
- Oregon Health & Science University, Portland, OR, USA
| | - M C Neale
- Virginia Commonwealth University, Richmond, VA, USA
| | - G Neigh
- Virginia Commonwealth University, Richmond, VA, USA
| | - A Nencka
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - A Noronha
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - S J Nixon
- University of Florida, Gainesville, FL, USA
| | - C E Palmer
- University of California, San Diego, La Jolla, CA, USA
| | - V Pariyadath
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - M P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - W E Pelham
- Florida International University, Miami, FL, USA
| | | | - C Pierpaoli
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - A Prescot
- University of Utah, Salt Lake City, UT, USA
| | - D Prouty
- SRI International, Menlo Park, CA, USA
| | | | - N Rajapaske
- National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | | | - G Reeves
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - M C Riedel
- Florida International University, Miami, FL, USA
| | - P Rojas
- Florida International University, Miami, FL, USA
| | - M de la Rosa
- Florida International University, Miami, FL, USA
| | | | - M J Ross
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - M Sanchez
- Florida International University, Miami, FL, USA
| | - C Schirda
- University of Pittsburgh, Pittsburgh, PA, USA
| | - D Schloesser
- NIH Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
| | | | - K J Sher
- University of Missouri, Columbia, MO, USA
| | - C Sheth
- University of Utah, Salt Lake City, UT, USA
| | - P D Shilling
- University of California, San Diego, La Jolla, CA, USA
| | - W K Simmons
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - E R Sowell
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - N Speer
- University of Colorado, Boulder, CO, USA
| | - M Spittel
- NIH Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
| | - L M Squeglia
- Medical University of South Carolina, Charleston, SC, USA
| | - C Sripada
- University of Michigan, Ann Arbor, MI, USA
| | - J Steinberg
- Virginia Commonwealth University, Richmond, VA, USA
| | - C Striley
- University of Florida, Gainesville, FL, USA
| | | | - J Tanabe
- University of Colorado, Boulder, CO, USA
| | - S F Tapert
- University of California, San Diego, La Jolla, CA, USA
| | - W Thompson
- University of California, San Diego, La Jolla, CA, USA
| | - R L Tomko
- Medical University of South Carolina, Charleston, SC, USA
| | - K A Uban
- University of California, Irvine, CA, USA
| | - S Vrieze
- University of Minnesota, Minneapolis, MN, USA
| | - N E Wade
- University of California, San Diego, La Jolla, CA, USA
| | - R Watts
- Yale University, New Haven, CT, USA
| | - S Weiss
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - B A Wiens
- University of Florida, Gainesville, FL, USA
| | - O D Williams
- Florida International University, Miami, FL, USA
| | - A Wilbur
- SRI International, Menlo Park, CA, USA
| | - D Wing
- University of California, San Diego, La Jolla, CA, USA
| | - D Wolff-Hughes
- NIH Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
| | - R Yang
- University of California, San Diego, La Jolla, CA, USA
| | | | - R A Zucker
- University of Michigan, Ann Arbor, MI, USA
| | - A Potter
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - H P Garavan
- Department of Psychiatry, University of Vermont, Burlington, VT, USA.
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Courville EL, Shantzer L, Vitzthum von Eckstaedt HC, Mellot H, Keng M, Sen J, Morris A, Williams E, El Chaer F. Variant Acute Promyelocytic Leukemia Presenting Without Auer Rods Highlights the Need for Correlation with Cytogenetic Data in Leukemia Diagnosis. Lab Med 2021; 53:95-99. [PMID: 34268555 DOI: 10.1093/labmed/lmab051] [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] [Indexed: 11/13/2022] Open
Abstract
Variant acute promyelocytic leukemia (vAPL) is a rare leukemia characterized by rearrangement between RARα and a non-PML partner gene. This type of leukemia can be difficult to recognize by histomorphologic evaluation, particularly in patients with few or no Auer rods, and by flow cytometry, but it can be identified by distinct cytogenetic features. Herein, we report on a patient with vAPL with t(11;17)(q23;q21) who presented an initial diagnostic challenge. Detailed flow cytometry findings are presented for this rare entity. Our case study also presents novel treatment (chemotherapy in combination with venetoclax) chosen based on mechanistic data from preclinical studies.
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Affiliation(s)
- Elizabeth L Courville
- Department of Pathology, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Lindsey Shantzer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | | | - Holly Mellot
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Michael Keng
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Jeremy Sen
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Amy Morris
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Eli Williams
- Department of Pathology, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
| | - Firas El Chaer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, US
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Kelly CP, Murray JA, Leffler DA, Getts DR, Bledsoe AC, Smithson G, First MR, Morris A, Boyne M, Elhofy A, Wu TT, Podojil JR, Miller SD. TAK-101 Nanoparticles Induce Gluten-Specific Tolerance in Celiac Disease: A Randomized, Double-Blind, Placebo-Controlled Study. Gastroenterology 2021; 161:66-80.e8. [PMID: 33722583 PMCID: PMC9053078 DOI: 10.1053/j.gastro.2021.03.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS In celiac disease (CeD), gluten induces immune activation, leading to enteropathy. TAK-101, gluten protein (gliadin) encapsulated in negatively charged poly(dl-lactide-co-glycolic acid) nanoparticles, is designed to induce gluten-specific tolerance. METHODS TAK-101 was evaluated in phase 1 dose escalation safety and phase 2a double-blind, randomized, placebo-controlled studies. Primary endpoints included pharmacokinetics, safety, and tolerability of TAK-101 (phase 1) and change from baseline in circulating gliadin-specific interferon-γ-producing cells at day 6 of gluten challenge, in patients with CeD (phase 2a). Secondary endpoints in the phase 2a study included changes from baseline in enteropathy (villus height to crypt depth ratio [Vh:Cd]), and frequency of intestinal intraepithelial lymphocytes and peripheral gut-homing T cells. RESULTS In phase 2a, 33 randomized patients completed the 14-day gluten challenge. TAK-101 induced an 88% reduction in change from baseline in interferon-γ spot-forming units vs placebo (2.01 vs 17.58, P = .006). Vh:Cd deteriorated in the placebo group (-0.63, P = .002), but not in the TAK-101 group (-0.18, P = .110), although the intergroup change from baseline was not significant (P = .08). Intraepithelial lymphocyte numbers remained equal. TAK-101 reduced changes in circulating α4β7+CD4+ (0.26 vs 1.05, P = .032), αEβ7+CD8+ (0.69 vs 3.64, P = .003), and γδ (0.15 vs 1.59, P = .010) effector memory T cells. TAK-101 (up to 8 mg/kg) induced no clinically meaningful changes in vital signs or routine clinical laboratory evaluations. No serious adverse events occurred. CONCLUSIONS TAK-101 was well tolerated and prevented gluten-induced immune activation in CeD. The findings from the present clinical trial suggest that antigen-specific tolerance was induced and represent a novel approach translatable to other immune-mediated diseases. ClinicalTrials.gov identifiers: NCT03486990 and NCT03738475.
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Affiliation(s)
- Ciarán P. Kelly
- Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Daniel A. Leffler
- Beth Israel Deaconess Medical Center, Harvard Medical School Celiac Research Program, Boston, Massachusetts;,Takeda Pharmaceuticals International Co., Cambridge, Massachusetts
| | - Daniel R. Getts
- COUR Pharmaceuticals Development Co, Inc, Northbrook, Illinois;,Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Adam C. Bledsoe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Glennda Smithson
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts
| | - M. Roy First
- COUR Pharmaceuticals Development Co, Inc, Northbrook, Illinois
| | - Amy Morris
- COUR Pharmaceuticals Development Co, Inc, Northbrook, Illinois
| | - Michael Boyne
- COUR Pharmaceuticals Development Co, Inc, Northbrook, Illinois
| | - Adam Elhofy
- COUR Pharmaceuticals Development Co, Inc, Northbrook, Illinois
| | - Tsung-Teh Wu
- Department of Pathology, Mayo Clinic, Rochester, Minnesota
| | - Joseph R. Podojil
- COUR Pharmaceuticals Development Co, Inc, Northbrook, Illinois;,Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stephen D. Miller
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Tordoff M, Smith S, Lopez Isac E, Morris A, Eyre S, Thomson W, Bowes J. OP0014 HLA ASSOCIATIONS IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS ASSOCIATED UVEITIS AND CLINICAL SUBTYPES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Juvenile idiopathic arthritis (JIA) is a childhood onset rheumatic disease which is classified into seven different clinical subtypes based upon the ILAR classification criteria. The most common extra articular manifestation of JIA is its associated uveitis (JIAU); particularly chronic anterior uveitis (CAU). Uveitis is a serious complication with the potential to lead to visual impairment and blindness. The rheumatoid factor negative polyarthritis and oligoarthritis ILAR subtypes, often referred to as the “polygo” subgroup, are at a higher risk for developing JIAU, with up to 30% of polygos afflicted by CAU. The HLA region has long been reported as a genetic risk factor for JIA susceptibility, with evidence suggesting that different amino acids of HLA genes infer risk to different JIA subtypes.Objectives:Investigate the association of amino acids and genetic variants in the HLA region with susceptibility to JIAU and the ILAR clinical subtypes.Methods:Samples were genotyped using the Illumina Infinium CoreExome and Infinium Onmiexpress arrays. Samples were excluded based on <98% call rate, discrepancy between genetically inferred sex and database records, inferred relatedness (identify-by-descent) and ancestral outliers based on principal component analysis (PCA). SNPs were excluded based on <0.01 minor allele frequency (MAF), and call rate <98%. SNP2HLA was used to impute HLA amino acids, SNPs and alleles. Analysis was then executed on markers with an information score >0.9 and MAF >.01 using logistic regression or an omnibus test for multiallelic markers, including 3 PCs as covariates. Independent associations were identified using forward stepwise logistic regression including previously identified variants as covariates. Comparison of regression models was performed using a likelihood ratio test (LRT).Results:We analysed 7425 markers within the HLA region in 450 JIAU and 2024 JIA cases without uveitis. The most significant association was to amino acid positions 13 of HLA-DRB1 (p=2.9×10-30). Conditional analysis on DRB1 position 13 revealed an independent signal at DRB1 position 67 (p=2.4×10-6). Conditioning on all DRB1 alleles revealed an independent signal at HLA-DPB1 position 69 (p=5.3×10-7). As expected, ILAR subtype was found to be associated with JIAU (p=1.58×10-6). We used LRT to test if genetics provided further information above ILAR subtype alone and found that including residues at DRB1 position 13 significantly improved the fit of a model based on ILAR subtype alone (LRT p = 3.6×10-27). The reciprocal analysis, adding ILAR subtype to a model based on DRB1 position 13 alone, did not significantly improve the fit of a model (LRT p=0.83). Exploring associations in the polygo subgroup (n=1646) we found significant associations to the three previously described amino acids and JIAU (DRB1 position 13 p=3.4×10-20, DRB1 position 67 p=3.3×10-4, DPB1 position 69 p=2.2×10-6).Conclusion:This is largest analysis of HLA markers in JIAU patients to date and we identify two independent associations to amino acids in HLA-DRB1 and a further independent association to HLA-DPB1. This analysis demonstrates that including data on genetic risk factors adds further information to that captured by ILAR subtype alone. It also reveals that the previously validated associations at position 13 of HLA-DRB1 are also correlated with JIAU in the polygo subtype suggesting that genetic risk factors will help refine risk within clinical subtypes. Conditioning on DRB1 alleles reveals that the secondary independent DRB1 position 69 association is also strongly associated in the polygo subset of this cohort. Together these results highlight the potential future use of genetics risk factors for risk classification for uveitis in patients with JIADisclosure of Interests:None declared
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Kaul V, Morris A, Chae JM, Town JA, Kelly WF. Delivering a Novel Medical Education "Escape Room" at a National Scientific Conference: First Live, Then Pivoting to Remote Learning Because of COVID-19. Chest 2021; 160:1424-1432. [PMID: 34029564 PMCID: PMC8457933 DOI: 10.1016/j.chest.2021.04.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Received: 02/18/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022] Open
Abstract
Escape Rooms are gaining prominence as education modalities; the use of principles of game design have been shown to augment knowledge acquisition in a fun, team-based learning experience ("edutainment"). In this report, we outline some of the medical literature and then provide our step-by-step approach and lessons learned when building what was, to our knowledge, the first continuing medical education Escape Room at a national scientific meeting. We then comment on how this innovative educational offering was reimagined the following year for remote (virtual) learning because of the COVID-19 pandemic.
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Affiliation(s)
- Viren Kaul
- Crouse Health/SUNY Upstate Medical University, Syracuse, NY
| | | | | | | | - William F Kelly
- Uniformed Services University of the Health Sciences, Bethesda, MD.
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Alexy T, Morris A, Flattery M, Ortega-Legaspi J, Devore A, Shah P, Sinha S, Cole R. Universal CMV Prophylaxis Mitigates the Risks of Basiliximab Induction in Heart Transplant Recipients at Intermediate Risk (R+) for Post-Transplant CMV Complications. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.372] [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: 10/21/2022] Open
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Morris A, Flattery M, Ortega-Legaspi J, Devore A, Alexy T, Shah P, Nair K, Cole R. The Risk of Leukopenia with Universal vs. Preemptive Prophylaxis Strategies in Heart Transplant Recipients at Intermediate Risk for CMV Complications. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.371] [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: 11/17/2022] Open
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Hood C, Morris A, Corrado O, Swanson E, Bourke L, Crawford M, Quirk A, Doxford H. 116 Impact of COVID 19 Pandemic on Hospital Care For People with Dementia—Feedback From Hospital Leads and Carers. Age Ageing 2021. [PMCID: PMC7989599 DOI: 10.1093/ageing/afab030.77] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction The National Audit of Dementia (NAD) is funded by the Healthcare Quality Improvement Partnership to collect data from acute general hospital in England and Wales. In June 2020 NAD circulated optional surveys to leads for dementia in acute hospitals and carers asking about the impact of the pandemic on the organisation and provision of hospital care. Methods Anonymous survey links were sent to hospital dementia leads directly and circulated to carers of people with dementia via social media and representative organisations. Dementia Leads’ questions included whether they and/or their team had been redeployed during the pandemic and whether wards had access to specialist services. Carers’ questions included whether patients’ needs were discussed, whether they were permitted to visit/how this was communicated, any measures to facilitate communication with their loved ones, and whether they were updated about progress and discharge. Results 53 dementia hospital leads completed the questionnaire. 32% had been redeployed to other clinical areas during the pandemic, 45% said the same for members of the dementia team. Specialist support for people with dementia on both Covid and Non-Covid wards was significantly compromised. 32 carers completed the questionnaire. 48% were not asked about the needs of the patient they cared for, 90% not allowed to visit, 43% were not given any explanation about visiting and 48% not given support to keep in touch with their loved one. Conclusions Clinical priorities inevitably meant redeployment of dementia specialist staff, and changes to visiting. However, continuation of specialist support is a requirement for people with dementia admitted to hospital. Liaison with carers/families must be a priority, including facilitating remote support. Hospitals should take note of NHS guidance permitting carer visits to support a person with dementia experiencing distress.
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Affiliation(s)
- C Hood
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - A Morris
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - O Corrado
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - E Swanson
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - L Bourke
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - M Crawford
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - A Quirk
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - H Doxford
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
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Kechagioglou P, Bowler M, Morris A. Advanced Radiotherapy Techniques and the Role of Knowledge Reinforcement in Their Adoption Across a Healthcare System. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2556] [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: 10/23/2022]
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Mackler ER, Morris A, Carro GW, Guerrier V, Cunningham G, Gilmore T, Keng MK. Organizational partnership to expand the ASCO Quality Training Program to oncology pharmacists. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.198] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
198 Background: Pharmacists have a recognized role in optimizing medication management and enhancing patient quality of care. In an effort to enhance knowledge related to oncology quality improvement (QI), the Hematology/Oncology Pharmacy Association (HOPA) partnered with the American Society of Clinical Oncology (ASCO) Quality Training Program (QTP) to provide a 1-day HOPA-ASCO QTP Workshop. Methods: HOPA’s Quality Oversight Committee identified several areas of priority focus, including identifying and developing opportunities for members to participate in education focused on oncology value and quality-based patient care. The ASCO QTP program most closely met HOPA goals for training due to the practical outcomes associated with the program, the interdisciplinary focus, the successful experience of prior HOPA-member participants, and expertise of the faculty. In addition, both organizations have a unified goal in improving the care of cancer patients. Surveys were formulated to assess knowledge pre- and post-participation and actionable efforts participants made given knowledge gained from the workshop. Results: A total of 24 HOPA members participated in the 1-day workshop with 40% having been in oncology practice for 15+ years and 70% involved in some aspect of QI within their role. Primary reasons for participation were – to help lead oncology multidisciplinary initiatives in my organization (44%), to increase skills to complete QI projects (28%), and to help lead oncology pharmacy practitioners in my organization (20%). Measures of knowledge and competence increased after participation. Knowledge increased by an average of 3 points from 4.57 to 7.55 (0-10 scale) and competence increased an average of 2.8 points from 4.48 to 7.32. In a 3-month follow-up survey (67% response rate), the majority (93%) of participants indicated they were very likely or extremely likely to use the skills gained from the workshop in practice and 88% of respondents indicated they used the skills gained from the program somewhat often, very often or extremely often. Since the 9 months from the workshop, 2 pharmacists who participated have enrolled in the ASCO QTP 6-month course. Conclusions: The 1-day HOPA-ASCO QTP Workshop proved to be a successful partnership between the two organizations, providing excellent training and education to HOPA members. Next steps of this collaboration include additional 1-day workshops available to more members and a modified 6-month ASCO QTP program for HOPA members with oncology pharmacists serving as the interdisciplinary team leader.
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Affiliation(s)
| | - Amy Morris
- University of Virginia, Charlottesville, VA
| | | | | | | | - Terry Gilmore
- American Society of Clinical Oncology, Alexandria, VA
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Vieira C, Morris A, Erlich S, Durham M, Feinberg E. Development of a Facilitated Cross‐Agency Mentoring Strategy to Support Scale‐up and Spread of a Pediatric Behavioral Health Integration Model. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- C. Vieira
- Boston Medical Center Boston MA United States
| | - A. Morris
- Boston Medical Center Boston MA United States
| | - S. Erlich
- Boston Medical Center Boston MA United States
| | - M. Durham
- Boston Medical Center Boston MA United States
- Boston University School of Medicine Boston MA United States
| | - E. Feinberg
- Boston University School of Medicine Boston MA United States
- Boston University School of Public Health Boston MA United States
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Vusse LV, Shepherd A, Bergam B, Andros J, Morris A. Procedure Training Workshop for Internal Medicine Residents that Emphasizes Procedural Ultrasound: Logistics and Teaching Materials. MedEdPORTAL 2020; 16:10897. [PMID: 32656318 PMCID: PMC7331964 DOI: 10.15766/mep_2374-8265.10897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/25/2019] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Early formal instruction in procedural skills may increase the frequency with which residents perform procedures in the clinical setting. This workshop trained internal medicine residents in ultrasound skills and manual skills required to perform procedures common on medicine wards and required for board eligibility. METHODS Since 2016, our internal medicine residency program has executed three annual half-day workshops for interns during orientation, before clinical duties began. Prior to the workshop, we directed interns to relevant educational resources in the form of online modules and videos. At the workshop, trainees rotated in small groups through facilitated stations to learn basics of procedural ultrasound and to practice manual tasks performed during paracentesis, thoracentesis, lumbar puncture, and peripheral intravenous catheter placement. We administered questionnaires before and immediately after the workshop and used Wilcoxon signed rank tests to compare self-assessed independence and confidence. RESULTS Two hundred four interns with little prior procedural training participated in the workshop. Most participants (85%) indicated that orientation was the best timing for this training experience when compared to later options. Confidence and independence increased for ultrasound-marked thoracentesis, paracentesis, and peripheral intravenous catheters and for lumbar puncture without ultrasound. DISCUSSION This internal medicine intern orientation workshop on procedures and procedural ultrasound was well received and increased participants' confidence and sense of independence. This publication contains materials needed to reproduce the training experience.
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Affiliation(s)
- Lisa Vande Vusse
- Assistant Professor, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington; Associate Program Director, Internal Medicine Residency Program, University of Washington
- Corresponding author:
| | - Amanda Shepherd
- Assistant Professor, Department of Medicine, Division of General Internal Medicine, University of Washington
| | - Brittany Bergam
- Program Operations Specialist, Department of Medicine, University of Washington
| | - Justin Andros
- Scientific Instructional Technician, WWAMI Institute for Simulation in Healthcare, University of Washington
| | - Amy Morris
- Associate Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington
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Hemingway H, Lyons R, Li Q, Buchan I, Ainsworth J, Pell J, Morris A. A national initiative in data science for health: an evaluation of the UK Farr Institute. Int J Popul Data Sci 2020; 5:1128. [PMID: 32935051 PMCID: PMC7480324 DOI: 10.23889/ijpds.v5i1.1128] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the extent to which the inter-institutional, inter-disciplinary mobilisation of data and skills in the Farr Institute contributed to establishing the emerging field of data science for health in the UK. DESIGN AND OUTCOME MEASURES We evaluated evidence of six domains characterising a new field of science:defining central scientific challenges,demonstrating how the central challenges might be solved,creating novel interactions among groups of scientists,training new types of experts,re-organising universities,demonstrating impacts in society.We carried out citation, network and time trend analyses of publications, and a narrative review of infrastructure, methods and tools. SETTING Four UK centres in London, North England, Scotland and Wales (23 university partners), 2013-2018. RESULTS 1. The Farr Institute helped define a central scientific challenge publishing a research corpus, demonstrating insights from electronic health record (EHR) and administrative data at each stage of the translational cycle in 593 papers with at least one Farr Institute author affiliation on PubMed. 2. The Farr Institute offered some demonstrations of how these scientific challenges might be solved: it established the first four ISO27001 certified trusted research environments in the UK, and approved more than 1000 research users, published on 102 unique EHR and administrative data sources, although there was no clear evidence of an increase in novel, sustained record linkages. The Farr Institute established open platforms for the EHR phenotyping algorithms and validations (>70 diseases, CALIBER). Sample sizes showed some evidence of increase but remained less than 10% of the UK population in primary care-hospital care linked studies. 3.The Farr Institute created novel interactions among researchers: the co-author publication network expanded from 944 unique co-authors (based on 67 publications in the first 30 months) to 3839 unique co-authors (545 papers in the final 30 months). 4. Training expanded substantially with 3 new masters courses, training >400 people at masters, short-course and leadership level and 48 PhD students. 5. Universities reorganised with 4/5 Centres established 27 new faculty (tenured) positions, 3 new university institutes. 6. Emerging evidence of impacts included: > 3200 citations for the 10 most cited papers and Farr research informed eight practice-changing clinical guidelines and policies relevant to the health of millions of UK citizens. CONCLUSION The Farr Institute played a major role in establishing and growing the field of data science for health in the UK, with some initial evidence of benefits for health and healthcare. The Farr Institute has now expanded into Health Data Research (HDR) UK but key challenges remain including, how to network such activities internationally.
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Affiliation(s)
- H Hemingway
- HDR UK London
- UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA
| | - R Lyons
- HDRUK Wales/Northern Ireland
- Swansea University Medical School, Fourth Floor, Data Science Building, Singleton Campus, Swansea, SA2 8PP
| | - Q Li
- UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA
- West China Hospital, Chengdu, China
| | - I Buchan
- University of Liverpool, Liverpool L69 3BX
| | - J Ainsworth
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Oxford Rd, Manchester M13 9PL
| | - J Pell
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ
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Jaffar S, Gelovani D, Jeakle W, Bacyinski A, Chagas C, Morris A. Abstract No. 466 Targeted case presentations introducing interventional radiology to medical students interested in primary care specialties. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.527] [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: 10/25/2022] Open
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Wiles PG, Gray IK, Kissling RC, Delahanty C, Evers J, Greenwood K, Grimshaw K, Hibbert M, Kelly K, Luckin H, McGregor K, Morris A, Petersen M, Ross F, Valli M. Routine Analysis of Proteins by Kjeldahl and Dumas Methods: Review and Interlaboratory Study Using Dairy Products. J AOAC Int 2020. [DOI: 10.1093/jaoac/81.3.620] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
abstract
The Kjeldahl and Dumas (combustion) methods were compared in 11 laboratories analyzing samples of milk, skim milk powder, whole milk powder, whey protein concentrate, infant formula, casein, caseinate, 2 reference compounds (glycine and EDTA), and a secondary reference skim milk powder. The comparison was conducted by using international standards where applicable. Overall means were 8.818 g N/100 g by the Kjeldahl method and 8.810 g N/100 g by the Dumas method. No evidence was found for a consistent bias between methods that may be of concern in the trading of dairy produce. A review of more than 10 related trials revealed a lack of consensus in the bias between the 2 methods, suggesting that differences in methodology and sources of systematic error may be contributors. For samples containing >2 g N/100 g, the Dumas relative repeatability and reproducibility standard deviations were consistently about 0.35 and 0.75%, respectively, whereas the corresponding Kjeldahl values declined generally with N content and were significantly larger. The Dumas precision characteristics may be due to the dominance of Leco analyzers in this trials, and in most other recent trials, rather than an inherent method attribute. Protein determination methods for dairy products need to be reviewed and updated. The Dumas method needs Codex Alimentarius status as a recognized test method.
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Affiliation(s)
- Peter G Wiles
- New Zealand Dairy Research Institute, Private Bag 11 029, Palmerston North, New Zealand
| | - Ian K Gray
- New Zealand Dairy Research Institute, Private Bag 11 029, Palmerston North, New Zealand
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