1
|
Kapur A, Aalami Harandi A, Hartman-Kenzler J, Kim J. Shifts in patient preference of third-line overactive bladder therapy after introduction of the implantable tibial nerve stimulator. Neurourol Urodyn 2024; 43:959-966. [PMID: 38390786 DOI: 10.1002/nau.25421] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/27/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Third-line therapies for overactive bladder (OAB) that are currently recommended include intravesical Onabotulinumtoxin-A injections (BTX-A), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM). The implantable tibial nerve stimulator (ITNS) is a novel therapy that is now available to patients with OAB. OBJECTIVE The objective of this study was to analyze shifts in patient preference of third-line therapies for OAB after introducing ITNS as an option among the previously established therapies for non-neurogenic OAB. METHODS A survey was designed and distributed via SurveyMonkey to the platform's audience of U.S. adults of age 18 and older. Screening questions were asked to include only subjects who reported symptoms of OAB. Descriptions of current AUA/SUFU guideline-approved third-line therapies (BTX-A, PTNS, and SNM) were provided, and participants were asked to rank these therapies in order of preference (stage A). Subsequently, ITNS was introduced with a description, and participants were then asked to rank their preferences amongst current guideline-approved therapies and ITNS (stage B). Absolute and relative changes in therapy preferences between stage A and stage B were calculated. Associations between ultimate therapy choice in stage B and participant characteristics were analyzed. RESULTS A total of 485 participants completed the survey (62.5% female). The mean age was 49.1 ± 36.5 years (SD). The most common OAB symptoms reported were urgency urinary incontinence (UUI) (73.0%) and urinary urgency (68.0%). 29.2% of patients had tried medication for OAB in the past, and 8.0%-10.3% of patients were previously treated with a third-line therapy for OAB. In stage A, participants ranked their first choice of third-line therapy as follows: 28% BTX-A, 27% PTNS, and 13.8% SNM. 26.6% of participants chose no therapy, and 4.5% chose all three equally. In stage B, participants ranked their first choice as follows: 27.6% BTX-A, 19.2% PTNS, 7.8% SNM, and 19.2% ITNS. 21.9% of participants chose no therapy and 4.3% chose all four equally as their first choice. There were both absolute and relative declines in proportions of patients interested in BTX-A, SNM, and PTNS as their first choice of third-line therapy with the introduction of ITNS. Patients originally interested in PTNS in stage A had the greatest absolute change after the introduction of ITNS with 7.8% of participants opting for ITNS in stage B. Those interested in SNM in stage A had the largest relative change in interest, with 43.5% of those originally interested in SNM opting for ITNS in stage B. Finally, with the introduction of ITNS, the number of participants initially not interested in any third-line therapy declined by an absolute change of 4.7% and relative change of 17.6%. Participants experiencing concurrent stress urinary incontinence (SUI) symptoms were more likely to choose a current guideline-approved third-line therapy than ITNS or no therapy at all (p = 0.047). Those who had prior experience with third-line therapies were more likely to choose a third-line therapy other than ITNS as their ultimate choice of therapy in stage B. Of those who had chosen a guideline-approved third-line therapy in stage B (not ITNS), 13.6% had prior experience with BTX-A, 14.7% with PTNS, and 32 (11.2%) with SNM (p < 0.001, p < 0.001, p = 0.009, respectively). CONCLUSION From our study, it appears that ITNS may attract a subset of patients who would not have otherwise pursued current guideline-approved third-line therapies for OAB. When patients are provided with descriptions of third-line OAB therapies including ITNS as an option, ITNS appears to compete with SNM and PTNS. It is possible that ITNS will provide patients with a different phenotype of neuromodulation therapy that can appeal to a niche OAB population. Given that ITNS devices have been introduced relatively recently to the market, their application will largely depend on cost and payer coverage, provider bias, and patient comorbidities. Further study is needed to understand how these factors interact with and influence patient preference of advanced OAB therapy to understand which patients will most benefit from this treatment modality.
Collapse
Affiliation(s)
- Anjali Kapur
- Department of Urology, Stony Brook Medicine, Stony Brook, New York, USA
| | | | | | - Jason Kim
- Department of Urology, Stony Brook Medicine, Stony Brook, New York, USA
| |
Collapse
|
2
|
Tchelebi L, Kapur A, Chou H, Potters L. Improving Radiation Quality Through the Implementation of Prospective Peer Review. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1738] [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: 11/25/2022]
|
3
|
Kapur A, Harandi AA, Cohen T, Ruan H, Dabrowski C, Anderson R, Hwang K, Lee E, Weissbart S, Kim J. An analysis of factors that influence patient preference of third‐line therapy for overactive bladder. Neurourol Urodyn 2022; 41:1906-1913. [DOI: 10.1002/nau.25046] [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] [Received: 07/13/2022] [Revised: 08/17/2022] [Accepted: 09/01/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Anjali Kapur
- Department of Urology Stony Brook University Medical Center Stony Brook New York USA
| | | | - Tal Cohen
- The New York Institute of Technology College of Osteopathic Medicine Glen Head New York USA
| | - Heng Ruan
- Department of Urology Stony Brook University Medical Center Stony Brook New York USA
| | - Colin Dabrowski
- Staten Island University Hospital Staten Island New York USA
| | - Rebecca Anderson
- Department of Surgery, Urology Division, Rutgers New Jersey Medical School Newark New Jersey USA
| | - Kuemin Hwang
- Department of Urology, Houston Methodist Hospital Houston Texas USA
| | - Edwin Lee
- Renaissance School of Medicine at Stony Brook University Stony Brook New York USA
| | - Steven Weissbart
- Department of Urology Stony Brook University Medical Center Stony Brook New York USA
| | - Jason Kim
- Department of Urology Stony Brook University Medical Center Stony Brook New York USA
| |
Collapse
|
4
|
Chen A, Kapur A, Mossack S, Weissbart SJ, Kim JM. Initial experience using the Axonics sacral neuromodulation system in patients with multiple sclerosis. Neurourol Urodyn 2022; 41:1373-1379. [PMID: 35579263 DOI: 10.1002/nau.24955] [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: 11/01/2021] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) is third-line therapy approved for urge urinary incontinence (UUI) and urgency, and nonobstructive urinary retention. Multiple sclerosis (MS) patients often suffer from neurogenic lower urinary tract dysfunction (NLUTD). The utility of SNM in the MS population is limited by magnetic resonance imaging (MRI) incompatibility as routine MRIs to evaluate for disease progression are required. The Axonics System is the first Food and Drug Administration-approved SNM device that is 1.5/3 T full-body MRI-conditionally safe. This study seeks to investigate the symptomatic improvement in MS patients after implantation of the Axonics System. METHODS All MS patients who elected for Axonics SNM from December 2019 to January 2021 were included. Demographics and scores were queried for urogenital distress inventory (UDI-6), incontinence impact questionnaire (IIQ-7), and global response assessment (GRA). RESULTS Fifteen MS patients with UUI were included. The time to follow-up averaged 121 days. On UDI-6, 12 patients reported improvement, 1 worsening, and 2 no change. Average UDI-6 scores before and after implantation were 56.6 and 25.2 (p < 0.0001). Improvements were significant for all questions under stress urinary incontinence, UUI, and voiding difficulty subcategories. On IIQ-7, 14 patients reported improvement and 1 reported worsening. Average IIQ-7 scores before and after implantation were 59.0 and 22.2 (p < 0.001). Improvements were significant for travel, social, and emotional subcategories, but not for physical activity. The average GRA score was 6 ("moderately improved"). CONCLUSION The majority of MS patients reported significant initial improvement in UUI and associated quality of life measures on validated questionnaires after implantation of the Axonics System. Future studies are needed to determine the long-term outcomes and durability of this MRI full-body conditionally-safe system.
Collapse
Affiliation(s)
- Annie Chen
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Anjali Kapur
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Spencer Mossack
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Steven J Weissbart
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Jason M Kim
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
| |
Collapse
|
5
|
Kumar A, Goyal A, Gauba K, Kapur A, Singh SK, Mehta SK. An evaluation of remineralised MIH using CPP-ACP and fluoride varnish: An in-situ and in-vitro study. Eur Arch Paediatr Dent 2022; 23:79-87. [PMID: 34057698 DOI: 10.1007/s40368-021-00630-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/12/2020] [Accepted: 05/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Molar incisor hypomineralization (MIH) affected teeth have enamel with altered mineral content like decreased calcium and phosphorus and increased carbon content leading to porous enamel and subsequent post-eruptive breakdown. AIM An in situ study was conducted to evaluate and compare the effects of a Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP)-based cream and fluoride varnish on the remineralization of MIH affected teeth. METHODS Enamel slabs were prepared from MIH affected teeth that had been extracted for various reasons and inserted in appliances of 30 participants who were undergoing interceptive orthodontic therapy. They were randomly divided into two groups using block randomization technique: Group A-daily single application of CPP-ACP cream (n = 15); Group B-professional application of fluoride varnishes every 3 months (n = 15). After 6 months of regular wear of the appliance, the enamel slabs were placed under Field Emission Scanning Microscope (FESEM) and Energy-Dispersive Spectroscopy (EDS) for evaluation of ultra structure and mineral content, respectively. RESULTS A significant increase in calcium and phosphorus content, and a decrease in carbon content was observed within the 6 months period, suggesting remineralization in both the groups. On comparing the Ca:P and Ca:C ratios, a significant increase in the Ca:C ratio was evident in the two groups. No significant difference was seen in the Ca:P ratio in the CPP-ACP group at six months. The inter-group comparison did not reveal any significant difference between the two groups either at baseline or at 6 months post-intervention. CONCLUSION Remineralization can be achieved in MIH affected teeth with the use of remineralizing agents.
Collapse
Affiliation(s)
- A Kumar
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Goyal
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kapur
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Singh
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - S K Mehta
- Punjab University, Chandigarh, India
| |
Collapse
|
6
|
Mukhtar U, Goyal A, Luthra-Guptasarma M, Gauba K, Kapur A, Thakur AK. Label-free quantitative proteomics reveals molecular correlates of altered biomechanical properties in molar incisor hypomineralization (MIH): an in vitro study. Eur Arch Paediatr Dent 2022; 23:179-191. [PMID: 35013981 DOI: 10.1007/s40368-021-00687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Molar-incisor hypomineralization (MIH) is a qualitative developmental defect of enamel that affects first permanent molars with or without affecting permanent incisors. We aimed to carry out a quantitative proteomics-based study to compare and evaluate proteins in sound and MIH-affected enamel. MATERIALS AND METHODS Ten blocks each of the MIH-affected enamel and sound enamel were processed and prepared for LC-MS/MS analysis. Label-free quantitation was carried out to evaluate the differentially expressed proteins in the two groups of samples. RESULTS A significant increase in the number of proteins in MIH-affected enamel (50.3 ± 29.6) was observed compared to the sound enamel (21.4 ± 3.2). While proteins like collagens, α1-anti-trypsin, kallikrein-4 (KLK4), matrix metalloprotease-20 (MMP-20), alpha-2-macroglobulin, and alpha-2-HS-glycoprotein were upregulated in sound enamel, there was over-expression of albumin, calcium-binding proteins, anti-thrombin III, and dentin sialophosphoprotein (DSPP), along with proteins implicated in stress response and inflammatory processes in MIH. CONCLUSION We propose that altered biomechanical properties of the enamel in MIH samples arise due to (i) down-regulation of proteins contributing to collagen biosynthesis and fibril formation; (ii) an overall imbalance in required levels of proteases (KLK4 and MMP-20) and anti-proteases (anti-thrombin-III which inhibits KLK-4), essential for optimal mineralization; (iii) very low levels of alpha-2-macroglobulin with important consequences in enamel mineralization and amelogenesis; and (iv) increased albumin in MIH, preventing proper growth of hydroxyapatite crystals. Increased inflammatory component was also seen in MIH; however, whether inflammation is a cause or consequence of the poor mineralization process needs to be assessed.
Collapse
Affiliation(s)
- U Mukhtar
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Goyal
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - M Luthra-Guptasarma
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kapur
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Thakur
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Kapur A, Boutin S, Lyster K, Irvine J, Sawchuk K. Retrospective application of the HEAR score on patients evacuated for chest pain: Assessing the utility of point-of-care troponin. Can J Rural Med 2022; 27:16-21. [PMID: 34975112 DOI: 10.4103/cjrm.cjrm_23_21] [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: 11/04/2022]
Abstract
Introduction The HEART scoring system codifies the clinical gestalt used by physicians with 0-2 points assigned to 5 criteria (history, electrocardiography, age, risk factors and troponin). This scoring provides a prognostic tool that assists in disposition planning. The use of a truncated HEART score, minus the troponin data (HEAR score), was used for patients presenting with chest pain at one of four outpost nursing stations served by La Ronge Health Centre in northern Saskatchewan. These nursing stations have no onsite physician and no ability to obtain any troponin data. This study set out to determine if there was any utility in conducting point-of-care (PoC) troponins in these nursing outposts. Materials and Methods A retrospective analysis was conducted using the La Ronge regional electronic medical record by searching for all patients for whom an outpost nurse had called a physician regarding chest pain symptoms between 01 January 2011 and 31 December 2016. The HEAR and HEART score were then calculated for each individual presentation of patients with chest pain that met inclusion and exclusion criteria. Results By calculating both the patient's HEART score before evacuation from the outposts and after (i.e. with the troponin data), we were able to determine that, in 89.4% of cases (110/123 events), patients would require evacuation regardless of the troponin values due to a HEART score ≥4. In 10.6% (13/124 events) of cases, the patients who were evacuated had a HEART score ≤3, and in only one case did the troponin data increase this score. Conclusions The majority of patients would continue to be evacuated regardless of the result of their PoC troponin due to an already elevated HEAR score. PoC troponin is unlikely to reduce the rate of evacuation of patients with chest pain from the nursing stations served by the La Ronge Health Centre.
Collapse
Affiliation(s)
- A Kapur
- Emergency Medicine, University of Saskatchewan, Regina, SK, Canada
| | - S Boutin
- Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - K Lyster
- Family Medicine, University of Saskatchewan, Regina, SK, Canada
| | - J Irvine
- Internal Medicine, Regina Qu'appelle Health Region, Regina, SK, Canada
| | - K Sawchuk
- Academic Family Medicine, University of Saskatchewan, LaRonge, SK, Canada
| |
Collapse
|
8
|
Mishra R, Kapur A, Goyal A, Gauba K, Trehan A. Salivary parameters and their correlation with neutrophil counts in children with acute lymphoblastic leukemia. Eur Arch Paediatr Dent 2021; 23:281-287. [PMID: 34843095 DOI: 10.1007/s40368-021-00679-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 03/24/2021] [Accepted: 10/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chemotherapy for Acute Lymphoblastic Leukemia (ALL) is known to render children immuno-deficient. A concomitant suppression of local defence mechanisms, such as saliva may further aggravate the adverse consequences of chemotherapy. The present study was conducted to evaluate alterations in salivary flow rate, pH and buffering capacity and to correlate these parameters with Absolute Neutrophil Counts (ANC). METHODS A cohort of 43 patients, aged 3-12 years were evaluated for the aforementioned parameters at baseline, post-induction and post-consolidation phases. Salivary collection was done and ANC was measured from routine haematological reports. RESULTS A decrease in the salivary parameters was observed at the end of Induction phase as compared to baseline, with a statistically significant decrease in unstimulated salivary flow rates (p < 0.01). Statistically significant positive correlations were found between ANC and salivary flow rate (p = 0.005), pH (p < 0.00) and buffering capacity (p < 0.00). On testing the significance of these correlations, all the values for these parameters were found to be statistically significant. CONCLUSION Salivary parameters showed derangements over the phases of chemotherapy, with maximum decrease at the end of induction phase. The positive correlations of salivary parameters with ANC of the subjects may be considered indicative of a concomitant immunological compromise in these children.
Collapse
Affiliation(s)
- R Mishra
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kapur
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - A Goyal
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Trehan
- Unit of Hematology and Oncology, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
9
|
Kapur A, Hung M, Wang K, Gross M, Lee W, Weissbart S, Kim J. The Future is Female: The Influence of Female Faculty and Resident Representation on Female Applicant Match Rate Amongst Urology Residency Programs Over 3 Years. Urology 2021; 160:46-50. [PMID: 34740713 DOI: 10.1016/j.urology.2021.10.020] [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: 05/08/2021] [Revised: 09/13/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate whether there is a correlation between the proportion of female faculty and residents at urology residency programs and the proportion of females matched to those programs. MATERIALS AND METHODS We utilized official results from three consecutive AUA match cycles from 2018 to 2020 to obtain the number of females matched to each program. The number of female residents and faculty members in each program was acquired through querying program websites and contact with residency program coordinators. The correlation between the proportion of females in the newly matched class of residents and the proportion of current female faculty members and residents in that program was calculated for each match cycle. RESULTS There was a positive correlation between the proportion of matched female applicants and the proportion of female residents in each program for the 2018, 2019, and 2020 match cycles (R=0.23, p=0.01; R=0.21, p=0.02, R=0.11, p<0.001, respectively). There was a positive correlation between the proportion of matched female applicants and the proportion of female faculty at their matched program in the 2018 and 2020 match cycles (R=0.22, p=0.02; R=0.06, p<0.01, respectively). There was no significant predilection of females matching to programs with a female program director or chairperson, and geographic location of program (based on AUA section) did not appear to influence female applicant match rates. CONCLUSION There has been a consistent trend in the proportion of matched female applicants to urology programs correlating positively with the proportion of female residents at those programs over the past three years. This is indicative of the increased potential for female mentorship and leadership opportunities. Further research is needed to investigate the factors that draw female applicants to urology programs with increased female representation.
Collapse
Affiliation(s)
- Anjali Kapur
- Department of Urology, Stony Brook Medicine, Stony Brook, NY.
| | - Michael Hung
- Department of Urology, Stony Brook Medicine, Stony Brook, NY
| | | | - Michael Gross
- Department of Urology, Cleveland Clinic, Cleveland, OH
| | - Wai Lee
- Smith Institute for Urology, North Shore-LIJ Health System, Lake Success, NY
| | | | - Jason Kim
- Department of Urology, Stony Brook Medicine, Stony Brook, NY
| |
Collapse
|
10
|
Kapur A, Potters L. Post Traumatic Growth in Radiation Medicine Following the COVID-19 Outbreak. Int J Radiat Oncol Biol Phys 2021. [PMCID: PMC8536227 DOI: 10.1016/j.ijrobp.2021.07.254] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose/Objective(s) Materials/Methods Results Conclusion
Collapse
|
11
|
Kapur A, Cornforth D, Diggle F, Duncan R, Moustafa D, Goldberg J, Whiteley M, Bomberger J. 659: Using computational analyses to establish an integrated synthetic sputum and airway epithelial co-culture model for chronic Pseudomonas aeruginosa infections in cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)02082-8] [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]
|
12
|
Kapur A, Potters L. Cultural Barriers and Enablers for Event Reporting. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1457] [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]
|
13
|
Kapur A, Potters L. Variations in Staff Perceptions of Patient Safety Culture in Radiation Medicine. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1438] [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]
|
14
|
Ma D, Kapur A, Potters L, Parashar B. A Culture of Safety: Departmental No Fly Policy Resulted in Fewer Unsafe Incidents Compared to National RO-ILS Database. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Lee W, Cheung A, Du C, Loeb C, Cohen T, Kapur A, Weissbart S, Kim J. Access to Academic Female Pelvic Medicine and Reconstructive Surgery Providers for New Patient Visits: How Long Are Wait Times? Urology 2020; 150:170-174. [PMID: 32535074 DOI: 10.1016/j.urology.2020.04.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the wait times to see an academic Female Pelvic Medicine and Reconstructive Surgery (FPMRS) urologist or gynecologist and to identify factors that may impact these wait times. METHODS We reviewed all Accreditation Council for Graduate Medical Education accredited urology and gynecology residency programs. Offices of FPMRS providers were called to ascertain the earliest available new patient visit for a fictional female patient with "urine leakage." Programs without FPMRS faculty (18.7%) were excluded. FPMRS providers that did not accept Medicaid (15.6%) were also excluded. Negative binomial regression was performed using SPSS v24. RESULTS Final analysis included 362 FPMRS providers. Median wait time for a patient with Medicaid was 30 days (interquartile range [IQR] 15-51) and 26 days (IQR 14-42) for Medicare. The median wait time to see an FPMRS-trained gynecologist was 28 days (IQR 15-50) while FPMRS-trained urologists had a median wait time of 25 days (IQR 13.8-43.3). Female providers had longer median wait times when compared to male providers (30 vs 25 days). On regression analysis, only female gender of the provider was significant (P < .01). CONCLUSION Our study found that nearly 1 in 5 academic departments did not have an FPMRS-trained provider. We found that new patients with urinary incontinence encountered substantial wait times to see FPMRS providers at academic institutions. As we project increased demand for the FPMRS workforce, our findings reflect a challenging landscape where training additional FPMRS providers may be needed to meet demand.
Collapse
Affiliation(s)
- Wai Lee
- Virginia Mason Seattle, WA, United States.
| | - Alice Cheung
- Albany Medical Center Albany, NY, United States, Department of Urology
| | - Chris Du
- Stony Brook Medicine Stony Brook, NY, United States, Department of Urology
| | - Charles Loeb
- University of California Irvine Irvine, CA, United States, Department of Urology
| | - Tal Cohen
- Stony Brook Medicine Stony Brook, NY, United States, Department of Urology
| | - Anjali Kapur
- Stony Brook Medicine Stony Brook, NY, United States, Department of Urology
| | - Steven Weissbart
- Stony Brook Medicine Stony Brook, NY, United States, Department of Urology
| | - Jason Kim
- Stony Brook Medicine Stony Brook, NY, United States, Department of Urology
| |
Collapse
|
16
|
Lin Y, Harries AD, Kumar AMV, Critchley JA, van Crevel R, Owiti P, Dlodlo RA, Kapur A. Tackling diabetes mellitus and tuberculosis: a new Union guide on the management of diabetes-tuberculosis. Int J Tuberc Lung Dis 2020; 23:771-772. [PMID: 31439106 DOI: 10.5588/ijtld.19.0119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Y Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, London School of Hygiene & Tropical Medicine, London, UK
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France, International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, Yenepoya Medical College, Yenepoya (deemed University), Mangaluru, India
| | | | - R van Crevel
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - P Owiti
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark, ,
| |
Collapse
|
17
|
Kapur A. Randomised clinical trials for tuberculosis prophylaxis in people with diabetes mellitus. Int J Tuberc Lung Dis 2020; 24:465-466. [PMID: 32317075 DOI: 10.5588/ijtld.19.0779] [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: 11/10/2022] Open
Affiliation(s)
- A Kapur
- World Diabetes Foundation, Bagsværd, Denmark, ,
| |
Collapse
|
18
|
Potters L, Chou H, Kapur A. Reducing Treatment Delays with a Modified No-Fly Policy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.424] [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: 10/26/2022]
|
19
|
Mudd LM, Scheurer JM, Pruett M, Demerath EW, Kapur A, Ramel SE. Relations among maternal physical activity during pregnancy and child body composition. Obes Sci Pract 2019; 5:246-250. [PMID: 31275598 PMCID: PMC6587308 DOI: 10.1002/osp4.332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/31/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Physical activity (PA) during pregnancy is associated with lower neonatal fat mass, but associations with child body composition are mixed. The purpose of this study was to examine associations between trimester-specific pregnancy PA and child body composition at 4 years. METHODS Participants of the Minnesota Infant Nutrition, Neurodevelopment, and Obesity Study were asked to recall participation in any moderate or vigorous PA in the first (T1), second (T2) and third (T3) trimesters at about 5 years postpartum. Child fat mass and fat-free mass were measured via air displacement plethysmography at 2 weeks, 3 months and 4 years of age. Multivariate linear regression was used for analyses. RESULTS Of 51 possible participants, 37 recalled pregnancy PA. Any vigorous PA in T3 was associated with lower child fat mass at 4 years (adjβ = -1.077, p < 0.05). CONCLUSION Late pregnancy PA may have lasting benefits for child body composition. Replication of these findings is needed in a larger sample with prospective measures.
Collapse
Affiliation(s)
- L. M. Mudd
- National Center for Complementary and Integrative HealthNational Institutes of HealthBethesdaMDUSA
| | - J. M. Scheurer
- Department of PediatricsUniversity of MinnesotaMinneapolisMNUSA
| | - M. Pruett
- Department of KinesiologyMichigan State UniversityEast LansingMIUSA
| | - E. W. Demerath
- School of Public HealthUniversity of MinnesotaMinneapolisMNUSA
| | - A. Kapur
- Department of PediatricsUniversity of MinnesotaMinneapolisMNUSA
| | - S. E. Ramel
- Department of PediatricsUniversity of MinnesotaMinneapolisMNUSA
| |
Collapse
|
20
|
Smith C, Kapur A, Chetty K, Seddon P. P329 Dietary fibre - an important but poorly achieved nutrient. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30621-6] [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]
|
21
|
Dhareula A, Goyal A, Gauba K, Bhatia SK, Kapur A, Bhandari S. A clinical and radiographic investigation comparing the efficacy of cast metal and indirect resin onlays in rehabilitation of permanent first molars affected with severe molar incisor hypomineralisation (MIH): a 36-month randomised controlled clinical trial. Eur Arch Paediatr Dent 2019; 20:489-500. [DOI: 10.1007/s40368-019-00430-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/05/2019] [Indexed: 11/29/2022]
|
22
|
Aronoff K, Kapur A, Riegel A, Antone J, Somerstein G, Lim M, Potters L. ASTRO's Radiation Oncology-Incident Learning System (RO-ILS): A Multi-site, Multi-faculty Radiation Department Culture Immersion into RO-ILS. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1315] [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: 11/28/2022]
|
23
|
Sharma M, Pathania OP, Kapur A, Thomas S, Kumar A. A randomised controlled trial of excision versus invagination in the management of indirect inguinal hernial sac. Ann R Coll Surg Engl 2018; 101:119-122. [PMID: 30286628 DOI: 10.1308/rcsann.2018.0160] [Citation(s) in RCA: 3] [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] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Lichtenstein tension-free mesh hernioplasty of primary inguinal hernia is currently considered as the preferred method for the plastic reconstruction of inguinal hernia by the majority of surgeons. Several studies have examined the best way to manage the hernial sac in this surgery, but no consensus has been reached. This study was designed to compare the effects of excision of sac and invagination of sac on post-operative outcomes. METHODS AND METHODS This prospective randomised study included a total of 70 patients with primary unilateral uncomplicated indirect inguinal hernia. Group A (35 patients) underwent high dissection and invagination of the hernial sac and group B (35 patients) underwent high ligation and excision of the hernial sac. The repair of the posterior wall of the inguinal canal was done according to Lichtenstein tension-free technique. The primary outcome of this study was postoperative pain and secondary outcomes were wound infection, chronic sepsis, sinus formation, persistent pain, testicular atrophy and recurrence during the one-year follow-up period. RESULTS There was a significant difference (P < 0.01) in pain experienced by the patients in the immediate post-operative period between the two groups; group A experienced less postoperative pain than group B. There was no significant difference in incidence of infection between the groups. CONCLUSIONS Invagination of the sac results in less postoperative pain compared with excision, with no significant difference in other postoperative outcomes.
Collapse
Affiliation(s)
- M Sharma
- Department of Surgery, Hindu Rao Hospital , New Delhi , India
| | - O P Pathania
- Department of Surgery, Lady Hardinge Medical College and Associated Hospitals , New Delhi , India
| | - A Kapur
- Department of Pharmacology, Lady Hardinge Medical College and Associated Hospitals , New Delhi , India
| | - S Thomas
- Department of Surgery, Lady Hardinge Medical College and Associated Hospitals , New Delhi , India
| | - A Kumar
- Department of Surgery, Lady Hardinge Medical College and Associated Hospitals , New Delhi , India
| |
Collapse
|
24
|
Smith C, Chetty K, Kapur A, Seddon P. P200 Food diary analysis and growth: do they correlate? A pilot study. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30495-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Berg W, Forsyth E, Du C, Loeb C, Kapur A, Kapadia K, Cheung A, Wang Y, Darras F. MP61-19 PREOPERATIVE USE OF ANTIPLATELETS AND ANTICOAGULANTS IN DECEASED DONOR RENAL TRANSPLANTS DOES NOT RESULT IN INCREASED COMPLICATION RATES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1998] [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: 10/17/2022]
|
26
|
Cox B, Kapur A, Chou H, Potters L. Long-Term Outcomes With Prospective Contouring Rounds. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Potters L, Kapur A. Subverting Risk by Instituting No Fly II. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1945] [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: 12/01/2022]
|
28
|
Affiliation(s)
- A Kapur
- Department of Gastroenterology, The Wollongong Hospital, Wollongong, NSW, Australia
| | - V Nagaraja
- Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia
| |
Collapse
|
29
|
Kapur A, Mahmood T, Hod M. The unmet need for universal testing for hyperglycaemia in pregnancy and the FIGO guideline. BJOG 2017; 125:529-531. [DOI: 10.1111/1471-0528.14659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 12/01/2022]
Affiliation(s)
- A Kapur
- World Diabetes Foundation; Gentofte Denmark
- FIGO Working Group on Hyperglycaemia in Pregnancy; London UK
| | - T Mahmood
- FIGO Working Group on Hyperglycaemia in Pregnancy; London UK
- European Board and College of Obstetrics and Gynaecology; Kirkcaldy Scotland
| | - M Hod
- FIGO Working Group on Hyperglycaemia in Pregnancy; London UK
- European Association of Perinatal Medicine; Tel Aviv Israel
| |
Collapse
|
30
|
Riegel AC, Rea A, Kuruvilla A, Gill G, Souri S, Kapur A, Cao Y, Jamshidi A. TH-CD-304-02: Clinical Uncertainty of in Vivo Dosimetry for Intensity-Modulated Radiation Therapy Using Optically-Stimulated Luminescent Dosimeters. Med Phys 2016. [DOI: 10.1118/1.4926208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
31
|
Cox B, Vallabhajosula S, Rini J, Ghiuzeli C, Wang L, Kapur A, Potters L, Antony J, Kamvosoulis P, Brown K, Connelly E, Stieb J, Gaballa H, Ben Levi E, Palestro C, Paul D. A Phase I Dose Escalation Study of Targeted Radionuclide Therapy of Malignant Tumors Using 18F Fluorodeoxyglucose (18F-FDG): Initial Experience and Early Results. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1909] [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]
|
32
|
Kapur A, Adair N, O'Brien M, Naparstek N, Cangelosi T, Jancasz J, Zuvic P, Joseph S, Meier J, Bloom B, Potters L. Improving Efficiency and Safety in External Beam Radiation Therapy Treatment Delivery Using a Kaizen Approach. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.186] [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: 10/20/2022]
|
33
|
Kapur A. TU-FG-BRA-03: Systems Engineering and Treatment Planning Process Control in Radiation Medicine. Med Phys 2016. [DOI: 10.1118/1.4957560] [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: 11/07/2022] Open
|
34
|
Kapur A, Evans S, Brown D, Ezzell G, Hoopes D, Dieterich S, Kapetanovic K, Tomlinson C. TU-D-201-04: Veracity of Data Elements in Radiation Oncology Incident Learning Systems. Med Phys 2016. [DOI: 10.1118/1.4957470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
35
|
Harries AD, Kumar AMV, Satyanarayana S, Lin Y, Zachariah R, Lönnroth K, Kapur A. Diabetes mellitus and tuberculosis: programmatic management issues. Int J Tuberc Lung Dis 2016; 19:879-86. [PMID: 26162352 PMCID: PMC4497633 DOI: 10.5588/ijtld.15.0069] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In August 2011, the World Health Organization and the International Union Against Tuberculosis and Lung Disease launched the Collaborative Framework for Care and Control of Tuberculosis (TB) and diabetes mellitus (DM) to guide policy makers and implementers in combatting the epidemics of both diseases. Progress has been made, and includes identifying how best to undertake bidirectional screening for both diseases, how to provide optimal treatment and care for patients with dual disease and the most suitable framework for monitoring and evaluation. Key programmatic challenges include the following: whether screening should be directed at all patients or targeted at those with high-risk characteristics; the most suitable technologies for diagnosing TB and diabetes in routine settings; the best time to screen TB patients for DM; how to provide an integrated, coordinated approach to case management; and finally, how to persuade non-communicable disease programmes to adopt a cohort analysis approach, preferably using electronic medical records, for monitoring and evaluation. The link between DM and TB and the implementation of the collaborative framework for care and control have the potential to stimulate and strengthen the scale-up of non-communicable disease care and prevention programmes, which may help in reducing not only the global burden of DM but also the global burden of TB.
Collapse
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; London School of Hygiene & Tropical Medicine, London, UK
| | - A M V Kumar
- The Union South-East Asia Regional Office, New Delhi, India
| | | | - Y Lin
- The Union China Office, Beijing, China
| | - R Zachariah
- Medical Department, Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Luxembourg
| | - K Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - A Kapur
- World Diabetes Foundation, Gentofte, Denmark
| |
Collapse
|
36
|
Back L, Nagaraja V, Kapur A, Eslick GD. Role of decompressive hemicraniectomy in extensive middle cerebral artery strokes: a meta-analysis of randomised trials. Intern Med J 2016; 45:711-7. [PMID: 25684396 DOI: 10.1111/imj.12724] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 12/22/2014] [Accepted: 02/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prognosis for patients with 'malignant' or space-occupying oedema post middle cerebral artery infarct remains poor despite maximal medical therapy delivered in the intensive care setting. AIM We performed a meta-analysis to evaluate the value of surgical decompression versus medical management alone in patients suffering from malignant middle cerebral artery infarct. METHODS A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct and Web of Science. Original data was abstracted from each study and used to calculate a pooled odds ratio (OR) and 95% confidence interval (95% CI). RESULTS The overall OR for mRS 6 (death) at 6 months for decompressive surgery as compared with standard medical management revealed a statistically significant reduction with OR of 0.19 (95% CI: 0.10-0.37). The frequency of patients with mRS 2, 3 and 5 outcomes was higher in the decompressive surgery cohort; however, these outcomes did not reach statistical significance. On the other hand, the number of patients with a mRS score of 4 was significantly higher in the decompressive surgery cohort with an OR of 3.29 (95% CI: 1.76-6.13). The overall OR for mRS 6 (death) at 12 months for decompressive surgery as compared with standard medical management revealed a statistically significant reduction with OR of 0.17 (95% CI: 0.10-0.29). The frequency of patients with mRS 3 and 5 outcomes was higher in the decompressive surgery cohort; however, these outcomes did not reach statistical significance. On the other hand, the number of patients with a mRS score of 4 was significantly higher in the decompressive surgery cohort with an OR of 4.43 (95% CI: 2.27-8.66). In the long run it was also observed that the number of patients with a mRS score of 2 was significantly higher in the decompressive surgery cohort an OR of 4.51 (95% CI: 1.06-19.24). CONCLUSIONS Our results imply that surgical intervention decreased mortality of patients with fatal middle cerebral artery infarct at the expense of increasing the proportion suffering from substantial disability at the conclusion of follow up.
Collapse
Affiliation(s)
- L Back
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
| | - V Nagaraja
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
| | - A Kapur
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
| | - G D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
37
|
Gajraj S, Karunakaran S, Kapur A. Validation of diagnostic criteria for genital tubercusosis in cases of infertility. J Mar Med Soc 2016. [DOI: 10.4103/0975-3605.202974] [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: 11/04/2022] Open
|
38
|
Cox B, Chou H, Kapur A, Goode G, Antone J, Sharma A, Teckie S, Potters L. Quantifying Physician Performance Using Peer Review During Prospective Contouring Rounds. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1812] [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: 10/22/2022]
|
39
|
Skar M, Kirstein E, Kapur A. Lessons learnt from school-based health promotion projects in low- and middle-income countries. Child Care Health Dev 2015; 41:1114-23. [PMID: 25652140 DOI: 10.1111/cch.12231] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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] [Accepted: 12/31/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-communicable diseases (NCD) are now the leading cause of death worldwide. As habits and lifestyle are established in childhood and adolescence, targeting school children before they develop unhealthy habits offers a window of opportunity to halt and reverse the emerging NCD epidemic. However, few experiences from school interventions in low- and middle-income countries have been collected. Therefore, the aim of this study was to review experiences of implementing school-based health promotion interventions to identify barriers and recommendations for future interventions. METHODS A qualitative investigation of 17 school-based health promotion interventions in low- and middle-income countries was conducted. Data were collected through questionnaires (15 project leaders) and in-depth interviews with nine project leaders. The data from the questionnaires and interviews was triangulated and analysed using content analysis, where themes and categories emerging from the material were explored. RESULTS Three key themes emerged from the data: 1) policy environment and stakeholder engagement, 2) health education sessions, and 3) practical health promotion activities. The themes explored the experiences and lessons learned from 17 school-based health promotion projects in low- and middle-income countries. Stakeholders at different administrative levels were important for the projects; however, stakeholders close to implementation were seen to be more engaged. Most projects conducted traditional health education lectures, which formed the basis of their intervention. Promotion of physical activity and healthy eating through participatory approaches were identified; however, barriers such as lack of areas suitable for physical activity and lack of healthy food alternatives in schools can obstruct the successful implementation of interventions. CONCLUSIONS This study has documented experiences with school-based health promotion in low- and middle-income countries, and has shown that schools can play an important role in facilitating NCD-related behavioural change in children. The study recommends increased emphasis on a whole-school approach where activities focusing on individual behavioural change are supported by interventions improving the structural environment.
Collapse
Affiliation(s)
- M Skar
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - E Kirstein
- World Diabetes Foundation, Gentofte, Denmark
| | - A Kapur
- World Diabetes Foundation, Gentofte, Denmark
| |
Collapse
|
40
|
Kumar AMV, Satyanarayana S, Wilson NC, Chadha SS, Gupta D, Nair S, Zachariah R, Kapur A, Harries AD. Operational research leading to rapid national policy change: tuberculosis-diabetes collaboration in India. Public Health Action 2015; 4:85-8. [PMID: 26399204 DOI: 10.5588/pha.14.0012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/07/2014] [Accepted: 03/10/2014] [Indexed: 11/10/2022] Open
Abstract
In 2011, bi-directional screening for tuberculosis (TB) and diabetes mellitus (DM) was recommended by the World Health Organization (WHO), although how best to implement the activity was not clear. In India, with early engagement of national programme managers and all important stakeholders, a countrywide, multicentre operational research (OR) project was designed in October 2011 and completed in 2012. The results led to a rapid national policy decision to routinely screen all TB patients for DM in September 2012. The process, experience and enablers of implementing this unique and successful collaborative model of operational research are presented.
Collapse
Affiliation(s)
- A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - N C Wilson
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - S S Chadha
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - D Gupta
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - S Nair
- Office of the World Health Organization Representative in India, New Delhi, India
| | - R Zachariah
- Medical Department, Médecins Sans Frontières, Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - A Kapur
- World Diabetes Foundation, Gentofte, Denmark
| | - A D Harries
- The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
41
|
Khader A, Ballout G, Shahin Y, Hababeh M, Farajallah L, Zeidan W, Abu-Zayed I, Kochi A, Harries AD, Zachariah R, Kapur A, Shaikh I, Seita A. Diabetes mellitus and treatment outcomes in Palestine refugees in UNRWA primary health care clinics in Jordan. Public Health Action 2015; 3:259-64. [PMID: 26393043 DOI: 10.5588/pha.13.0083] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 09/11/2013] [Accepted: 10/17/2013] [Indexed: 12/22/2022] Open
Abstract
SETTING Six primary health care clinics in Jordan, serving Palestine refugees diagnosed with diabetes mellitus (DM). OBJECTIVES To report on the number and characteristics of new DM patients registered in the second quarter of 2013 and of all DM patients ever registered by 30 June 2013, with treatment outcomes and cumulative burden of late-stage complications. DESIGN A descriptive cohort study using routine data collected through e-Health. RESULTS Of the 288 new patients in Q2 2013 and 12 548 patients ever registered with DM by 30 June 2013, smoking, physical inactivity and obesity were recorded in 19%, 50% and 47%, respectively. In Q2 2013, 9740 (78%) patients attended a clinic, with >99% having undergone disease control measures: of these, 72% had postprandial blood glucose ⩽ 180 mg/dl, 71% had blood cholesterol < 200 mg/dl, 82% had blood pressure < 140/90 and 40% had body mass index < 30 kg/m(2). Late-stage complications were present in 1130 (11.6%) patients who attended a clinic, with cardiovascular disease and stroke being the most common. Several differences in outcomes were found between males and females. CONCLUSION There is a high burden of disease due to DM at primary health care clinics in Jordan. Cohort analysis using e-Health is a vital way to assess management and follow-up.
Collapse
Affiliation(s)
- A Khader
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - G Ballout
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - Y Shahin
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - M Hababeh
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - L Farajallah
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - W Zeidan
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - I Abu-Zayed
- Field Health Programme, UNRWA, Amman, Jordan
| | - A Kochi
- Tokyo University Medical School, Tokyo, Japan
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - R Zachariah
- Medical Department, Operational Research Unit, Brussels Operational Center, Médecins Sans Frontières, Luxembourg
| | - A Kapur
- World Diabetes Foundation, Gentofte, Denmark
| | - I Shaikh
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - A Seita
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| |
Collapse
|
42
|
Harries AD, Satyanarayana S, Kumar AMV, Nagaraja SB, Isaakidis P, Malhotra S, Achanta S, Naik B, Wilson N, Zachariah R, Lönnroth K, Kapur A. Epidemiology and interaction of diabetes mellitus and tuberculosis and challenges for care: a review. Public Health Action 2015; 3:S3-9. [PMID: 26393066 DOI: 10.5588/pha.13.0024] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [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: 05/03/2013] [Accepted: 07/15/2013] [Indexed: 12/11/2022] Open
Abstract
The global burden of diabetes mellitus (DM) is immense, with numbers expected to rise to over 550 million by 2030. Countries in Asia, such as India and China, will bear the brunt of this unfolding epidemic. Persons with DM have a significantly increased risk of developing active tuberculosis (TB) that is two to three times higher than in persons without DM. This article reviews the epidemiology and interactions of these two diseases, discusses how the World Health Organization and International Union Against Tuberculosis and Lung Disease developed and launched the Collaborative Framework for the care and control of TB and DM, and examines three important challenges for care. These relate to 1) bi-directional screening of the two diseases, 2) treatment of patients with dual disease, and 3) prevention of TB in persons with DM. For each area, the gaps in knowledge and the priority research areas are highlighted. Undiagnosed, inadequately treated and poorly controlled DM appears to be a much greater threat to TB prevention and control than previously realised, and the problem needs to be addressed. Prevention of DM through attention to unhealthy diets, sedentary lifestyles and childhood and adult obesity must be included in broad non-communicable disease prevention strategies. This collaborative framework provides a template for action, and the recommendations now need to be implemented and evaluated in the field to lay down a firm foundation for the scaling up of interventions that work and are effective in tackling this dual burden of disease.
Collapse
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | | | - A M V Kumar
- The Union South-East Asia Office, New Delhi, India
| | - S B Nagaraja
- Office of the WHO Representative in India, World Health Organization, New Delhi, India ; Department of Community Medicine, Employees State Insurance Corporation (ESIC) Medical College, Bangalore, India
| | - P Isaakidis
- Médecins Sans Frontières, Brussels Operational Centre, Mumbai, India
| | - S Malhotra
- All India Institute of Medical Sciences, New Delhi, India
| | - S Achanta
- Office of the WHO Representative in India, World Health Organization, New Delhi, India
| | - B Naik
- Office of the WHO Representative in India, World Health Organization, New Delhi, India
| | - N Wilson
- The Union South-East Asia Office, New Delhi, India
| | - R Zachariah
- Medical Department, Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Luxembourg
| | - K Lönnroth
- Stop TB Department, World Health Organization, Geneva, Switzerland
| | - A Kapur
- World Diabetes Foundation, Gentofte, Denmark
| |
Collapse
|
43
|
Kapur A. MO-DE-BRA-02: From Teaching to Learning: Systems-Based-Practice and Practice-Based-Learning Innovations in Medical Physics Education Programs. Med Phys 2015. [DOI: 10.1118/1.4925337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
44
|
Pappas D, Reis S, Ali A, Kapur A. SU-E-T-511: Inter-Rater Variability in Classification of Incidents in a New Incident Reporting System. Med Phys 2015. [DOI: 10.1118/1.4924873] [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: 11/07/2022] Open
|
45
|
Kapur A. MO-B-BRB-03: Systems Engineering Tools for Treatment Planning Process Optimization in Radiation Medicine. Med Phys 2015. [DOI: 10.1118/1.4925309] [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: 11/07/2022] Open
|
46
|
Jung SB, Nagaraja V, Kapur A, Eslick GD. Association between vitamin B12 deficiency and long-term use of acid-lowering agents: a systematic review and meta-analysis. Intern Med J 2015; 45:409-16. [DOI: 10.1111/imj.12697] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/08/2015] [Indexed: 01/20/2023]
Affiliation(s)
- S. B. Jung
- Prince of Wales Hospital; Sydney Australia
- University of New South Wales; Sydney Australia
| | - V. Nagaraja
- University of New South Wales; Sydney Australia
- The Whiteley-Martin Research Centre; Discipline of Surgery; The University of Sydney; Nepean Hospital; Sydney Australia
| | - A. Kapur
- Prince of Wales Hospital; Sydney Australia
- University of New South Wales; Sydney Australia
- University of Wollongong; Wollongong New South Wales Australia
| | - G. D. Eslick
- The Whiteley-Martin Research Centre; Discipline of Surgery; The University of Sydney; Nepean Hospital; Sydney Australia
| |
Collapse
|
47
|
Goyal R, Blood AJ, Potters L, Kapur A. The Effect of Assessment Criteria on Inter-rater Variability in the Evaluation of Skin Reactions following Breast Cancer Radiation Therapy. IFMBE Proceedings 2015. [DOI: 10.1007/978-3-319-19387-8_123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
48
|
Khader A, Farajallah L, Shahin Y, Hababeh M, Abu-Zayed I, Zachariah R, Kochi A, Kapur A, Harries AD, Shaikh I, Seita A. Hypertension and treatment outcomes in Palestine refugees in United Nations Relief and Works Agency primary health care clinics in Jordan. Trop Med Int Health 2014; 19:1276-83. [DOI: 10.1111/tmi.12356] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A. Khader
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
| | - L. Farajallah
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
| | - Y. Shahin
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
| | - M. Hababeh
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
| | - I. Abu-Zayed
- Field Health Programme; United Nations Relief and Works Agency; Amman Jordan
| | - R. Zachariah
- Medical Department; Brussels Operational Center; Medecins Sans Frontieres; Luxembourg
| | - A. Kochi
- Tokyo University Medical School; Tokyo Japan
| | - A. Kapur
- World Diabetes Foundation; Gentofte Denmark
| | - A. D. Harries
- International Union Against Tuberculosis and Lung Disease; Paris France
- London School of Hygiene and Tropical Medicine; London UK
| | - I. Shaikh
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
| | - A. Seita
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
| |
Collapse
|
49
|
Gallagher S, Kapur A, Lovell MJ, Jones DA, Kirkwood A, Hassan S, Archbold RA, Wragg A, Uppal R, Yaqoob MM. Impact of diabetes mellitus and renal insufficiency on 5-year mortality following coronary artery bypass graft surgery: a cohort study of 4869 UK patients. Eur J Cardiothorac Surg 2014; 45:1075-81. [DOI: 10.1093/ejcts/ezt630] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
50
|
Ghaly M, Kapur A, Kushnirsky M, Raince J, Jain P, Puckett L, Hyder J, Montchal E, Marrero M, Knisely J. The Role of Spine Radiosurgery in the Management Paradigm of Spine Metastases. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.697] [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: 10/26/2022]
|