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Dhoyer R, Tudor C. Non-central limit theorem for the spatial average of the solution to the wave equation with Rosenblatt noise. Theor Probability and Math Statist 2022. [DOI: 10.1090/tpms/1167] [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: 11/11/2022]
Abstract
We analyze the limit behavior in distribution of the spatial average of the solution to the wave equation driven by the two-parameter Rosenblatt process in spatial dimension
d
=
1
d=1
. We prove that this spatial average satisfies a non-central limit theorem, more precisely it converges in law to a Wiener integral with respect to the Rosenblatt process. We also give a functional version of this limit theorem.
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Li X, Zhao H, Guo A, Tudor C, Tian C. Effects of Training-for-Transformation Program on TB/MDR-TB Developed by the International Council of Nurses in China. J Contin Educ Nurs 2021; 51:233-237. [PMID: 32347960 DOI: 10.3928/00220124-20200415-08] [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] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 10/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study evaluated the effects of the Training-for-Transformation (TFT) program on tuberculosis (TB)/multidrug-resistant TB (MDR-TB) in China. METHOD Participants who received training from 2009 to 2017 (n = 230) were invited to complete an online survey using a self-designed questionnaire. RESULTS A total of 130 (56.5%) trainees completed the survey for a valid response rate of 70% (91 of 130). All of the participants created a schedule and offered a TFT program on TB/MDR-TB for health care providers, clients, and communities by a variety of methods that included brainstorming, group work, and role-play, in addition to lectures. The most important supporting factors to train others were related to opportunity and managers' support, and the biggest barriers were lack of space and time. Trainees also made changes to practices that influenced the way nurses worked within their institution, infection control, team cooperation, extended care, and nurses' attitudes toward patients. CONCLUSION The TFT program led to ongoing training provision and practical improvements, and can transform attitudes, practices, and changes in patient care. [J Contin Educ Nurs. 2020;51(5):233-237.].
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Petrescu M, Mitrea A, Tudor C, Vasile D. Changes in sleep quality amidst COVID-19 pandemic among psychiatric patients in Romania. Eur Psychiatry 2021. [PMCID: PMC9471108 DOI: 10.1192/j.eurpsy.2021.729] [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 Sleep disturbances can occur as a result of major stressful events. Additionally, research evidence suggests that COVID-19 pandemic may have negatively impacted the quality of sleep among various populations. However, individuals respond differently to the stress, uncertainty and social isolation related with COVID-19 pandemic. Objectives This study aimed to explore the changes in sleep quality and pattern among voluntary psychiatric patients visiting our clinic in Romania during COVID-19 pandemic. Methods We implemented a cross-sectional study over a period of 3 months, utilizing a Romanian-translated version of the Pittsburgh Sleep Quality Index (PSQI) which was administered through Google Forms web application. Participants lacking digital skills were provided with guidance for completing the questionnaire. Informed consent was obtained prior to participating in this study and data anonymity and confidentiality were ensured. Results Among a total of 98 responders, 63% reported a global PSQI score greater than 5, indicating poor sleep. Approximately 25% of participants subjectively marked their sleep as either fairly bad or very bad. When analysing the 7 components of PSQI, our participants struggled most with long sleep latency. About a third of participants reported using sleep medication (both prescription and over-the-counter) three or more times a week within the past month. Conclusions Considering the fact that the current situation is likely to evolve for an unknown period of time, there is a dire need to assess the effect of prolonged adjustments in daily routine and their impact on the sleep and the quality of life of our patients.
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Vasile D, Vasiliu O, Mangalagiu A, Petrescu B, Tudor C, Candea C. Mindfulness-based cognitive therapy for major depressive disorder- a literature review. Eur Psychiatry 2021. [PMCID: PMC9476091 DOI: 10.1192/j.eurpsy.2021.1320] [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 Mindfulness-based cognitive therapy (MBCT) is a third wave cognitive-behavioral therapy (CBT) that incorporates meditation exercises in the classical, structured intervention. Mindfulness has been associated with psychological well-being, and certain symptoms that occur in major depressive disorder (MDD), e.g. worries, ruminations, ideas of incapacity or self-devaluation, are considered potential targets for MBCT. Objectives To evaluate the current level of evidence for the MCBT efficacy in MDD. Methods A literature serach was performed in the main electronic databases, targeting clinical trials that evaluated in a randomized manner the efficacy of MCBT versus active comparators or placebo in patients with MDD. Results MBCT was efficient in a 10-week randomized controlled trial (RCT) versus standard treatment, and it decreased ruminations, increased patients quality of life, mindfulness abilities, and self-compassion. In another randomized, 8-week RCT, MBCT prevented relapses in MDD, with similar rates when compared to psychoeducation and standard treatment. A 26-month follow-up study evidenced the persistence of symptoms improvement detected after 12 months of the trial, when compared to active control group and treatment as usual. MCBT was compared to cognitive therapy in a randomized 8-week trial, and both treatments had similar efficacy in MDD relapse prevention. Conclusions MCBT may be an useful adjuvant to the current treatment in acute MDD, but it may also decrease the risk of relapse after psychotherapy termination.
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Tudor C, Bunea A, Dulf F, Socaci S, Pintea A. The influence of carotenoids and tocopherols on the oxidative stability of edible oils. J Biotechnol 2019. [DOI: 10.1016/j.jbiotec.2019.05.160] [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: 11/24/2022]
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Kim HY, Dowdy DW, Martinson NA, Kerrigan D, Tudor C, Golub J, Bridges JFP, Hanrahan CF. Maternal Motivation to Take Preventive Therapy in Antepartum and Postpartum Among HIV-Positive Pregnant Women in South Africa: A Choice Experiment. AIDS Behav 2019; 23:1689-1697. [PMID: 30415430 DOI: 10.1007/s10461-018-2324-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 11/25/2022]
Abstract
HIV-positive pregnant women who are initiated on lifelong antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) have lower adherence rates after delivery. We quantified maternal motivation to take preventive therapy before and after delivery among pregnant women newly diagnosed with HIV. We enrolled pregnant women (≥ 18 years) with a recent HIV diagnosis (< 6 months) at 14 public primary health clinics in Matlosana, South Africa and followed them in the postpartum period. Participants received eight choice tasks comparing two mutually exclusive sub-sets of seven possible benefits related to preventive therapy identified through literature reviews and key informant interviews. Data was analyzed using conditional logit regression in the antepartum versus postpartum periods. Coefficients are reported with 95% confidence intervals (CI). Sixty-five women completed surveys both at enrollment and in the postpartum period. All women were already on ART, while 21 (32%) were receiving IPT at enrollment. The mean CD4 count was 436 (± 246) cells/mm3. In the antepartum period, preventing HIV transmission to partners was the most important benefit (coefficients (ß) = 0.87, 95% CI 0.64, 1.11), followed by keeping healthy for family (ß = 0.75, 95% CI 0.52, 0.97). Such prioritization significantly decreased in the postpartum period (p < 0.001). Compared to other motivators, keeping a high CD4 count was least prioritized in the antepartum period (ß = 0.19, 95% CI - 0.04, 0.43) but was most prioritized in the postpartum period (ß = 0.39, 95% CI 0.21, 0.57). These results highlight that messages on family might be particularly salient in the antepartum period, and keeping CD4 count high in the postpartum period. Understanding maternal motivation may help to design targeted health promotion messages to HIV-positive women around the time of delivery.
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Affiliation(s)
- Hae-Young Kim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
- Africa Health Research Institute, Kwazulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Kwazulu-Natal, South Africa
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neil A Martinson
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - Deanna Kerrigan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Tudor
- International Council of Nurses, Geneva, Switzerland
| | - Jonathan Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - John F P Bridges
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colleen F Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
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Tudor C. The importance of TB transmission prevention in health care settings. Int J Tuberc Lung Dis 2018; 22:971. [DOI: 10.5588/ijtld.18.0424] [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)
- Carrie Tudor
- Associate Editor, IJTLD, International Council of Nurses, Chair, End TB Transmission Initiative, Geneva, Switzerland
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Kerrigan D, Tudor C, Motlhaoleng K, Lebina L, Qomfu C, Variava E, Chon S, Martinson N, Golub JE. Relevance and acceptability of using the Quantiferon gold test (QGIT) to screen CD4 blood draws for latent TB infection among PLHIV in South Africa: formative qualitative research findings from the TEKO trial. BMC Health Serv Res 2018; 18:288. [PMID: 29661197 PMCID: PMC5902890 DOI: 10.1186/s12913-018-3088-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/03/2017] [Accepted: 04/03/2018] [Indexed: 11/20/2022] Open
Abstract
Background Tuberculosis (TB) is the leading cause of mortality among people living with HIV (PLHIV), despite the availability of effective preventive therapy. The TEKO trial is assessing the impact of using a blood test, Quantiferon-TB Gold In-Tube Test (QGIT), to screen for latent TB compared to the Tuberculin Screening Test (TST) among PLHIV in South Africa. Methods Fifty-six qualitative interviews were conducted with PLHIV and clinical providers participating in the TEKO trial. We explored TB screening, diagnosis, and treatment guidelines and processes and the use of the QGIT to screen for latent TB infection at the time of CD4 blood draw. Thematic content analysis was conducted. Results Considerable variability in TB screening procedures was documented due to lack of personnel and clarity regarding current national TB guidelines for PLHIV. Few clinics had started using the TST per national guidelines and many patients had never heard of isoniazid preventive therapy (IPT). Nearly all participants supported the idea of latent TB screening using routine blood drawn for CD4 counts. Conclusions Findings indicate that screening for latent TB infection using QGIT from blood drawn for CD4 counts among PLHIV is an acceptable approach to increase latent TB detection given the challenges associated with ensuring systematic latent TB screening in overburdened public clinics. Trial registration The results presented here were from formative research related to the TEKO trial (Identifier NCT02119130, registered 10 April 2014). Electronic supplementary material The online version of this article (10.1186/s12913-018-3088-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deanna Kerrigan
- The Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 North Broadway Street, HH257, Baltimore, MD, 21205, USA.
| | - Carrie Tudor
- The Johns Hopkins School of Medicine, Center for Tuberculosis Research, Baltimore, MD, USA
| | - Katlego Motlhaoleng
- The University of the Witwatersrand, Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Limakatso Lebina
- The University of the Witwatersrand, Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Cokiswa Qomfu
- The University of the Witwatersrand, Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Ebrahim Variava
- The University of the Witwatersrand, Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Sandy Chon
- The Johns Hopkins School of Medicine, Center for Tuberculosis Research, Baltimore, MD, USA
| | - Neil Martinson
- The University of the Witwatersrand, Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Jonathan E Golub
- The Johns Hopkins School of Medicine, Center for Tuberculosis Research, Baltimore, MD, USA
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Hurvitz SA, Turner NC, Telli ML, Rugo HS, Mailliez A, Ettl J, Grischke EM, Mina LA, Balmaña J, Fasching PA, Tudor C, Quek RGW, Hannah AL, Robson ME, Wardley AM. Abstract P5-19-05: Health-related quality of life during a phase 2 study of talazoparib in patients with advanced breast cancer and germline BRCA1/2 mutations (ABRAZO). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-19-05] [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: 11/16/2022]
Abstract
Abstract
Background: Talazoparib (TALA; 1 mg/d) was well tolerated and exhibited promising antitumor activity in ABRAZO, a 2-cohort, 2-stage, open-label phase 2 study (NCT02034916) in patients (pts) with locally advanced or metastatic breast cancer and gBRCA1/2 mutations following platinum-based therapy (cohort 1 [C1]) or ≥3 platinum-free cytotoxic-based regimens (cohort 2 [C2]). This analysis evaluates health-related quality of life (QoL) for both cohorts.
Methods: QoL was assessed on day 1 (baseline) and every 6 weeks for the initial 24 weeks and every 12 weeks thereafter, or sooner if progression was clinically suspected, using the EORTC QLQ-C30 and its breast cancer module, QLQ-BR23. For all scales, results were summarized using descriptive statistics for each cohort and at each time point, based on Characters (max 3400 including title, body and table [including spaces]): 3363 No abbreviations in title; title sentence case; define acronyms; no figures Category: Psychosocial, QOL, and Educational Aspects – Other 2 observed values and changes from baseline (clinically meaningful defined as ≥10-point change from baseline). Time to deterioration (TTD; defined as ≥10-point decrease in global health status [GHS]/functional scales or increase in symptom scales) analyses using survival analysis methods were carried out on the GHS/functional scales of QLQ-C30 and symptom scales of QLQ-BR23.
Results:GHS was maintained from baseline across all time points for both C1 and C2 except at week 24 in C2, when a statistically significant but not clinically meaningful improvement in GHS was observed. In C1, statistically significant and clinically meaningful improvement was observed at specific time points in 4 functional scales (body image, week 6; sexual functioning, week 24; sexual enjoyment, week 36; and future perspective, weeks 6, 18, and 24) and in 3 symptom scales (dyspnea, week 24; insomnia, week 24; and breast symptoms, weeks 6 and 36). Statistically significant and clinically meaningful deterioration in C1 was observed in 2 functional scales (emotional functioning, week 12 and end of treatment, and role functioning, end of treatment) and in 1 symptom scale (fatigue, week 6). In C2, statistically significant and clinically meaningful improvement was observed at specific time points in 4 functional scales (role functioning, week 24; social functioning, week 24; sexual enjoyment, week 18; and future perspective, weeks 6, 12, and 18) and in 5 symptom scales (nausea/vomiting, week 18; pain, weeks 12, 18, and 24; insomnia, week 24; breast symptoms, weeks 12 and 18; and arm symptoms, week 48). For C2, no statistically significant and clinically meaningful deterioration was observed for any functional or symptoms scales across all time points, except in the dyspnea symptom scale at week 18. For C1 and C2, the median (95% confidence interval) TTD of GHS was 2.8 (2.1-3.0) and 5.5 (4.2-5.7) months, respectively. The median TTD for all QLQ-C30 functional scales for C1 and C2 ranged 2.1-3.1 and 4.2-5.6 months, respectively; the median TTD for all QLQ-BR23 symptoms scales ranged 2.6-4.0 and 4.2-5.6 months, respectively.
Conclusions: The QoL of TALA-treated patients during ABRAZO was maintained. QoL is being evaluated among atients with germline BRCA1/2 mutated advanced BC treated with TALA vs physician's choice chemotherapy in the phase 3 EMBRACA trial (NCT01945775).
Citation Format: Hurvitz SA, Turner NC, Telli ML, Rugo HS, Mailliez A, Ettl J, Grischke E-M, Mina LA, Balmaña J, Fasching PA, Tudor C, Quek RGW, Hannah AL, Robson ME, Wardley AM. Health-related quality of life during a phase 2 study of talazoparib in patients with advanced breast cancer and germline BRCA1/2 mutations (ABRAZO) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-19-05.
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Affiliation(s)
- SA Hurvitz
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - NC Turner
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - ML Telli
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - HS Rugo
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - A Mailliez
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - J Ettl
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - E-M Grischke
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - LA Mina
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - J Balmaña
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - PA Fasching
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - C Tudor
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - RGW Quek
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - AL Hannah
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - ME Robson
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
| | - AM Wardley
- University of California Los Angeles Health, Santa Monica, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Stanford University School of Medicine, Stanford, CA; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom
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Telli ML, Turner NC, Mailliez A, Ettl J, Grischke EM, Mina LA, Balmaña J, Hurvitz SA, Wardley AM, Fasching PA, Tudor C, Nguyen L, Hannah AL, Robson ME, Rugo HS. Abstract P1-14-03: ABRAZO: Exposure-efficacy and -safety analyses of breast cancer patients with germline BRCA1/2 mutations receiving talazoparib in a phase 2 open-label trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-14-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Talazoparib (TALA) is a dual-mechanism poly (ADP-ribose) polymerase (PARP) inhibitor that traps PARP on DNA. Efficacy results of this phase 2 trial were previously presented (Turner et al, ASCO 2017, abstract 1007). This study included sparse pharmacokinetic (PK) sampling for patients through cycle 4 of therapy. Exploratory analyses included assessment of exposure versus parameters of efficacy and safety.
Methods: ABRAZO (NCT02034916) was a parallel-cohort, open-label phase 2 study of TALA (1 mg/d) following (i) platinum-based therapy (cohort 1) or (ii) ≥3 platinum-free cytotoxic-based regimens (cohort 2) in patients with locally advanced or metastatic breast cancer and germline BRCA1/2 mutation. Sparse PK sampling was performed on day 1 of cycles 1-4, consisting of a predose sample collected ≤60 minutes prior to dosing and 2 postdose samples collected ≥30 minutes after dosing (time of food ingestion prior to the dose was collected). The collection times of the 2 postdose samples were separated by ≥2 hours. Efficacy parameters included radiographic progression-free survival (rPFS) by central review and objective response rate (ORR). Safety parameters included incidence of overall adverse events (AEs) and grade ≥3 AEs. Individual AUCs (area under concentration-time curves) for exposure-response analyses were predicted by population PK analyses.
Results: Patients were divided into AUC tertiles: low (median, 109.0 ng*hr/mL; n=27), intermediate (median, 170.8 ng*hr/mL; n=27), and high (median, 219.2 ng*hr/mL; n=27). Median rPFS was 5.3 months (95% confidence interval [CI], 3.1, 8.3) in the lowest AUC tertile, 5.6 months (95% CI, 3.7, 8.4) in the intermediate AUC tertile, and 5.3 months (95% CI, 3.9, 5.6) in the highest AUC tertile. The ORR was 22.2% (95% CI, 8.6, 42.3) in the lowest AUC tertile, 25.9% (95% CI, 11.1, 46.3) in the intermediate AUC tertile, and 37.0% (95% CI, 19.4, 57.6) in the highest AUC tertile. AEs of any grade were reported in 11 patients (40.7%) in the lowest AUC tertile, 21 patients (77.8%) in the intermediate AUC tertile, and 22 patients (81.5%) in the highest AUC tertile. Grade ≥3 AEs were reported in 8 patients (29.6%) in the lowest AUC tertile and in 18 patients (66.7%) in the intermediate and highest AUC tertiles. The most common AEs in all 3 exposure tertiles were anemia, thrombocytopenia, and neutropenia.
Conclusions: Median rPFS did not change with increasing systemic exposure. There may be a trend to higher ORR in patients with highest systemic exposure. A larger percentage of patients experienced AEs with elevated systemic exposure. Increased response rates with greater exposure does not translate to improved rPFS. These results should be interpreted with caution due to the low patient numbers in each cohort.
Citation Format: Telli ML, Turner NC, Mailliez A, Ettl J, Grischke E-M, Mina LA, Balmaña J, Hurvitz SA, Wardley AM, Fasching PA, Tudor C, Nguyen L, Hannah AL, Robson ME, Rugo HS. ABRAZO: Exposure-efficacy and -safety analyses of breast cancer patients with germline BRCA1/2 mutations receiving talazoparib in a phase 2 open-label trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-14-03.
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Affiliation(s)
- ML Telli
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - NC Turner
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - A Mailliez
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - J Ettl
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - E-M Grischke
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - LA Mina
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - J Balmaña
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - SA Hurvitz
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - AM Wardley
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - PA Fasching
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - C Tudor
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - L Nguyen
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - AL Hannah
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - ME Robson
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - HS Rugo
- Stanford University School of Medicine, Stanford, CA; Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom; Centre Oscar Lambret, Lille, France; Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Universitats-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; Banner Health, Phoenix, AZ; Hospital Vall d'Hebron, Barcelona, Spain; University of California Los Angeles Health, Santa Monica, CA; The NIHR Cancer Research UK Christie Clinical Research Facility, Manchester, United Kingdom; University of Erlangen, Erlangen, Germany; Medivation, Inc. (Medivation was Acquired by Pfizer Inc., in September 2016), San Francisco, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
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Cuciureanu I, Cuciureanu A, Tudor C. Delirium in acute neurological care department. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.814] [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: 11/24/2022]
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12
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Kerrigan D, West N, Tudor C, Hanrahan CF, Lebina L, Msandiwa R, Mmolawa L, Martinson N, Dowdy D. Improving active case finding for tuberculosis in South Africa: informing innovative implementation approaches in the context of the Kharitode trial through formative research. Health Res Policy Syst 2017; 15:42. [PMID: 28558737 PMCID: PMC5450237 DOI: 10.1186/s12961-017-0206-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 02/08/2017] [Accepted: 05/10/2017] [Indexed: 11/12/2022] Open
Abstract
Background Tuberculosis (TB) is the leading infectious killer worldwide, with approximately 1.8 million deaths in 2015. While effective treatment exists, implementation of active case finding (ACF) methods to identify persons with active TB in a timely and cost-effective manner continues to be a major challenge in resource-constrained settings. Limited qualitative work has been conducted to gain an in-depth understanding of implementation barriers. Methods Qualitative research was conducted to inform the development of three ACF strategies for TB to be evaluated as part of the Kharitode cluster-randomised trial being conducted in a rural province of South Africa. This included 25 semi-structured in-depth interviews among 8 TB patients, 7 of their household members and 10 clinic health workers, as well as 4 focus group discussions (2 rural and 2 main town locations) with 6–8 participants each (n = 27). Interviews and focus group discussions explored the context, advantages and limitations, as well as the implications of three ACF methods. Content analysis was utilised to document salient themes regarding their feasibility, acceptability and potential effectiveness. Results Study participants (TB patients and community members) reported difficulty identifying TB symptoms and seeking care in a timely fashion. In turn, all stakeholder groups felt that more proactive case finding strategies would be beneficial. Clinic-based strategies (including screening all patients regardless of visit purpose) were seen as the most acceptable method based on participants’ preference ranking of the ACF strategies. However, given the resource constraints experienced by the public healthcare system in South Africa, many participants doubted whether it would be the most effective strategy. Household outreach and incentive-based strategies were described as promising, but participants reported some concerns (e.g. stigma in case of household-based and ethical concerns in the case of incentives). Participants offered insights into how to optimise each strategy, tailoring implementation to community needs (low TB knowledge) and realities (financial constraints, transport, time off from work). Conclusions Findings suggest different methods of TB ACF are likely to engage different populations, highlighting the utility of a comprehensive approach. Trial registration Clinicaltrials.gov (NCT02808507). Registered June 1, 2016. The participants in this formative study are not trial participants.
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Affiliation(s)
- Deanna Kerrigan
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 257, Baltimore, MD, 21205, United States of America
| | - Nora West
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6532, Baltimore, MD, 21205, United States of America.
| | - Carrie Tudor
- International Council of Nurses, 3 Place Jean Marteau, 1201, Geneva, Switzerland
| | - Colleen F Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6031, Baltimore, MD, 21205, United States of America
| | - Limakatso Lebina
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, 2000, South Africa
| | - Reginah Msandiwa
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, 2000, South Africa
| | - Lesego Mmolawa
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, 2000, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, 2000, South Africa
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6531, Baltimore, MD, 21205, United States of America
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Tudor C, Van der Walt ML, Margot B, Dorman SE, Pan WK, Yenokyan G, Farley JE. Occupational Risk Factors for Tuberculosis Among Healthcare Workers in KwaZulu-Natal, South Africa. Clin Infect Dis 2016; 62 Suppl 3:S255-61. [PMID: 27118855 PMCID: PMC4845891 DOI: 10.1093/cid/ciw046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tuberculosis is a known occupational hazard for healthcare workers (HCWs), especially in countries with a high burden of tuberculosis. It is estimated that HCWs have a 2- to 3-fold increased risk of developing tuberculosis compared with the general population. The objective of this study was to identify occupational risk factors for tuberculosis among HCWs in 3 district hospitals with specialized multidrug-resistant tuberculosis wards in KwaZulu-Natal, South Africa. METHODS We conducted a case-control study of HCWs diagnosed with tuberculosis between January 2006 and December 2010. Cases and controls were asked to complete a self-administered questionnaire regarding potential risk factors for tuberculosis. RESULTS Of 307 subjects selected, 145 (47%) HCWs responded to the questionnaire; 54 (37%) tuberculosis cases and 91 (63%) controls. Cases occurred more frequently among clinical staff 46% (n = 25) and support staff 35% (n = 19). Thirty-two (26% [32/125]) HCWs were known to be infected with human immunodeficiency virus (HIV), including 45% (21/54) of cases. HCWs living with HIV (odds ratio [OR], 6.35; 95% confidence interval [CI], 3.54-11.37) and those who spent time working in areas with patients (OR, 2.24; 95% CI, 1.40-3.59) had significantly greater odds of developing tuberculosis, controlling for occupation, number of wards worked in, and household crowding. CONCLUSIONS HIV was the major independent risk factor for tuberculosis among HCWs in this sample. These findings support the need for HCWs to know their HIV status, and for HIV-infected HCWs to be offered antiretroviral therapy and isoniazid preventive therapy. Infection prevention and control should also be improved to prevent transmission of tuberculosis in healthcare settings to protect both HCWs and patients.
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Affiliation(s)
- Carrie Tudor
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | | | - Bruce Margot
- Department of Communicable Diseases, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Susan E Dorman
- Division of Infectious Disease, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - William K Pan
- Nicholas School of Environment and Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Jason E Farley
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
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Serban D, Branescu C, Savlovschi C, Simion G, Mihai A, El-Khatib A, Tudor C, Nica A, Vancea G, Ghelase M, Dascalu AM. 5 -year complex clinical and histopathological follow-up of a case of early gastric carcinoma (signet ring cells type). J Med Life 2016; 9:291-293. [PMID: 27974937 PMCID: PMC5154317] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The paper presents the case of a male patient, hospitalized for acute abdomen due to perforated callous ulcer. Though the clinical appearance suggested a benign pathology, the histopathological exam of the resection piece showed multicentric early gastric carcinoma, signet ring cell type. At the patient's request, total gastrectomy was not performed, a conservative solution being chosen instead. Superior digestive endoscopy with biopsy and oncological dispensarization was performed one month after surgery, then at every 6 months. After 2 years of benign results, the histopathological exam revealed the presence of malign singlet ring cells in the bioptic specimen. Respecting the patient's option of preserving a good quality of life, subtotal gastrectomy with Pean type gastroenteroanastomosis was performed followed by postoperatory chemotherapy. Endoscopic and oncological follow-up were performed at every six months for another 3 years (up to present), and the evolution was favorable with no local or metastatic recurrence. Histopathological examination was of great help in the surgical management of this case, allowing a fortunate early diagnosis, a conservative surgical approach, and the preserving of a good quality of life.
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Affiliation(s)
- D Serban
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C Branescu
- IVth Upper Digestive Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - C Savlovschi
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - G Simion
- IVth Upper Digestive Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - A Mihai
- IVth Upper Digestive Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - A El-Khatib
- IVth Upper Digestive Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - C Tudor
- IVth Upper Digestive Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - A Nica
- IVth Upper Digestive Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - G Vancea
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - M Ghelase
- University of Medicine and Pharmacy, Craiova, Romania
| | - AM Dascalu
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,IVth Upper Digestive Surgery Clinic, University Emergency Hospital, Bucharest, Romania
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15
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Tudor C, Branescu C, Savlovschi C, El-Khatib A, Pantu H, Nica A, Dascalu AM, Masoumeh B, Tudor AS, Oprescu SM, Serban D. Gastrostomy with peritoneal collar versus percutaneous endoscopic gastrostomy. J Med Life 2016; 9:408-412. [PMID: 27928446 PMCID: PMC5141402] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim. The present study aimed to perform a medico-surgical comparative analysis of the 2 most widely used techniques: gastrostomy with peritoneal collar versus percutaneous endoscopic gastrostomy, based on the vast clinical experience in an Upper Digestive Surgery Clinic. Materials and method. A retrospective study was carried out between January 2010 and January 2015 on the patients admitted for a surgical solution for feeding. The indications, preoperative preparation, surgical techniques, and postoperative outcomes were analyzed. Results. Out of the 94 cases admitted for a surgical solution for feeding, 67 underwent gastrostomy with peritoneal collar (GPC) and in 27 cases percutaneous endoscopic gastrostomy (PEG) was performed. The indications for GPC were benign or malign causes of dysphagia, the most frequent being malign tumors of tongue, pharynx and larynx (47.76%), advanced inoperable esophageal or eso-cardiac cancers (26,86%), post-caustic esophageal stenosis (10.44%). PEG was performed in patients with functional difficulties of swallowing: sequelae of cerebral vascular accidents (44.44%), low Glasgow Coma Scale Score (29.62%) of different etiologies, Parkinson disease (18.51%) advanced dementia (7.4%), early nasopharyngeal cancer (2 cases). The intraoperatory and postoperatory complications were few and of minor importance in both techniques, but PEG allowed an immediate retake of alimentation (vs. at least 48 hours wait in GPC), with less gastric stasis, biliary reflux and aspiration related respiratory problems. Conclusions. Both techniques are easy and safe to perform, but an appropriate selection is required according to the cause of the swallowing difficulty. In cases with permeable digestive tube, PEG may be an excellent minimally invasive solution, but the costs and availability of the PEG kit and prehydrolyzed nutritive solution, as well as the co-existence of an upper digestive endoscopy service were limitations that had to be taken into account.
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Affiliation(s)
- C Tudor
- Upper Digestive Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - C Branescu
- Upper Digestive Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - C Savlovschi
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A El-Khatib
- Upper Digestive Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - H Pantu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A Nica
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - AM Dascalu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - B Masoumeh
- SC El-Khatib Medica SRL, Bucharest, Romania
| | - AS Tudor
- Medlife Hyper Clinic, Bucharest, Romania
| | - SM Oprescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - D Serban
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Serban D, Branescu C, Savlovschi C, El-Khatib A, Tudor C, Nica A, Kraft A, Dascalu AM. Complex histopathological and surgical aspects in a case of giant malignant gastric perforation. J Med Life 2016; 9:216-9. [PMID: 27453758 PMCID: PMC4863518] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
We present the case of a 52-year-old male patient, hospitalized on an emergency basis in the University Emergency Hospital in Bucharest, after being diagnosed with pneumoperitoneum acute abdomen, for which emergency surgery was mandatory. A 3,5-4 cm malignant gastric perforation, ascitis and peritoneal carcinomatosis were found. The histopathological exam revealed infiltrative mucinous gastric carcinoma with epiploic metastasis. Due to the lack of available gastric material, an atypical surgical solution was performed: gastric packing with epiploic material by means of transgastric traction. The solution proved to be successful for short-term recovery. The underlying condition was not focused on, the patient being directed to the Oncology Department. Acute gastric perforation is a rare complication of gastric cancer, and the association with gastric linitis is uncommon. This specific histopathological condition made the classical surgical repair techniques unsuitable for the presented case and an atypical solution had to be performed.
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Affiliation(s)
- D Serban
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C Branescu
- University Emergency Hospital, Upper Digestive Surgery Clinic, Bucharest, Romania
| | - C Savlovschi
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A El-Khatib
- University Emergency Hospital, Upper Digestive Surgery Clinic, Bucharest, Romania
| | - C Tudor
- University Emergency Hospital, Upper Digestive Surgery Clinic, Bucharest, Romania
| | - A Nica
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A Kraft
- University Emergency Hospital, Upper Digestive Surgery Clinic, Bucharest, Romania
| | - AM Dascalu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Serban D, Branescu C, Savlovschi C, Purcărea AP, El-Khatib A, Balasescu SA, Nica A, Dascalu AM, Vancea G, Oprescu SM, Tudor C. Laparoscopic cholecystectomy in patients aged 60 years and over - our experience. J Med Life 2016; 9:358-362. [PMID: 27928438 PMCID: PMC5141394] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim. To analyze the efficiency of laparoscopic cholecystectomy for the population aged 60 years and over admitted with acute cholecystitis, the clinical features and associated pathology presented by these patients and the impact of these factors on the choice of surgical technique. Materials and method. A retrospective study was carried out between February 2010 and February 2015, on patients aged 60 years and over, operated in emergency for acute cholecystitis in our clinic. All data were extracted from the registered medical documents and operatory protocols. Results. A total of 497 surgeries were performed for acute cholecystitis, of which 149 were patients aged 60 years and over (30%). Open surgery is much better represented in the population aged over 60 years (61.75% vs. 29.98%). One major cause is the associated pathology that increases the anesthetic risk and hampers a laparoscopic procedure. The conversion rate in the study group presented a higher percentage, but not more exaggerated than in the general population (6.71% vs. 4.63 %).Patients who underwent laparoscopic surgery had a faster recovery and required lower doses and shorter term pain medication, in contrast to conventional surgery (1,8 days vs. 5.7 days). Bile leak has been of reduced quantity, short-term and stopped spontaneously. Only one case needed reintervention, in which aberrant bile ducts that were clipped were found in the gallbladder bed, was operated by laparoscopy. Wound infections and swelling were also encountered more frequently in patients that underwent classic surgery (3.24%). Conclusions. Performing laparoscopic cholecystectomy, when possible, has produced very good results, reducing the average length of stay of patients and even decreasing the number of postoperative complications, thus allowing a faster reintegration of patients into society. The main concern was related to the associated pathology that increased the anesthetic risk.
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Affiliation(s)
- D Serban
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C Branescu
- Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania
| | - C Savlovschi
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - AP Purcărea
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A El-Khatib
- Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania
| | - SA Balasescu
- Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania
| | - A Nica
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - AM Dascalu
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - G Vancea
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - SM Oprescu
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C Tudor
- Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania
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18
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Xu J, Nolan MT, Heinze K, Yenokyan G, Hughes MT, Johnson J, Kub J, Tudor C, Sulmasy DP, Lehmann LS, Gallo JJ, Rockko F, Lee MC. Symptom frequency, severity, and quality of life among persons with three disease trajectories: cancer, ALS, and CHF. Appl Nurs Res 2015; 28:311-5. [PMID: 26608431 DOI: 10.1016/j.apnr.2015.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 08/06/2014] [Revised: 12/30/2014] [Accepted: 03/05/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE National reports on end-of-life symptom management reveal a gap in the evidence regarding symptoms other than pain and studies of diseases other than cancer. This study examines the frequency and severity of symptoms and quality of life (QOL) in persons with advanced cancer, amyotrophic lateral sclerosis (ALS), and congestive heart failure (CHF). METHODS The present study is a cross-sectional examination of symptoms and QOL measured using the McGill QOL Questionnaire, among 147 participants. RESULTS Forty one percent of participants had advanced cancer, 22% had ALS, and 37% had advanced CHF. A total of 266 symptoms were reported, with the common symptom categories being discomfort/pain, weakness/fatigue/sleep, and respiratory. Participants with CHF had the highest mean symptom severity and the lowest QOL. CONCLUSION Clinicians should be aware and attentive for symptoms other than pain in patients with advanced illness. Studies on diseases other than cancer, such as CHF and ALS, are important to improve symptom management in all disease groups.
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Affiliation(s)
- Jiayun Xu
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | - Marie T Nolan
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | - Katherine Heinze
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | - Gayane Yenokyan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Mark T Hughes
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Julie Johnson
- The University of Chicago Medicine, Chicago, IL 60637, USA.
| | - Joan Kub
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | - Carrie Tudor
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | | | | | - Joseph J Gallo
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Felicia Rockko
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
| | - Mei Ching Lee
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA.
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Tudor C, Van der Walt M, Margot B, Dorman SE, Pan WK, Yenokyan G, Farley JE. Tuberculosis among health care workers in KwaZulu-Natal, South Africa: a retrospective cohort analysis. BMC Public Health 2014; 14:891. [PMID: 25174848 PMCID: PMC4161912 DOI: 10.1186/1471-2458-14-891] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is an occupational hazard for health care workers (HCWs) who are at greater risk of developing TB than the general population. The objective of this study was to compare the difference in TB incidence among HCWs with versus without a history of working in TB wards, to estimate the incidence of TB among HCWs, and to identify risk factors for TB disease in HCWs. METHODS A retrospective cohort study (January 2006 to December 2010) was conducted in three district hospitals in KwaZulu-Natal, South Africa. Data were abstracted via chart review from occupational health medical records. Bivariate and multivariate analyses were performed using a Poisson multilevel mixed model. RESULTS Of 1,313 (92%) medical charts reviewed with data on location of work documented, 112 (9%) cases of TB were identified. Among HCWs with TB 14 (13%) had multidrug-resistant TB. Thirty-six (32%) were cured, 33 (29%) completed treatment, and 13 (12%) died. An increased incidence of TB was reported for HCWs with a history of working in TB wards (incidence rate ratio [IRR] 2.03, 95% CI 1.11-3.71), pediatric wards (IRR 1.82 95% CI 1.07-3.10), outpatient departments (IRR 2.08 95% CI 1.23-3.52), and stores/workshop (IRR 2.38 95% CI 1.06-5.34) compared with those without such a history. HCWs living with HIV had a greater incidence of TB (IRR 3.2, 95% CI 1.54-6.66) than HIV-negative HCWs. TB incidence among HCWs was approximately two-fold greater than that of the general population over the study period. CONCLUSIONS HCWs working in a TB ward had an increased incidence of TB. However, a greater incidence of TB was also found in HCWs working in other wards including pediatric wards, outpatient departments and stores. We also identified a greater incidence of TB among HCWs than the general population. These findings further support the need for improved infection control measures not only in TB or drug-resistant TB wards or areas perceived to be at high-risk but also throughout hospitals to protect HCWs. Additionally, it is recommended for occupational health services to routinely screen HCWs for TB and provide HCWs with access to care for TB and HIV.
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Affiliation(s)
- Carrie Tudor
- />Fogarty Global Health Post-doctoral Fellow, University of North Carolina, Chapel Hill, 211 W. Sierra Circle, San Marcos, TX 78666 USA
| | | | - Bruce Margot
- />KwaZulu-Natal Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Susan E Dorman
- />Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - William K Pan
- />Duke University Nicholas School of Environment and Duke Global Health Institute, Durham, NC USA
| | - Gayane Yenokyan
- />Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland USA
| | - Jason E Farley
- />Johns Hopkins University School of Nursing, Baltimore, Maryland USA
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Clausel M, Roueff F, Taqqu M, Tudor C. Asymptotic behavior of the quadratic variation of the sum of two Hermite processes of consecutive orders. Stoch Process Their Appl 2014. [DOI: 10.1016/j.spa.2014.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Tudor C, Mphahlele M, Van der Walt M, Farley JE. Health care workers' fears associated with working in multidrug- and or extensively-resistant tuberculosis wards in South Africa. Int J Tuberc Lung Dis 2014; 17:22-29. [PMID: 24020597 DOI: 10.5588/ijtld.13.0109] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Twenty-four drug-resistant tuberculosis (TB) hospitals and wards across all nine provinces of South Africa. OBJECTIVE To assess health care workers' (HCWs') fears of working in multidrug-resistant TB (MDR-TB) or extensively drug-resistant TB (XDR-TB) wards. DESIGN A cross-sectional descriptive study was conducted from June to September 2009 in 24 drug-resistant TB hospitals across South Africa. HCWs completed a self-administered questionnaire, including one open-ended question regarding personal concerns about their fear of contracting MDR- or XDR-TB. Responses were analysed by content analysis. RESULTS Among the 24 hospitals, 499 HCWs were surveyed, of whom 363 (73%) responded to the open-ended question: 286 (86%) were nurses, 38 (11%) medical officers and 10 (3%) others. Six major themes regarding fears associated with the personal risk of acquiring drug-resistant TB emerged. These included the fear of 1) developing MDR- and XDR-TB, 2) the treatment course, 3) the financial implications, 4) family concerns, 5) working environment and 6) psychosocial issues. CONCLUSIONS These data suggest that the greatest fear of HCWs working in drug-resistant TB wards is contracting MDR- or XDR-TB and infecting others. This fear may negatively impact the provision of quality patient-centred care, and highlights the need for training of HCWs in infection control measures, and specifically on how HCWs can protect themselves and others from developing TB.
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Affiliation(s)
- C Tudor
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - M Mphahlele
- South African Medical Research Council TB Epidemiology and Intervention Research Unit, Pretoria, South Africa
| | - M Van der Walt
- South African Medical Research Council TB Epidemiology and Intervention Research Unit, Pretoria, South Africa
| | - J E Farley
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Clausel M, Roueff F, Taqqu M, Tudor C. Wavelet estimation of the long memory parameter for Hermite polynomial of Gaussian processes. ESAIM-PROBAB STAT 2013. [DOI: 10.1051/ps/2012026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Tudor C, Van der Walt M, Hill MN, Farley JE. Occupational health policies and practices related to tuberculosis in health care workers in KwaZulu-Natal, South Africa. Public Health Action 2013; 3:141-5. [PMID: 26393017 PMCID: PMC4463108 DOI: 10.5588/pha.12.0098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 12/13/2012] [Accepted: 02/22/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Three district hospitals in KwaZulu-Natal, South Africa, with specialized drug-resistant tuberculosis (TB) wards. OBJECTIVE To increase understanding of the implementation of occupational health (OH) and infection control (IC) guidelines for the prevention and control of TB among health care workers (HCWs). DESIGN An operational cross-sectional study conducted between July and September 2011, consisting of interviews with OH and IC nurses and chart review of OH medical records. RESULTS Although general national and provincial OH policies are in place, no specific OH policies exist for hospital settings. Two of three hospitals had a full-time OH nurse and all had a full-time IC nurse. All hospitals offered TB symptom screening; however, only 19% of HCWs were screened in 2010. TB incidence among HCWs was 1958 per 100 000 population in 2010. All hospitals offered HIV counseling and testing; however, only 22% of staff were tested across sites. Two hospitals offered isoniazid preventive therapy to HIV-positive staff and reassigned these staff to low TB risk areas. CONCLUSIONS While OH policies and procedures are in place, implementation of these policies and procedures is inconsistent. This potentially places HCWs at risk of acquiring TB. These findings support the need for strengthening OH and IC services to prevent TB.
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Affiliation(s)
- C Tudor
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - M Van der Walt
- South African Medical Research Council, Pretoria, South Africa
| | - M N Hill
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - J E Farley
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Morris J, Theiss-Nyland K, Coelius R, Stenson A, Tudor C, Cuomo M, Miller S. O679 COMPARING ZB11, A TRADITIONAL TIBETAN MEDICINE, TO MISOPROSTOL FOR PREVENTION OF POSTPARTUM HEMORRHAGE. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61109-6] [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: 10/27/2022]
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25
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Mphahlele MT, Tudor C, Van der Walt M, Farley J. An infection control audit in 10 primary health-care facilities in the Western Cape Province of South Africa. ACTA ACUST UNITED AC 2012. [DOI: 10.3396/ijic.v8i3.025.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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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26
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Farley JE, Tudor C, Mphahlele M, Franz K, Perrin NA, Dorman S, Van der Walt M. A national infection control evaluation of drug-resistant tuberculosis hospitals in South Africa. Int J Tuberc Lung Dis 2012; 16:82-9. [PMID: 22236851 DOI: 10.5588/ijtld.10.0791] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of infection control (IC) in health care settings with tuberculosis (TB) patients has been highlighted by recent health care-associated outbreaks in South Africa. OBJECTIVE To conduct operational evaluations of IC in drug-resistant TB settings at a national level. METHODS A cross-sectional descriptive study was conducted from June to September 2009 in all multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) facilities in South Africa. Structured interviews with key informants were completed, along with observation of IC practices. Health care workers (HCWs) were asked to complete an anonymous knowledge, attitudes and practices (KAP) questionnaire. Multilevel modeling was used to take into consideration the relationship between center and HCW level variables. RESULTS Twenty-four M(X)DR-TB facilities (100%) were enrolled. Facility infrastructure and staff adherence to IC recommendations were highly varied between facilities. Key informant interviews were incongruent with direct observation of practices in all settings. A total of 499 HCWs were enrolled in the KAP evaluation. Higher level of clinical training was associated with greater IC knowledge (P < 0.001), more appropriate attitudes (P < 0.001) and less time spent with coughing patients (P < 0.001). IC practices were poor across all disciplines. CONCLUSION These findings demonstrate a clear need to improve and standardize IC infrastructure in drug-resistant TB settings in South Africa.
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Affiliation(s)
- J E Farley
- School of Nursing, Johns Hopkins University, Baltimore, Maryland 21205, USA.
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Prithviraj GK, Sommers SR, Jump RL, Halmos B, Chambless LB, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC, Chambless LB, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC, Hunter K, Chamberlain MC, Le EM, Lee ELT, Chamberlain MC, Sadighi ZS, Pearlman ML, Slopis JM, Vats TS, Khatua S, DeVito NC, Yu M, Chen R, Pan E, Cloughesy T, Raizer J, Drappatz J, Gerena-Lewis M, Rogerio J, Yacoub S, Desjardin A, Groves MD, DeGroot J, Loghin M, Conrad CA, Hess K, Ni J, Ictech S, Hunter K, Yung WA, Porter AB, Dueck AC, Karlin NJ, Chamberlain MC, Olson J, Silber J, Reiner AS, Panageas KS, Iwamoto FM, Cloughesy TF, Aldape KD, Rivera AL, Eichler AF, Louis DN, Paleologos NA, Fisher BJ, Ashby LS, Cairncross JG, Roldan GB, Wen PY, Ligon KL, Shiff D, Robins HI, Rocque BG, Chamberlain MC, Mason WP, Weaver SA, Green RM, Kamar FG, Abrey LE, DeAngelis LM, Jhanwar SC, Rosenblum MK, Lassman AB, Cachia D, Alderson L, Moser R, Smith T, Yunus S, Saito K, Mukasa A, Narita Y, Tabei Y, Shinoura N, Shibui S, Saito N, Flechl B, Ackerl M, Sax C, Dieckmann K, Crevenna R, Widhalm G, Preusser M, Marosi C, Marosi C, Ay C, Preusser M, Dunkler D, Widhalm G, Pabinger I, Dieckmann K, Zielinski C, Belongia M, Jogal S, Schlingensiepen KH, Bogdahn U, Stockhammer G, Mahapatra AK, Venkataramana NK, Oliushine V, Parfenov V, Poverennova I, Hau P, Jachimczak P, Heinrichs H, Mammoser AG, Shonka NA, de Groot JF, Shibahara I, Sonoda Y, Kumabe T, Saito R, Kanamori M, Yamashita Y, Watanabe M, Ishioka C, Tominaga T, Silvani A, Gaviani P, Lamperti E, Botturi A, DiMeco F, Broggi G, Fariselli L, Solero CL, Salmaggi A, Green RM, Woyshner EA, Cloughesy TF, Shu F, Oh YS, Iganej S, Singh G, Vemuri SL, Theeler BJ, Ellezam B, Gilbert MR, Aoki T, Kobayashi H, Takano S, Nishikawa R, Shinoura N, Nagane M, Narita Y, Muragaki Y, Sugiyama K, Kuratsu J, Matsutani M, Sadighi ZS, Khatua S, Langford LA, Puduvalli VK, Shen D, Chen ZP, Zhang JP, Chen ZP, Bedekar D, Rand S, Connelly J, Malkin M, Paulson E, Mueller W, Schmainda K, Gallego O, Benavides M, Segura PP, Balana C, Gil M, Berrocal A, Reynes G, Garcia JL, Murata P, Bague S, Quintana MJ, Vasishta VG, Nagane M, Kobayashi K, Tanaka M, Tsuchiya K, Shiokawa Y, Bavle AA, Ayyanar K, Puduvalli VK, Prado MP, Hess KR, Hunter K, Ictech S, Groves MD, Gilbert MR, Liu V, Conrad CA, de Groot J, Loghin ME, Colman H, Levin VA, Alfred Yung WK, Hackney JR, Palmer CA, Markert JM, Cure J, Riley KO, Fathallah-Shaykh H, Nabors LB, Saria MG, Corle C, Hu J, Rudnick J, Phuphanich S, Mrugala MM, Lee LK, Fu BD, Bota DA, Kim RY, Brown T, Feely H, Hu A, Drappatz J, Wen PY, Lee JW, Carter B, Kesari S, Fu BD, Kong XT, Bota DA, Fu BD, Bota DA, Sparagana S, Belousova E, Jozwiak S, Korf B, Frost M, Kuperman R, Kohrman M, Witt O, Wu J, Flamini R, Jansen A, Curtalolo P, Thiele E, Whittemore V, De Vries P, Ford J, Shah G, Cauwel H, Edrich P, Sahmoud T, Franz D, Khasraw M, Brown C, Ashley DM, Rosenthal MA, Jiang X, Mou YG, Chen ZP, Oh M, kim E, Chang J, Juratli TA, Kirsch M, Schackert G, Krex D, Gilbert MR, Wang M, Aldape KD, Stupp R, Hegi M, Jaeckle KA, Armstrong TS, Wefel JS, Won M, Blumenthal DT, Mahajan A, Schultz CJ, Erridge SC, Brown PD, Chakravarti A, Curran WJ, Mehta MP, Hofland KF, Hansen S, Sorensen M, Schultz H, Muhic A, Engelholm S, Ask A, Kristiansen C, Thomsen C, Poulsen HS, Lassen UN, Zalatimo O, Weston C, Zoccoli C, Glantz M, Rahmanuddin S, Shiroishi MS, Cen SY, Jones J, Chen T, Pagnini P, Go J, Lerner A, Gomez J, Law M, Ram Z, Wong ET, Gutin PH, Bobola MS, Alnoor M, Silbergeld DL, Rostomily RC, Chamberlain MC, Silber JR, Martha N, Jacqueline S, Thaddaus G, Daniel P, Hans M, Armin M, Eugen T, Gunther S, Hutterer M, Tseng HM, Zoccoli CM, Glantz M, Zalatimo O, Patel A, Rizzo K, Sheehan JM, Sumrall AL, Vredenburgh JJ, Desjardins A, Reardon DA, Friiedman HS, Peters KB, Taylor LP, Stewart M, Blondin NA, Baehring JM, Foote T, Laack N, Call J, Hamilton MG, Walling S, Eliasziw M, Easaw J, Shirsat NV, Kundar R, Gokhale A, Goel A, Moiyadi AA, Wang J, Mutlu E, Oyan A, Yan T, Tsinkalovsky O, Jacobsen HK, Talasila KM, Sleire L, Pettersen K, Miletic H, Andersen S, Mitra S, Weissman I, Li X, Kalland KH, Enger PO, Sepulveda J, Belda C, Balana C, Segura PP, Reynes G, Gil M, Gallego O, Berrocal A, Blumenthal DT, Sitt R, Phishniak L, Bokstein F, Philippe M, Carole C, Andre MDP, Marylin B, Olivier C, L'Houcine O, Dominique FB, Philippe M, Isabelle NM, Olivier C, Frederic F, Stephane F, Henry D, Marylin B, L'Houcine O, Dominique FB, Errico MA, Kunschner LJ, Errico MA, Kunschner LJ, Soffietti R, Trevisan E, Ruda R, Bertero L, Bosa C, Fabrini MG, Lolli I, Jalali R, Julka PK, Anand AK, Bhavsar D, Singhal N, Naik R, John S, Mathew BS, Thaipisuttikul I, Graber J, DeAngelis LM, Shirinian M, Fontebasso AM, Jacob K, Gerges N, Montpetit A, Nantel A, Albrecht S, Jabado N, Mammoser AG, Shah K, Conrad CA, Di K, Linskey M, Bota DA, Thon N, Eigenbrod S, Kreth S, Lutz J, Tonn JC, Kretzschmar H, Peraud A, Kreth FW, Muggeri AD, Alderuccio JP, Diez BD, Jiang P, Chao Y, Gallagher M, Kim R, Pastorino S, Fogal V, Kesari S, Rudnick JD, Bresee C, Rogatko A, Sakowsky S, Franco M, Hu J, Lim S, Lopez A, Yu L, Ryback K, Tsang V, Lill M, Steinberg A, Sheth R, Grimm S, Helenowski I, Rademaker A, Raizer J, Nunes FP, Merker V, Jennings D, Caruso P, Muzikansky A, Stemmer-Rachamimov A, Plotkin S, Spalding AC, Vitaz TW, Sun DA, Parsons S, Welch MR, Omuro A, DeAngelis LM, Omuro A, Beal K, Correa D, Chan T, DeAngelis L, Gavrilovic I, Nolan C, Hormigo A, Lassman AB, Kaley T, Mellinghoff I, Grommes C, Panageas K, Reiner A, Barradas R, Abrey L, Gutin P, Lee SY, Slagle-Webb B, Glantz MJ, Sheehan JM, Connor JR, Schlimper CA, Schlag H, Stoffels G, Weber F, Krueger DA, Care MM, Holland K, Agricola K, Tudor C, Byars A, Sahmoud T, Franz DN, Raizer J, Rice L, Rademaker A, Chandler J, Levy R, Muro K, Grimm S, Nayak L, Iwamoto FM, Rudnick JD, Norden AD, Omuro A, Kaley TJ, Thomas AA, Fadul CE, Meyer LP, Lallana EC, Colman H, Gilbert M, Alfred Yung WK, Aldape K, De Groot J, Conrad C, Levin V, Groves M, Loghin M, Chris P, Puduvalli V, Nagpal S, Feroze A, Recht L, Rangarajan HG, Kieran MW, Scott RM, Lew SM, Firat SY, Segura AD, Jogal SA, Kumthekar PU, Grimm SA, Avram M, Patel J, Kaklamani V, McCarthy K, Cianfrocca M, Gradishar W, Mulcahy M, Von Roenn J, Helenowski I, Rademaker A, Raizer J, Galanis E, Anderson SK, Lafky JM, Kaufmann TJ, Uhm JH, Giannini C, Kumar SK, Northfelt DW, Flynn PJ, Jaeckle KA, Buckner JC, Omar AI, Panageas KS, Iwamoto FM, Cloughesy TF, Aldape KD, Rivera AL, Eichler AF, Louis DN, Paleologos NA, Fisher BJ, Ashby LS, Cairncross JG, Roldan GB, Wen PY, Ligon KL, Schiff D, Robins HI, Rocque BG, Chamberlain MC, Mason WP, Weaver SA, Green RM, Kamar FG, Abrey LE, DeAngelis LM, Jhanwar SC, Rosenblum MK, Lassman AB, Delios A, Jakubowski A, DeAngelis L, Grommes C, Lassman AB, Theeler BJ, Melguizo-Gavilanes I, Shonka NA, Qiao W, Wang X, Mahajan A, Puduvalli V, Hashemi-Sadraei N, Bawa H, Rahmathulla G, Patel M, Elson P, Stevens G, Peereboom D, Vogelbaum M, Weil R, Barnett G, Ahluwalia MS, Alvord EC, Rockne RC, Rockhill JK, Mrugala MM, Rostomily R, Lai A, Cloughesy T, Wardlaw J, Spence AM, Swanson KR, Zadeh G, Alahmadi H, Wilson J, Gentili F, Lassman AB, Wang M, Gilbert MR, Aldape KD, Beumer JJ, Wright J, Takebe N, Puduvalli VK, Hormigo A, Gaur R, Werner-Wasik M, Mehta MP, Gupta AJ, Campos-Gines A, Le K, Arango C, Richards M, Landeros M, Juan H, Chang JH, Kim JS, Cho JH, Seo CO, Baldock AL, Rockne R, Canoll P, Born D, Yagle K, Swanson KR, Alexandru D, Bota D, Linskey ME, Nabeel S, Raval SN, Raizer J, Grimm S, Rice L, Rosenow J, Levy R, Bredel M, Chandler J, New PZ, Plotkin SR, Supko JG, Curry WT, Chi AS, Gerstner ER, Stemmer-Rachamimov A, Batchelor TT, Ahluwalia MS, Hashemi N, Rahmathulla G, Patel M, Chao ST, Peereboom D, Weil RJ, Suh JH, Vogelbaum MA, Stevens GH, Barnett GH, Corwin D, Holdsworth C, Stewart R, Rockne R, Swanson K, Graber JJ, Kaley T, Rockne RC, Anderson AR, Swanson KR, Jeyapalan S, Goldman M, Boxerman J, Donahue J, Elinzano H, Evans D, O'Connor B, Puthawala MY, Oyelese A, Cielo D, Blitstein M, Dargush M, Santaniello A, Constantinou M, DiPetrillo T, Safran H, Plotkin SR, Halpin C, Merker V, Barker FG, Maher EA, Ganji S, DeBerardinis R, Hatanpaa K, Rakheja D, Yang XL, Mashimo T, Raisanen J, Madden C, Mickey B, Malloy C, Bachoo R, Choi C, Ranjan T, Yono N, Zalatimo O, Zoccoli C, Glantz M, Han SJ, Sun M, Berger MS, Aghi M, Gupta N, Parsa AT. MEDICAL AND NEURO-ONCOLOGY. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor152] [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: 11/14/2022] Open
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Sharma RK, Hughes MT, Nolan MT, Tudor C, Kub J, Terry PB, Sulmasy DP. Family understanding of seriously-ill patient preferences for family involvement in healthcare decision making. J Gen Intern Med 2011; 26:881-6. [PMID: 21499822 PMCID: PMC3138973 DOI: 10.1007/s11606-011-1717-6] [Citation(s) in RCA: 35] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Surrogate accuracy in predicting patient treatment preferences (i.e., what patients want) has been studied extensively, but it is not known whether surrogates can predict how patients want loved ones to make end-of-life decisions on their behalf. OBJECTIVE To evaluate the ability of family members to correctly identify the preferences of seriously-ill patients regarding family involvement in decision making. DESIGN Cross-sectional survey. PARTICIPANTS Twenty-five pancreatic cancer and 27 amyotrophic lateral sclerosis (ALS) patients and their family members (52 dyads total). MAIN MEASURES Patients and family members completed the Decision Control Preferences (DCP) scale regarding patient preferences for family involvement in health care decisions using conscious and unconscious scenarios. KEY RESULTS Patient and family member agreement was 56% (29/52 dyads) for the conscious scenario (kappa 0.29) and 46% (24/52 dyads) for the unconscious scenario (kappa 0.15). Twenty-four family members identified the patient's preference as independent in the unconscious scenario, but six of these patients actually preferred shared decision making and six preferred reliant decision making. In the conscious scenario, preference for independent decision making was associated with higher odds of patient-family agreement (AOR 5.28, 1.07-26.06). In the unconscious scenario, cancer patients had a higher odds of agreement than ALS patients (AOR 3.86; 95% CI 1.02-14.54). CONCLUSION Family members were often unable to correctly identify patient preferences for family involvement in end-of-life decision making, especially when patients desired that decisions be made using the best-interest standard. Clinicians and family members should consider explicitly eliciting patient preferences for family involvement in decision making. Additional research is still needed to identify interventions to improve family member understanding of patient preferences regarding the decision-making process itself.
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Affiliation(s)
- Rashmi K Sharma
- Division of Hospital Medicine, Northwestern University, Chicago, IL 60611, USA.
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Coelius RL, Stenson A, Morris JL, Cuomu M, Tudor C, Miller S. The tibetan uterotonic zhi byed 11: mechanisms of action, efficacy, and historical use for postpartum hemorrhage. Evid Based Complement Alternat Med 2011; 2012:794164. [PMID: 21822444 PMCID: PMC3142552 DOI: 10.1155/2012/794164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/12/2011] [Accepted: 05/25/2011] [Indexed: 11/29/2022]
Abstract
Objective. To explore evidence for the traditional Tibetan medicine, Zhi Byed 11 (ZB11), for use as a uterotonic. Methods. The eleven ingredients in ZB11 were chemically analyzed by mass spectroscopy. A review was conducted of Western allopathic literature for scientific studies on ZB11's individual components. Literature from Tibetan and other traditional paradigms were reviewed. Results. Potential mechanisms of action for ZB11 as a uterotonic include laxative effects, a dose-dependant increase in smooth muscle tissue peristalsis that may also affect the uterus smooth muscle, and chemical components that are prostaglandin precursors and/or increase prostaglandin synthesis. A recent RCT demonstrated comparable efficacy to misoprostol in reducing severe postpartum hemorrhage (PPH) (>1000 mL) and greater effect than placebo. Historical and anecdotal evidence for ZB11 and its ingredients for childbirth provide further support. Discussion. ZB11 and its ingredients are candidates for potentially effective uterotonics, especially in low-resource settings. Further research is warranted to understand the mechanisms of action and synergy between ingredients.
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Affiliation(s)
- Rebecca Lynn Coelius
- School of Medicine, University of California, San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA
| | - Amy Stenson
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, Center for the Health Sciences, University of California, Los Angeles, 10,833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Jessica L. Morris
- Safe Motherhood Program, University of California, San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA
| | - Mingji Cuomu
- The Institute for Social and Cultural Anthropology, University of Oxford, 386 London Road, Headington, Oxford OX3 8DW, UK
- Tibetan Medical College, Lhasa, Tibet 850000, China
| | - Carrie Tudor
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Suellen Miller
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA
- Safe Motherhood Programs, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA
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Serban D, Brănescu C, Savlovschi C, Tiucă F, Tudor C, Kraft A, Sajin M, Simion G, Nistor A, Brumă G, Tudor A, Dascălu AM, Muşat L, Comandaşu M, Borcan R, Dumitrescu D, Popa-Cherecheanu A, Shanabli A, Găvan C, Bejgăneanu A, El-Khatib A, Ursache E, Oprescu S. [Clinical and morphological features in a case of recent gastric carcinoma (the signet ring cell carcinoma type)]. Chirurgia (Bucur) 2011; 106:383-387. [PMID: 21853750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The article presents the case of a male patient, hospitalized due to severe pain in the upper abdomen area, nausea, and vomiting. The patient was diagnosed with surgical acute abdomen, for which emergency surgery is performed. Upon penetration into the peritoneal cavity, stomach inspection shows at the medio-gastric level, on the greater curvature, a callous gastric ulcer, with a central perforation. A large excision is decided up to the healthy (normal) gastric tissue, and the resulting pieces are sent to the pathological anatomy laboratory. The histopathological exam reveals signet ring cell recent gastric carcinoma. The biopsy performed 1 month after surgery, prelevated from the antropyloric zone, reveals antropyloric gastritis with moderate activity and Helicobacter pylori positive. Due to the fact that such cases when this gastric cancer type is diagnosed in recent stages are extremely rare, we considered it useful to present it and look into its macroscopic and microscopic aspects, as well as into the differentiating diagnosis.
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Affiliation(s)
- D Serban
- Universitatea de Medicină şi Farmacie "Carol Davila", Bucureşti, România.
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Vasile D, Vasiliu O, Tudor C, Bogdan V, Mangalagiu A, Vasile M, Terpan M. Therapeutic efficacy of duloxetine versus selective serotonin reuptake inhibitors in irritable bowel syndrome. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72996-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
IntroductionSelective serotonin reuptake inhibitors (SSRIs) are frequently used for irritable bowel syndrome, while duloxetine was evaluated in other similar psycho-somatic syndromes.ObjectiveThis prospective, single-blind trial intends to compare the efficacy of SSRIs and duloxetine in the treatment of irritable bowel syndrome.MethodsA group of 22 patients, 15 female and 7 male, mean age 50.2, diagnosed with irritable bowel syndrome according to the Rome II Diagnostic Criteria (1992) were treated with either an SSRI (escitalopram 20 mg/day, n = 6 or fluoxetine 40 mg/day, n = 6) or duloxetine (90 mg/day, n = 10). Patients were evaluated initially and every 4 weeks, for 6 months, using Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale 17 items version (HAMD), Clinical Global Impressions -Severity/Improvement (CGI-I/S) and a 7-points Likert scale (LS) for self-evaluated severity.ResultsDuloxetine improved anxiety and depressive symptoms, as reflected by the significant decrease of HAMA (−17.6 points, p < 0.05) and HAMD scores (−18.2 points, p < 0.05) at week 12. SSRIs also reduced the affective symptoms, significantly to baseline (p < 0.05), but less than duloxetine (−14.3, −15.2) at week 12, with no significant difference at week 24 (p = 0.120). The CGI-I results paralleled the decrease of HAMD and HAMA, while the LS evaluation of gastrointestinal symptoms improved similarly in both groups, with no significant difference (p = 0.09).ConclusionDuloxetine is an efficient agent in the treatment of irritable bowel syndrome, because it decreases the mood symptoms more rapidly than SSRIs. The overall efficacy of SSRIs and duloxetine at 6 months is nevertheless similar.
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Vasile D, Vasiliu O, Mangalagiu A, Tudor C, Bogdan V, Paraico I. Cognitive behavioral therapy focused upon communicational skills enhancement in anorexia nervosa- a case series. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72445-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
IntroductionAnorexia nervosa (AN) has been approached from multiple medical, social and psychological perspectives, but it still stands as a major challenge for the clinician, due to its resistance to treatment, low therapeutic compliance and severe complications.ObjectiveTo asses the efficacy of an interpersonal focused cognitive-behavioral therapy (CBT) in patients diagnosed with AN.MethodsWe enrolled in 12 weeks, 3 sessions a week, CBT program a number of three patients, females, admitted successively in our departments, diagnosed with AN, who didn’t have previously any kind of psychotherapy. The first patient was 22, diagnosed with AN-restricting type, had a BMI of 14.5 and a score on Eating Attitudes Test (EAT) of 34. The second patient was 19, presented AN-binge eating-purging, had a BMI of 14 and an EAT score of 35. The third patient was 25, had also AN-binge eating-purging, a BMI of 15 and an EAT score of 32.ResultsThe first two patients responded well to the CBT program, but the first signs of recovery (EAT decreases of at least 5 points and increases of at least 1 unit on BMI) appeared after 10 weeks (15 sessions). The third patient discontinued rather fast the psychological treatment. The follow up (12 weeks after endpoint) showed relapse in one CBT-treated patient and a severe status of the patient that discontinued psychotherapy.ConclusionThe CBT focused on communicational skills enhancement is beneficial in patients with AN, but responses appear rather late and need to be boosted by frequent follow-up sessions.
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Vasile D, Vasiliu O, Vasile B, Tudor C, Grigorescu G, Mangalagiu A, Ojog D. Valproate and cognitive therapy combined treatment efficacy in pathological gambling. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72995-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
IntroductionValproate is used in psychiatry as a mood-stabilizer and has efficacy in controlling impulsivity, therefore it seems to be a useful pharmacologic agent in pathologic gambling.ObjectiveTo assess the efficacy of valproate in the treatment of pathologic gambling.MethodsA group of 13 patients, 9 male and 4 female, mean age 32.6, diagnosed with pathologic gambling, according to the DSM-IV-TR criteria, received treatment with flexible dose of valproate (600–1400 mg/day, mean dose 850 mg/day) and 2 times/week cognitive therapy sessions. Patients with other axis I and II conditions were excluded. Also, none of these patients received valproate or structured cognitive therapy prior to this trial. Patients were monitored for 3 months using monthly administered Gambling Symptoms Assessment Scale (G-SAS), Clinical Global Impressions (CGI) and 10 points self-evaluated Visual Analogue Scale (VAS).ResultsValproate was associated with a mean decrease of 10.5 points on G-SAS at week 12, compared to baseline (p < 0.05), while the CGI decreased with only 1.3 points (p = 0.122) and the VAS improved with 2.3 points (p < 0.05). The combined treatment was associated with good tolerability profile, since no drop-out was recorded in the study group due to side events and only 7 reports of mild and medium adverse events were recorded.ConclusionValproate treatment associated with cognitive therapy could be a useful strategy in the management of pathologic gambling. Valproate's tolerability profile is good and the cognitive therapy offer an opportunity to ventilate the negative automatic thoughts, emotional distress and low impulse control strategies.
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Clarke JL, Ennis MM, Lamborn KR, Prados MD, Puduvalli VK, Penas-Prado M, Gilbert MR, Groves MD, Hess KR, Levin VA, de Groot J, Colman H, Conrad CA, Loghin ME, Hunter K, Yung WK, Chen C, Damek D, Liu A, Gaspar LE, Waziri A, Lillehei K, Kavanagh B, Finlay JL, Haley K, Dhall G, Gardner S, Allen J, Cornelius A, Olshefski R, Garvin J, Pradhan K, Etzl M, Goldman S, Atlas M, Thompson S, Hirt A, Hukin J, Comito M, Bertolone S, Torkildson J, Joyce M, Moertel C, Letterio J, Kennedy G, Walter A, Ji L, Sposto R, Dorris K, Wagner L, Hummel T, Drissi R, Miles L, Leach J, Chow L, Turner R, Gragert MN, Pruitt D, Sutton M, Breneman J, Crone K, Fouladi M, Friday BB, Buckner J, Anderson SK, Giannini C, Kugler J, Mazurczac M, Flynn P, Gross H, Pajon E, Jaeckle K, Galanis E, Badruddoja MA, Pazzi MA, Stea B, Lefferts P, Contreras N, Bishop M, Seeger J, Carmody R, Rance N, Marsella M, Schroeder K, Sanan A, Swinnen LJ, Rankin C, Rushing EJ, Hutchins LF, Damek DM, Barger GR, Norden AD, Lesser G, Hammond SN, Drappatz J, Fadul CE, Batchelor TT, Quant EC, Beroukhim R, Ciampa A, Doherty L, LaFrankie D, Ruland S, Bochacki C, Phan P, Faroh E, McNamara B, David K, Rosenfeld MR, Wen PY, Hammond SN, Norden AD, Drappatz J, Phuphanich S, Reardon D, Wong ET, Plotkin SR, Lesser G, Mintz A, Raizer JJ, Batchelor TT, Quant EC, Beroukhim R, Kaley TJ, Ciampa A, Doherty L, LaFrankie D, Ruland S, Smith KH, Wen PY, Chamberlain MC, Graham C, Mrugala M, Johnston S, Kreisl TN, Smith P, Iwamoto F, Sul J, Butman JA, Fine HA, Westphal M, Heese O, Warmuth-Metz M, Pietsch T, Schlegel U, Tonn JC, Schramm J, Schackert G, Melms A, Mehdorn HM, Seifert V, Geletneky K, Reuter D, Bach F, Khasraw M, Abrey LE, Lassman AB, Hormigo A, Nolan C, Gavrilovic IT, Mellinghoff IK, Reiner AS, DeAngelis L, Omuro AM, Burzynski SR, Weaver RA, Janicki TJ, Burzynski GS, Szymkowski B, Acelar SS, Mechtler LL, O'Connor PC, Kroon HA, Vora T, Kurkure P, Arora B, Gupta T, Dhamankar V, Banavali S, Moiyadi A, Epari S, Merchant N, Jalali R, Moller S, Grunnet K, Hansen S, Schultz H, Holmberg M, Sorensen MM, Poulsen HS, Lassen U, Reardon DA, Vredenburgh JJ, Desjardins A, Janney DE, Peters K, Sampson J, Gururangan S, Friedman HS, Jeyapalan S, Constantinou M, Evans D, Elinzano H, O'Connor B, Puthawala MY, Goldman M, Oyelese A, Cielo D, Dipetrillo T, Safran H, Anan M, Seyed Sadr M, Alshami J, Sabau C, Seyed Sadr E, Siu V, Guiot MC, Samani A, Del Maestro R, Bogdahn U, Stockhammer G, Mahapatra AK, Venkataramana NK, Oliushine VE, Parfenov VE, Poverennova IE, Hau P, Jachimczak P, Heinrichs H, Schlingensiepen KH, Shibui S, Kayama T, Wakabayashi T, Nishikawa R, de Groot M, Aronica E, Vecht CJ, Toering ST, Heimans JJ, Reijneveld JC, Batchelor T, Mulholland P, Neyns B, Nabors LB, Campone M, Wick A, Mason W, Mikkelsen T, Phuphanich S, Ashby LS, DeGroot JF, Gattamaneni HR, Cher LM, Rosenthal MA, Payer F, Xu J, Liu Q, van den Bent M, Nabors B, Fink K, Mikkelsen T, Chan M, Trusheim J, Raval S, Hicking C, Henslee-Downey J, Picard M, Reardon D, Kaley TJ, Wen PY, Schiff D, Karimi S, DeAngelis LM, Nolan CP, Omuro A, Gavrilovic I, Norden A, Drappatz J, Purow BW, Lieberman FS, Hariharan S, Abrey LE, Lassman AB, Perez-Larraya JG, Honnorat J, Chinot O, Catry-Thomas I, Taillandier L, Guillamo JS, Campello C, Monjour A, Tanguy ML, Delattre JY, Franz DN, Krueger DA, Care MM, Holland-Bouley K, Agricola K, Tudor C, Mangeshkar P, Byars AW, Sahmoud T, Alonso-Basanta M, Lustig RA, Dorsey JF, Lai RK, Recht LD, Reardon DA, Paleologos N, Groves M, Rosenfeld MR, Meech S, Davis T, Pavlov D, Marshall MA, Sampson J, Slot M, Peerdeman SM, Beauchesne PD, Faure G, Noel G, Schmitt T, Kerr C, Jadaud E, Martin L, Taillandier L, Carnin C, Desjardins A, Reardon DA, Peters KB, Herndon JE, Kirkpatrick JP, Friedman HS, Vredenburgh JJ, Nayak L, Panageas KS, Deangelis LM, Abrey LE, Lassman AB. Ongoing Clinical Trials. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s9] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Spătariu A, Nicolau AE, Beuran M, Tudor C, Oprescu C. [Conversion in laparoscopic cholecystectomy for acute cholecystitis]. Chirurgia (Bucur) 2010; 105:469-472. [PMID: 20941967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION By definition, conversion means giving up laparoscopic surgery and continuing the operation with open, conventional surgery no matter the reason, nor the moment of the operation. PURPOSE To evaluate the causes and the moment of conversion, the technique used to perform the cholecystectomy after conversion, analysing the experience of the surgical team in deciding the moment of conversion. METHOD A retrospective study performed on patients which underwent a laparoscopic operation for acute cholecystitis between January 1st 2004 - December 31st 2007. Clinical examination, biological parameters, surgical proceedings, histopathological examination of the pieces removed and the patient's postoperative evolution were analysed. FINDINGS There were performed 1522 laparoscopic cholecystectomies for acute cholecystitis, out of which 108 (7.1% of all) were converted to open surgery. Analysing the experience of the surgical team, we can say that the converted laparoscopic cholecystectomies are found mainly in teams formed by senior surgeons assisted by junior surgeons--43% (46/108), in comparison with teams formed by residents assisted by senior surgeons--22% (25/108). The nondissecable fibrotic shirt front, woody inflammation of the pedicle, adhesions after past surgery and suspicion of a fistula are the most frequent causes of conversion--45.35% (49/108). The distribution according to the gender was analysed in patients which underwent conversion, showing a significant difference: 5.39% (60/1112) in women and 11.7% (48/410) in men. The percentage of conversion was significantly higher for operations performed at more than 96 hours away from the beginning of the symptoms--15.1% (29/192). The highest number of conversions occurred for gangrenous acute cholecystitis--72% (77/108). 82.40% of all the acute cholecystitis which were converted were complicated with shirt front (89/108). CONCLUSIONS Conversion performed for laparoscopic cholecystectomies is a proof of ripening and professional responsibility, a fit solution for cases in which the advantages of laparoscopic surgery are overwhelmed by the risks found during surgery; gangrenous acute cholecystitis is one of the most important causes of conversion--72%; the shirt front around the gallbladder was converted in 82.4% of cases; conversion is more frequent in men--11.7%; acute cholecystitis with symptoms found for more than 96 hours are converted in 15.1% of cases.
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Affiliation(s)
- A Spătariu
- Clinica de Chirurgie, Spitalul Clinic de Urgenţă Bucureşti
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Tudor C, Bumiller L, Birkholz T, Stockmann P, Wiltfang J, Kessler P. Static and dynamic periosteal elevation: a pilot study in a pig model. Int J Oral Maxillofac Surg 2010; 39:897-903. [PMID: 20576403 DOI: 10.1016/j.ijom.2010.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 04/29/2010] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
Abstract
The osteoinductive potential of periosteum and bone can be stimulated by elevating the periosteum in a distraction-like modus, but also by an ad-hoc elevation. This was tested and proved in an experiment in 9 Goettingen mini-pigs with elevation heights of 5, 10 and 15mm. Specially designed and perforated titanium meshes were implanted subperiosteally to compare the dynamic elevation procedure with static shielding. The cumulative results for bone formation underneath the mesh were 66% in dynamic and 67% in non-dynamic elevation. The cumulative results for mineralization of the bone regenerates in comparison with the underlying basal bone of the skull showed independently from the technique applied no difference bigger than 5%. No major difference in bone formation could be observed in this pilot study. The main advantages of dynamic periosteal elevation and static shielding are minimal invasion and morbidity. Periosteal elevation could be applied in cranio-maxillofacial surgery, in preimplantological augmentation and in reconstructive surgery of the skull; applications in other specialties may be possible.
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Affiliation(s)
- C Tudor
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Tudor C, Iana A, Jeberean R, Petrus A, Buzas R. P83 LDL-CHOLESTEROL AND CARDIOVASCULAR EVENTS IN PATIENTS WITH DIABETES MELLITUS TYPE 2. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70150-1] [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: 10/19/2022]
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Franz DN, Krueger DA, Care MM, Holland-Bouley K, Agricola K, Tudor C, Mangeshkar P, Byars AW, Sahmoud T. Everolimus for subependymal giant-cell astrocytomas (SEGAs) in tuberous sclerosis (TS). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Savlovschi C, Brănescu C, Serban D, Tudor C, Găvan C, Shanabli A, Comandaşu M, Vasilescu L, Borcan R, Dumitrescu D, Sandolache B, Sajin M, Grădinaru S, Munteanu R, Kraft A, Oprescu S. [Amyand's hernia--a clinical case]. Chirurgia (Bucur) 2010; 105:409-414. [PMID: 20726311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Amyand's hernia, a rare entity in the surgical pathology, presupposes the presence of the vermiform appendix inside a inguinal hernia sac (1). The hernia sac peritonitis by appendix swelling is even more rare, very few cases being presented in the surgical literature (1). The preoperatory diagnosis of Amyand's hernia is therefore very difficult. We herein present the case of a 71-year old male patient, operated on an emergency basis for hernia, which eventually turned out to be Amyand's hernia, a case which determined us to research the literature dedicated to this topic.
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Affiliation(s)
- C Savlovschi
- Universitatea de Medicină şi Farmacie Carol Davila, Bucureşti
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Kühnel TV, Tudor C, Neukam FW, Nkenke E, Stockmann P. Air gun pellet remaining in the maxillary sinus for 50 years: a relevant risk factor for the patient? Int J Oral Maxillofac Surg 2009; 39:407-11. [PMID: 19962278 DOI: 10.1016/j.ijom.2009.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 10/17/2009] [Accepted: 10/30/2009] [Indexed: 10/20/2022]
Abstract
The authors report the case of a 62-year-old man referred to the department of oral and maxillofacial surgery because of a clinical suspicion of palate carcinoma. Incidentally, diagnostic radiology showed a metallic foreign body in the left maxillary sinus. Anamnestic data revealed that a shot from an air gun accidentally hit the patient's left cheek in 1957. The lead-containing air gun pellet was removed by endoscopic antrostomy and the diagnosis of squamous cell carcinoma was confirmed by histopathological examination. 50 years after the pellet's impact, toxicological blood analysis showed no increased blood lead level. It remains unclear whether the air gun pellet has a potential toxicological effect or is related to the development of the patient's oral carcinoma. In this context the article reviews the literature and discusses the necessity of removing metal-containing foreign bodies, the role of lead in chronic toxicity and its possible carcinogenic effect in humans.
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Affiliation(s)
- T V Kühnel
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstrasse 11, 91054 Erlangen, Germany.
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Miller S, Tudor C, Thorsten V, Nyima, Kalyang, Sonam, Lhakpen, Droyoung, Quzong K, Dekyi T, Hartwell T, Wright LL, Varner MW. Randomized double masked trial of Zhi Byed 11, a Tibetan traditional medicine, versus misoprostol to prevent postpartum hemorrhage in Lhasa, Tibet. J Midwifery Womens Health 2009; 54:133-141.e1. [PMID: 19249659 PMCID: PMC2791828 DOI: 10.1016/j.jmwh.2008.09.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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: 05/22/2008] [Revised: 09/29/2008] [Accepted: 09/29/2008] [Indexed: 11/19/2022]
Abstract
The objective of this study was to compare a Tibetan traditional medicine (the uterotonic Zhi Byed 11 [ZB11]) to oral misoprostol for prophylaxis of postpartum hemorrhage (PPH). We conducted a double-blind randomized controlled trial at three hospitals in Lhasa, Tibet, People's Republic of China. Women (N = 967) were randomized to either ZB11 or misoprostol groups. Postpartum blood loss was measured in a calibrated blood collection drape. The primary combined outcome was incidence of PPH, defined as measured blood loss (MBL) > or = 500 mL, administration of open label uterotonics, or maternal death. We found that the rate of the combined outcome was lower among the misoprostol group (16.1% versus 21.8% for ZB11; P = .02). Frequency of PPH was lower with misoprostol (12.4% versus 17.4%; P = .02). There were no significant differences in MBL > 1000 mL or mean or median MBL. Fever was significantly more common in the misoprostol group (P = .03). The rate of combined outcome was significantly lower among women receiving misoprostol. However, other indices of obstetric hemorrhage were not significantly different.
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Affiliation(s)
- Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 50 Beale St., Ste. 1200, San Francisco, CA 94105, USA.
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Miller S, Tudor C, Thorsten V, Wright L, Varner M. Comparison of maternal and newborn outcomes of Tibetan and Han Chinese delivering in Lhasa, Tibet. J Obstet Gynaecol Res 2009; 34:986-93. [PMID: 19012697 DOI: 10.1111/j.1447-0756.2008.00804.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To compare maternal and neonatal outcomes of Tibetan and Han Chinese women delivering vaginally at high altitude (3650 meters) in Lhasa, Tibet Autonomous Region, People's Republic of China. METHOD Comparative analysis of data from a prospective observational study of Tibetan (n = 938) and Han Chinese (n = 146) women delivering at three hospitals between January 2004 and May 2005. RESULTS Han Chinese women had higher rates of pre-eclampsia/gestational hypertension than Tibetan women, (10.3% vs 5.9%, P = 0.04). There was no difference in rates of postpartum hemorrhage between Tibetan and Han women (12.8% vs 17.1%, P = 0.15). Han newborns weighed significantly less than Tibetan newborns (P < 0.01), and were twice as likely to be small for gestational age, (24.5% vs 11.6%, P < 0.01). Tibetan newborns were less likely to have poor neonatal outcomes than Han newborns (P < 0.01). CONCLUSION In high altitude deliveries in Tibet, adverse outcomes were significantly more common among Han Chinese.
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Affiliation(s)
- Suellen Miller
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94105, USA.
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Miller S, Le PV, Craig S, Adams V, Tudor C, Tshomo M, Varner M. How to make consent informed: possible lessons from Tibet. IRB 2007; 29:7-14. [PMID: 18237079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA
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Miller S, Tudor C, Thorsten VR, Craig S, Le P, Wright LL, Varner MW. Maternal and neonatal outcomes of hospital vaginal deliveries in Tibet. Int J Gynaecol Obstet 2007; 98:217-21. [PMID: 17481630 PMCID: PMC2194809 DOI: 10.1016/j.ijgo.2007.03.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [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: 01/03/2007] [Revised: 03/26/2007] [Accepted: 03/26/2007] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To determine the outcomes of vaginal deliveries in three study hospitals in Lhasa, Tibet Autonomous Region (TAR), People's Republic of China (PRC), at high altitude (3650 m). METHODS Prospective observational study of 1121 vaginal deliveries. RESULTS Pre-eclampsia/gestational hypertension (PE/GH) was the most common maternal complication 18.9% (n=212), followed by postpartum hemorrhage (blood loss > or = 500 ml) 13.4%. There were no maternal deaths. Neonatal complications included: low birth weight (10.2%), small for gestational age (13.7%), pre-term delivery (4.1%) and low Apgar (3.7%). There were 11 stillbirths (9.8/1000 live births) and 19 early neonatal deaths (17/1000 live births). CONCLUSION This is the largest study of maternal and newborn outcomes in Tibet. It provides information on the outcomes of institutional vaginal births among women delivering infants at high altitude. There was a higher incidence of PE/GH and low birth weight; rates of PPH were not increased compared to those at lower altitudes.
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Affiliation(s)
| | - C Tudor
- Women's Global Health Imperative, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - VR Thorsten
- RTI International, Research Triangle Park, NC USA
| | - S Craig
- Department of Anthropology, Dartmouth University, Hanover, NH, USA
| | - P Le
- Harvard University Medical School, Cambridge, MA, USA
| | - LL Wright
- Deputy Director, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, Bethesda, MD USA
| | - MW Varner
- Professor, Maternal Fetal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
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Burcoş T, Popa E, Stanilescu S, Cristian D, Jitea N, Barbulescu M, Tudor C, Popa I, Angelescu N. [The sentinel lymph node technique in colorectal cancer using in vivo dye--utility and limits]. Chirurgia (Bucur) 2007; 102:281-8. [PMID: 17687856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The aim of this work is to analyze the importance of sentinel lymph node technique in the treatment of colorectal cancer. There are presented data from literature concerning sentinel lymph node, especially papers about the place of sentinel lymph node method in the treatment of colorectal cancer. This work also shows the experience of Surgical Clinical Department of Coltea Hospital in the use of sentinel lymph node method in colorectal cancer (8 patients with colon cancer and 9 with rectal cancer). There are presented the criteria for inclusion in the study group (26 patients initially proposed for the study) and the exclusion criteria, the diagnostic method using an in vivo dye and the pathology study. The study of the literature and our experience leads to the conclusion that the identification of the sentinel lymph node in colorectal cancer doesn't modify the dissection of the lymphatic area. This procedure may change the adjuvant treatment for colorectal cancer. The discussion is still open concerning the importance of lymphatic micro metastases found by RT-PCR and immunohistochemistry methods. More studies are necessary to clarify these problems.
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Affiliation(s)
- T Burcoş
- Clinica Chirurgie, Spitalului Clinic Coļtea.
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Klöppel M, Tudor C, Kovacs L, Papadopulos NA, Höhnke C, Himsl I, Hoang NT, Biemer E. Comparison of experimental microvascular end-to-end anastomosis via VCS-Clips versus conventional suture technique in an animal model. J Reconstr Microsurg 2007; 23:45-9. [PMID: 17230321 DOI: 10.1055/s-2006-958702] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this experimental study on 96 CD rats, microvascular end-to-end anastomoses created via suture or alternatively by means of a VCS-Clip-Application-System, were compared. The aorta abdominalis of the animals, with a diameter of 1.5 +/- 0.2 mm, was experimentally dissected, and the free ends of the vessel then anastomosed. The results were evaluated using sonography, microangiography, histologic examination, and vascular imprints. Postoperative examination was carried out after 1, 3, 7, 14, or 30 days. Major advantages of the VCS-Clip technique over suturing were that it was easy to learn, significantly faster to perform (execution of anastomosis 10.9 +/- 2.6 min versus 19.4 +/- 5.0 min), and produced significantly more favorable histologic results in terms of less inflammatory response, foreign body reaction, necrosis of the tunica media, hyperplasia of the intima, and thrombosis of the vessel lumen. The main disadvantage of the clip technique was a significantly higher rate of stenoses (15.8 +/- 6.0 versus 4.1 +/- 6.6 percent).
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Affiliation(s)
- M Klöppel
- Department of Plastic and Reconstructive Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Lell M, Tudor C, Aigner T, Kessler P. Primary intraosseous meningioma of the mandible: CT and MR imaging features. AJNR Am J Neuroradiol 2007; 28:129-31. [PMID: 17213439 PMCID: PMC8134125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We describe the rare entity of an intraosseous meningioma arising in the mandible. The meningioma was found incidentally in an asymptomatic adult patient on dental radiography, mimicking other cystic-appearing jaw masses. The CT and MR imaging features of mandibular meningioma are reviewed with reference to prior published descriptions of this unusual entity.
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Affiliation(s)
- M Lell
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
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Tudor C, Miller S, Nyima, Sonam, Droyoung, Varner M. Preliminary progress report: Randomized double-blind trial of Zhi Byed 11
, a Tibetan traditional medicine, versus misoprostol to prevent postpartum hemorrhage in Lhasa, Tibet. Int J Gynaecol Obstet 2006; 94 Suppl 2:S145-S146. [DOI: 10.1016/s0020-7292(06)60017-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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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Tudor C, Jeberean R, Buzas R, Popescu A, Ionita M. We-P11:1 Reducing the cardiovascular risk at patients with type 2 diabetes by controlling the risk factors. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81357-7] [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: 10/23/2022]
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Tudor C, Jeberean R, Buzas R, Popescu A, Lungu V. We-P13:364 The prevalence of metabolic syndrome and cardiovascular events incidence related to its components. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81717-4] [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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