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Taylor JS, Fellman BM, Raty S, Lasala J, Iniesta MD, Cain KE, Horner AA, Bruno M, Folloder JP, Knippel SL, Khanh V, Popovich S, Katz MHG, Best C, Thosani S. Detection and Management of Perioperative Hyperglycemia at a Tertiary Cancer Center. Ann Surg Oncol 2024; 31:3017-3023. [PMID: 38347330 DOI: 10.1245/s10434-024-14986-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/15/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION To improve the detection and management of perioperative hyperglycemia at our tertiary cancer center, we implemented a glycemic control quality improvement initiative. The primary goal was to decrease the percentage of diabetic patients with median postoperative glucose levels > 180 mg/dL during hospitalization by 15% within 2 years. METHODS A multidisciplinary team standardized preoperative screening, preoperative, intraoperative, and postoperative hyperglycemia management. We included all patients undergoing nonemergent inpatient and outpatient operations. We used a t test, rank sum, chi-square, or Fisher's exact test to assess differences in outcomes between patients at baseline (BL) (10/2018-4/2019), during the first phase (P1) (10/2019-4/2020), second phase (P2) (5/2020-12/2020), and maintenance phase (M) (1/2021-10/2022). RESULTS The analysis included 9891 BL surgical patients (1470 with diabetes), 8815 P1 patients (1233 with diabetes), 10,401 P2 patients (1531 with diabetes) and 30,410 M patients (4265 with diabetes). The percentage of diabetic patients with median glucose levels >180 mg/dL during hospitalization decreased 32% during the initiative (BL, 20.1%; P1, 16.9%; P2, 12.1%; M, 13.7% [P < .001]). We also saw reductions in the percentages of diabetic patients with median glucose levels >180 mg/dL intraoperatively (BL, 34.0%; P1, 26.6%; P2, 23.9%; M, 20.3% [P < .001]) and in the postanesthesia care unit (BL, 36.0%; P1, 30.4%; P2, 28.5%; M, 25.8% [P < .001]). The percentage of patients screened for diabetes by hemoglobin A1C increased during the initiative (BL, 17.5%; P1, 52.5%; P2, 66.8%; M 74.5% [P < .001]). CONCLUSIONS Our successful initiative can be replicated in other hospitals to standardize and improve glycemic control among diabetic surgical patients.
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Affiliation(s)
- Jolyn S Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, USA.
| | - Bryan M Fellman
- Department of Biostatistics, M. D. Anderson Cancer Center, Houston, USA
| | - Sally Raty
- Department of Anesthesiology, M. D. Anderson Cancer Center, Houston, USA
| | - Javier Lasala
- Department of Anesthesiology, M. D. Anderson Cancer Center, Houston, USA
| | - Maria D Iniesta
- Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, USA
| | - Katherine E Cain
- Department of Pharmacy Clinical Programs, M. D. Anderson Cancer Center, Houston, USA
| | - Allison A Horner
- Department of Breast Surgical Oncology, M. D. Anderson Cancer Center, Houston, USA
| | - Morgan Bruno
- Department of Surgical Oncology, M. D. Anderson Cancer Center, Houston, USA
| | - Justin P Folloder
- Department of Surgical Oncology, M. D. Anderson Cancer Center, Houston, USA
| | - Susan L Knippel
- Department of Thoracic and Cardiovascular Surgery, M. D. Anderson Cancer Center, Houston, USA
| | - Vu Khanh
- Department of Internal Medicine, M. D. Anderson Cancer Center, Houston, USA
| | - Shannon Popovich
- Department of Perioperative Medicine, M. D. Anderson Cancer Center, Houston, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, M. D. Anderson Cancer Center, Houston, USA
| | - Conor Best
- Department of Endocrinology, M. D. Anderson Cancer Center, Houston, USA
| | - Sonali Thosani
- Department of Endocrinology, M. D. Anderson Cancer Center, Houston, USA
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Jeun R, Iyer PC, Best C, Lavis V, Varghese JM, Yedururi S, Brady V, Glitza Oliva IC, Dadu R, Milton DR, Brock K, Thosani S. Clinical outcomes of immune checkpoint inhibitor diabetes mellitus at a comprehensive cancer center. Immunotherapy 2023; 15:417-428. [PMID: 37013834 PMCID: PMC10088048 DOI: 10.2217/imt-2021-0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction: Immune checkpoint inhibitor-associated diabetes mellitus (ICI-DM) is a rare adverse event. In this study, we characterize clinical outcomes of patients with ICI-DM and evaluate survival impact of this complication on melanoma patients. Research design & methods: We conducted a retrospective review of 76 patients diagnosed with ICI-DM from April 2014 to December 2020. Results: 68% of patients presented in diabetic ketoacidosis, 16% had readmissions for hyperglycemia, and hypoglycemia occurred in 70% of patients after diagnosis. Development of ICI-DM did not impact overall survival or progression-free survival in melanoma patients. Conclusion: Development of ICI-DM is associated with long-term insulin dependence and pancreatic atrophy; the use of diabetes technology in this patient population can help improve glycemic control.
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Affiliation(s)
- Rebecca Jeun
- Department of Endocrinology, Diabetes & Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
| | - Priyanka C Iyer
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Conor Best
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Victor Lavis
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Jeena M Varghese
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Sireesha Yedururi
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Veronica Brady
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Isabella C Glitza Oliva
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ramona Dadu
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Denai R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kristy Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sonali Thosani
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Best C, Jennings K, Culbert BM, Flear K, Volkoff H, Gilmour KM. Too stressed to eat: Investigating factors associated with appetite loss in subordinate rainbow trout. Mol Cell Endocrinol 2023; 559:111798. [PMID: 36243201 DOI: 10.1016/j.mce.2022.111798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/23/2022] [Accepted: 10/09/2022] [Indexed: 11/18/2022]
Abstract
Juvenile rainbow trout (Oncorhynchus mykiss) form dominance hierarchies in which subordinates experience chronic social stress and suppression of food intake. Here we tested the hypothesis that inhibition of food intake reflects increased expression of anorexigenic (appetite inhibiting) signals and decreased expression of orexigenic (appetite stimulating) signals. Trout were confined in pairs for 1 or 4 days, or were confined in pairs for 4 days and then allowed to recover from social interactions for 2 or 4 days; sham fish were handled identically but held alone. Subordinates did not feed during social interaction and had lower food intake than dominants or shams during recovery. In parallel, plasma cortisol (∼18-26x) and liver leptin (lep-a1) transcript abundance (∼10-14x) were elevated in subordinates during social interaction but not recovery, suggesting that these factors contributed to the suppression of food intake. Fish deemed likely to become subordinate based on inhibition of food intake in response to a mild stressor also showed elevated liver lep-a1 transcript abundance (∼5x). The moderate response in these fish coupled with a correlation between liver lep-a1 and cortisol suggest that stress-induced elevation of cortisol increased liver lep-a1 transcript abundance in subordinate trout, contributing to stress-induced suppression of food intake.
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Affiliation(s)
- C Best
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
| | - K Jennings
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
| | - B M Culbert
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
| | - K Flear
- Department of Biology, University of Ottawa, Ottawa, ON, Canada
| | - H Volkoff
- Department of Biology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - K M Gilmour
- Department of Biology, University of Ottawa, Ottawa, ON, Canada.
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4
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Taylor J, Fellman B, Cain K, Iniesta-Donate M, Earles T, Harris M, James D, Siebel C, Lasala J, Mena GE, Raty S, Popovich S, Vu K, Thosani S, Best C, Schmeler K, Ramirez P, Meyer L. Surgical universal euglycemic attainment during recovery (SUGAR) initiative: Sweet results through quality improvement (286). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01507-4] [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: 12/01/2022]
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Ussher M, Best C, Lewis S, McKell J, Coleman T, Cooper S, Orton S, Bauld L. Financial Incentives for Preventing Postpartum return to Smoking (FIPPS): study protocol for a three-arm randomised controlled trial. Trials 2021; 22:512. [PMID: 34340694 PMCID: PMC8327045 DOI: 10.1186/s13063-021-05480-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/22/2021] [Indexed: 02/08/2023] Open
Abstract
Background Financial incentives are an effective way of helping women to stop smoking during pregnancy. Unfortunately, most women who stop smoking at this time return to smoking within 12 months of the infant’s birth. There is no evidence for interventions that are effective at preventing postpartum smoking relapse. Financial incentives provided after the birth may help women to sustain cessation. This randomised controlled trial will assess the effectiveness and cost-effectiveness of financial incentives to help women who are abstinent from smoking at end-of-pregnancy to avoid return to smoking up to 12 months postpartum. Methods This is a UK-based, multi-centre, three-arm, superiority, parallel group, individually randomised controlled trial, with 1:1:1 allocation. It will compare the effectiveness of two financial incentive interventions with each other (one intervention for up to 3 months postpartum offering up to £120 of incentives (£60 for the participant and £60 for a significant other support); the other for up to 12 months postpartum with up to £300 of incentives (£240 for the participant and £60 for a significant other support) and with a no incentives/usual care control group. Eligible women will be between 34 weeks gestation and 2 weeks postpartum, abstinent from smoking for at least 4 weeks, have an expired carbon monoxide (CO) reading < 4 parts per million (ppm), aged at least 16 years, intend remaining abstinent from smoking after the birth and able to speak and read English. The primary outcome is self-reported, lapse-free, smoking abstinence from the last quit attempt in pregnancy until 12 months postpartum, biochemically validated by expired CO and/or salivary cotinine or anabasine. Outcomes will be analysed by intention-to-treat and regression models used to compare the proportion of abstinent women between the two intervention groups and between each intervention group and the control group. An economic evaluation will assess the cost-effectiveness of offering incentives and a qualitative process evaluation will examine barriers and facilitators to trial retention, effectiveness and implementation. Discussion This pragmatic randomised controlled trial will test whether offering financial incentives is effective and cost-effective for helping women to avoid smoking relapse during the 12 months after the birth of their baby. Trial registration International Standard Randomised Controlled Trial Number 55218215. Registered retrospectively on 5th June 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05480-6.
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Affiliation(s)
- M Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK. .,Population Health Research Institute, St George's, University of London, SW17 ORE, London, UK.
| | - C Best
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK
| | - S Lewis
- Division of Epidemiology and Public Health, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - J McKell
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK
| | - T Coleman
- Division of Primary Care, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - S Cooper
- Division of Primary Care, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - S Orton
- Division of Primary Care, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - L Bauld
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
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6
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Jeun R, Yedururi S, Lavis V, Best C, Varghese J, Dadu R, Glitza IC, Thosani S. Pancreatic volumes in immune checkpoint inhibitor-induced diabetes. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.2644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2644 Background: Immune checkpoint inhibitor-mediated insulin dependent diabetes (ICI-DM) is a rare and irreversible adverse event often presenting with life-threatening diabetic ketoacidosis (DKA). Pancreatic volume changes have been studied in classic Type 1 and Type 2 diabetes as a surrogate for functional β-cell mass. In this study, we investigate longitudinal changes in pancreatic volumes in patients who develop ICI-DM. Methods: Among patients with ICI-DM seen at our institution between 2014 and 2020, 20 patients who had serial CT scans of the abdomen and pelvis before and after ICI DM diagnosis were identified for inclusion in this study. Demographic data and clinical variables were obtained from the electronic medical record. Weight-adjusted pancreatic volumes were calculated from CT scans at three time points. The most recent CT scan prior to ICI initiation was used as baseline, the CT scan immediately prior to ICI DM diagnosis was used as a midpoint, and the most recent CT scan prior to the end of the study period was used as the final time point for comparison. Results: Median age was 63 years old (range 35 to 83). Renal cell carcinoma and melanoma were the most common cancer types. Male gender predominated (80%). 18/20 patients were on a PD-1 inhibitor with the remaining two on a PD-L1 inhibitor. After initiation of ICI therapy there was a variable response in pancreatic volumes prior to the diagnosis of ICI-DM with 20% patients experiencing a volume loss of > 10% and 25% experiencing a volume gain of > 10%. Volume loss nor volume gain prior to diabetes diagnosis was associated with presentation with DKA. 9/13 (69%) of patients who had pancreatic enzymes checked at diagnosis of ICI-DM had elevated levels. Pancreatic atrophy with a median volume loss of 41% was seen in all patients at a median of 14.9 months (range 3-77 months) after ICI-DM diagnosis. Most had more than 20% volume loss from baseline to most recent scan with no correlation in degree of volume loss with the time interval. There was no evidence of pancreatic ductal dilation, increased pancreatic fat nor any changes consistent with chronic pancreatitis. Conclusions: This study shows a variable response in pancreatic volumes after initiation of ICI in patients who progress to developing ICI-DM, though most had a significant decline in volume after the diagnosis of ICI-DM with long-term pancreatic atrophy. As β-cell mass is thought to comprise 1-2% of the pancreas, these findings may suggest both endocrine and exocrine compartment changes because of ICI-DM, though exocrine dysfunction has not been clinically described in this patient population. As these patients receive frequent imaging during treatment, fluctuations in pancreatic volumes with new or worsening hyperglycemia may portend the onset of ICI-DM and clinicians should have a low threshold to screen for this diagnosis as many will present with life-threatening DKA.
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Affiliation(s)
| | | | - Victor Lavis
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Conor Best
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeena Varghese
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ramona Dadu
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sonali Thosani
- University of Texas MD Anderson Cancer Center, Houston, TX
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7
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Jeun R, Best C, Iyer P, Lavis VR, Varghese JM, Oliva IG, Dadu R, Thosani S. Immune Checkpoint Inhibitor Mediated Insulin Dependent Diabetes: Observations at a Cancer Center. J Endocr Soc 2021. [PMCID: PMC8090364 DOI: 10.1210/jendso/bvab048.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have rapidly changed the landscape of oncologic care and are now often used in the front line setting for many types of cancers. These agents attempt to harness the immune system to target cancer cells (ICIs) by releasing inhibition of T cell response against tumor cells. With increasing use of ICIs, a new spectrum of immune-related adverse events (irAEs) has emerged including a number of endocrinopathies. A distinct form of ICI-mediated insulin dependent diabetes (ICI-DM) has become increasingly recognized. To better characterize this disease entity and longer-term consequences, we performed a retrospective review of medical records of patients diagnosed with ICI-DM between April 2014 and July 2020 at the MD Anderson Cancer Center. This cohort of 68 patients represent the largest single institution cohort described to date. Baseline characteristics of our cohort are consistent with what has been reported in other case series and meta-analyses with median age at presentation 61 years old (range 32–83 years old), slight male predominance (59% vs 41%), and strong association with anti-programmed cell death protein 1 (anti-PD-1) therapy (59%). Melanoma was the most commonly represented underlying malignancy (29%). The majority of patients (66%) presented with diabetic ketoacidosis. At presentation, median HbA1c was 7.8 % (n < 5.7%) and median C-peptide was 0.2 ng/ml (range <0.1–3.4). Pancreatic autoantibodies were present in 49% of patients. Median insulin dose was 0.54 units per kg per day[T1] (range 0.25 to 1.07 units per kg) at first follow up suggesting these patients may have varying levels of insulin sensitivity[T2]. On most recent follow up at a median[T3] of 40 weeks (range 8 to 261 weeks), median HbA1c was 7.9% and median insulin requirement remained 0.54 units per kg (range 0.14 to 1.2 units per kg). 22% of patients were on insulin pump therapy[T4]. ICI-DM is an irreversible immune-related adverse endocrinopathy characterized by frequent presentation with fulminant hyperglycemia and DKA, persistent beta cell dysfunction necessitating long term insulin therapy and mixed evidence of beta-cell autoimmunity. Median insulin requirement was more consistent with type 1 diabetes, but a wide range was present. Adequate glycemic control was generally achievable on insulin therapy.
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Affiliation(s)
| | | | | | | | | | | | - Ramona Dadu
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Best C, Brown A, Semple S, Hunt K. How does smokefree policy impact nicotine-related and other prisoner spend (e.g. HFSS foods)? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
People in custody (PiC) have poor health compared to the general population, in part due to high smoking rates. Scotland's prisons became smokefree in 2018. Rechargeable e-cigarettes became available a few weeks before the removal of tobacco from the 'canteen' (prison shop for PiC).
Methods
Routinely collected weekly 'canteen' purchase data (no of units of given product purchased by an individual by date) were available for 29-7-18 to 31-3-19 (2112638 rows of data, 645 unique products). Products were categorised into: tobacco; e-cigarettes; food/drink; communication; hygiene; NRT; other and graphed as mean/person/week, for 'smokers' and 'non-smokers' (at baseline). Spend by product type pre- and post-implementation was compared in PiC for 31+ weeks over this period, using mixed effects models.
Results
Mean weekly spend for 'smokers' in custody for 31+ weeks over the pre-post ban comparison period (n = 2541) decreased from £21.36 to £19.80; mean weekly nicotine-related spend reduced from £6.64 (pre-) to £5.55 (post-) (p < 0.001), but showed an increasing trend in nicotine-related spend (£0.08/week) post-ban. No changes were seen for 'non-smokers' (n = 342) overall) or in nicotine-related spend. Trends in mean spend for other products remained flat, suggesting positive transfers of spend noted in qualitative interviews over a comparable period were not evident at population level.
Conclusions
Whilst there are benefits of removing tobacco from prisons, for staff and PiC, previously heavy smokers may find (mandated) tobacco abstinence difficult. Some jurisdictions have made e-cigarettes available to support people quitting/managing without tobacco, but long-term implications of e-cigarette use in this population are as yet unknown. When the introduction of smokefree policy is facilitated by the introduction of e-cigarettes, nicotine spend by PiC may remain high; the implications for whether or not PiC return to smoking on release from custody are unclear.
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Affiliation(s)
- C Best
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - A Brown
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - S Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - K Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Jozaghi Y, Zafereo ME, Perrier ND, Wang JR, Grubbs E, Gross ND, Fisher S, Sturgis EM, Goepfert RP, Lai SY, Best C, Busaidy NL, Cabanillas ME, Dadu R, Gagel RF, Habra MA, Hu MI, Jimenez C, Sherman SI, Thosani S, Varghese J, Waguespack SG, Weitzman S, Ying AK, Graham PH. Endocrine surgery in the Coronavirus disease 2019 pandemic: Surgical Triage Guidelines. Head Neck 2020; 42:1325-1328. [PMID: 32437031 PMCID: PMC7262055 DOI: 10.1002/hed.26169] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background In the face of the COVID‐19 pandemic, cancer care has had to adapt rapidly given the Centers for Disease Control and Prevention and the American College of Surgeons (ACS) issuing recommendations to postpone nonurgent surgeries. Methods An institutional multidisciplinary group of Head and Neck Surgical Oncology, Surgical Endocrinology, and Medical Endocrinology devised Surgical Triaging Guidelines for Endocrine Surgery during COVID‐19, aligned with phases of care published by the ACS. Results Phases of care with examples of corresponding endocrine cases are outlined. Most cases can be safely postponed with active surveillance, including most differentiated and medullary thyroid cancers. During the most acute phase, all endocrine surgeries are deferred, except thyroid tumors requiring acute airway management. Conclusions These guidelines provide context for endocrine surgery within the spectrum of surgical oncology, with the goal of optimal individualized multidisciplinary patient care and the expectation of significant resource diversion to care for patients with COVID‐19.
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Affiliation(s)
- Yelda Jozaghi
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nancy D Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer R Wang
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Fisher
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Conor Best
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naifa L Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ramona Dadu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert F Gagel
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mouhammed A Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven I Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sonali Thosani
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeena Varghese
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven Weitzman
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anita K Ying
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Taylor J, Cain K, Ramirez P, Earles T, Harris M, James D, Dottino J, Hubbs C, Stewart K, McGrew L, Siebel C, Enbaya A, Iniesta-Donate M, Vachhani S, Lasala J, Best C, Thosani S, Sahai S, Schmeler K, Meyer L. Integration of a standardized diabetic management protocol into an ERAS program. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2019.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pearce J, Cherrie M, Best C, Eadie D, Stead M, Amos A, MacGregor A, Currie D, Ozakinci G, Haw S. Has point-of-sale legislation led to a reduction in exposure to tobacco retailing? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.196] [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: 11/13/2022] Open
Affiliation(s)
- J Pearce
- University of Edinburgh, Edinburgh, UK
| | - M Cherrie
- University of Edinburgh, Edinburgh, UK
| | - C Best
- University of Stirling, Stirling, UK
| | - D Eadie
- University of Stirling, Stirling, UK
| | - M Stead
- University of Stirling, Stirling, UK
| | - A Amos
- University of Stirling, Stirling, UK
| | | | - D Currie
- University of St Andrews, St Andrews, UK
| | - G Ozakinci
- University of St Andrews, St Andrews, UK
| | - S Haw
- University of Stirling, Stirling, UK
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Taylor JS, Cain K, Earles T, Harris M, James D, Hubbs C, Dottino J, Stewart KI, McGrew L, Siebel C, Enbaya A, Iniesta M, Vachhani S, Lasala J, Thosani S, Best C, Sahai SK, Schmeler KM, Ramirez PT, Meyer L. Surgical Universal euGlycemic Attainment during Recovery (SUGAR) Initiative. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
252 Background: Surgical site infections (SSI) are infections of the surgical incision or organ space within 30 days of surgery and are associated with increased morbidity, mortality and healthcare expenditures. Diabetic patients undergoing laparotomy are at high risk. Prior studies have shown SSI reduction by avoiding hyperglycemia. The aim of our Quality Improvement (QI) initiative is to reduce the SSI rate among diabetic patients undergoing laparotomy by 40% within 2 years compared to the baseline (2/2015-8/2017) rate of 16%. Methods: We formed a multi-disciplinary QI team including physicians, nurses and advanced care providers from Gynecologic Oncology, Pharmacy, Nutrition, Endocrinology, Internal Medicine and Anesthesiology. The intervention began 2/2018 in our main center and 5 satellite sites including: screening gynecologic cancer patients undergoing laparotomy with hemoglobin A1C, intra-operative glucose monitoring with goal of < 180mg/dL, creation and use of a standardized basal-bolus insulin order set for post-operative care, and endocrine and nutritional consultation. The following variables were assessed: age, race, ethnicity, BMI, cancer type, comorbidities, smoking status, surgical procedure, receipt of antibiotic prophylaxis, hemoglobin A1C, post-operative glucose values, intervention compliance, intra-operative complications, post-operative complications including SSI, hospital readmissions, reoperation and mortality. Results: Since 2/2018, 39 gynecologic cancer patients have undergone laparotomy. Overall compliance with HgA1c screening is 64% (25/39), which has improved from 42% in 2/2018 to 70% in 3/2018 and 83% in 4/2018. Causes of non-compliance included unplanned conversion to laparotomy and need for additional education. Five of 39 (13%) patients were diabetic, including one newly diagnosed through this initiative. The post-intervention diabetic SSI rate is 0% (0/5) with all post-intervention glucose values < 180mg/dL. There have been no safety adverse events resulting in patient harm. Conclusions: Implementing a QI initiative to standardize management of diabetic patients undergoing surgery is both safe and feasible. Effectiveness data will continue to be collected.
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Affiliation(s)
| | - Katherine Cain
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Terri Earles
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melinda Harris
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Deepthi James
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cheryl Hubbs
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph Dottino
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Leon McGrew
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ahmed Enbaya
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maria Iniesta
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shital Vachhani
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Javier Lasala
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sonali Thosani
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Conor Best
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Pedro T Ramirez
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Larissa Meyer
- The University of Texas MD Anderson Cancer Center, Houston, TX
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13
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Best C, Coe J, Hewson J, Meehan M, Kelton D. Survey of Equine Referring Veterinarians' Satisfaction with Their Most Recent Equine Referral Experience. J Vet Intern Med 2018; 32:822-831. [PMID: 29469978 PMCID: PMC5867021 DOI: 10.1111/jvim.15053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/07/2017] [Accepted: 01/08/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Little is known about the veterinary referral process and factors that contribute to positive outcomes. OBJECTIVE To investigate equine referring veterinarians' (rDVMs') satisfaction with their most recent referral experience and compare rDVM and specialist perspectives. SAMPLE 187 rDVMs and 92 specialists (referral care providers). METHODS Cross-sectional observational study. An online survey was administered to both rDVMs and specialists. Referring veterinarian satisfaction with their most recent referral experience was evaluated. Both rDVMs and specialists were asked to identify factors influencing a rDVM's decision where to refer, and the top 3 factors they perceive are barriers to referral care. RESULTS Median rDVM satisfaction with their most recent referral care experience was 80 of 100 (mean, 75; range, 8-100). Referring veterinarians provided the lowest satisfaction score for the item asking about "The competition the referral hospital poses to your practice" (mean, 56.96; median, 62; range, 0-100). The top factor rDVMs identified as influencing their decision where to refer was "quality of care," whereas specialists identified "quality of communication and updates from the clinician." Referring veterinarians' top barrier to referral care was "high cost of referral care," and for specialists was "poor service provided to the client by the referral hospital." CONCLUSIONS AND CLINICAL IMPORTANCE Referring veterinarians generally were satisfied with referral care, but areas exist where rDVMs and specialists differ in what they view as important to the referral process. Exploring opportunities to overcome these differences is likely to support high quality care.
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Affiliation(s)
- C. Best
- Departments of Population Medicine (Best, Coe, Meehan, Kelton), and Clinical Studies (Hewson)Ontario Veterinary College, University of GuelphGuelphONCanada
| | - J.B. Coe
- Departments of Population Medicine (Best, Coe, Meehan, Kelton), and Clinical Studies (Hewson)Ontario Veterinary College, University of GuelphGuelphONCanada
| | - J. Hewson
- Departments of Population Medicine (Best, Coe, Meehan, Kelton), and Clinical Studies (Hewson)Ontario Veterinary College, University of GuelphGuelphONCanada
| | - M. Meehan
- Departments of Population Medicine (Best, Coe, Meehan, Kelton), and Clinical Studies (Hewson)Ontario Veterinary College, University of GuelphGuelphONCanada
| | - D. Kelton
- Departments of Population Medicine (Best, Coe, Meehan, Kelton), and Clinical Studies (Hewson)Ontario Veterinary College, University of GuelphGuelphONCanada
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Pearce J, Best C, Haseen F, Currie D, MacKintosh1 AM, Stead M, Eadie D, MacGregor A, Amos A, Frank J, Haw S. Electronic cigarette use and smoking initiation in Scottish adolescents: a cohort study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.096] [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: 11/13/2022] Open
Affiliation(s)
- J Pearce
- University of Edinburgh, Edinburgh, UK
| | - C Best
- University of Stirling, Stirling, UK
| | - F Haseen
- University of St Andrews, St Andrews, UK
| | - D Currie
- University of St Andrews, St Andrews, UK
| | | | - M Stead
- University of Stirling, Stirling, UK
| | - D Eadie
- University of Stirling, Stirling, UK
| | | | - A Amos
- University of Edinburgh, Edinburgh, UK
| | - J Frank
- University of Edinburgh, Edinburgh, UK
| | - S Haw
- University of Stirling, Stirling, UK
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Lloyd D, Best C, Summers J, Gordon H. PTU-116 The switch from bespoke parenteral nutrition to off-the-shelf bags may not be cost effective: experience from a dgh nutrition support team. Nutrition 2017. [DOI: 10.1136/gutjnl-2017-314472.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Stead M, Eadie D, MacKintosh AM, Best C, Miller M, Haseen F, Pearce JR, Tisch C, Macdonald L, MacGregor A, Amos A, van der Sluijs W, Frank JW, Haw S. Young people's exposure to point-of-sale tobacco products and promotions. Public Health 2016; 136:48-56. [PMID: 27178132 DOI: 10.1016/j.puhe.2016.03.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/22/2016] [Accepted: 03/26/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Point of sale (POS) displays are one of the most important forms of tobacco marketing still permitted in many countries. Reliable methods for measuring exposure to such displays are needed in order to assess their potential impact, particularly on smoking attitudes and uptake among young people. In this study we use a novel method for evaluating POS exposure based on young people's use of retail outlets and recall of tobacco displays and observational data on the characteristics of displays. STUDY DESIGN Observational audit of retail outlets (n = 96) and school-based pupil survey (n = 1482) in four Scottish communities reflecting different levels of social deprivation and urbanisation, conducted in 2013 before legislation to remove POS displays was implemented in supermarkets. METHODS Measures were taken of: visibility and placement of tobacco displays; internal and external advertising; display unit size, branding and design; visibility of pack warnings; proximity of tobacco products to products of potential interest to children and young people; pupils' self-reported frequency of visiting retail outlets; and pupils' recall of tobacco displays. Variation in POS exposure across social and demographic groups was assessed. RESULTS Displays were highly visible within outlets and, in over half the stores, from the public footway outside. Tobacco products were displayed in close proximity to products of interest to children (e.g. confectionery, in 70% of stores). Eighty percent of pupils recalled seeing tobacco displays, with those from deprived areas more likely to recall displays in small shops. When confectioners, tobacconists and newsagents (CTNs) and grocery/convenience stores (two of the outlet types most often visited by young people) were examined separately, average tobacco display unit sizes were significantly larger in those outlets in more deprived areas. CONCLUSIONS POS displays remain a key vector in most countries for advertising tobacco products, and it is important to develop robust measures of exposure. The data reported in this paper provide a baseline measure for evaluating the efficacy of legislation prohibiting such displays.
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Affiliation(s)
- M Stead
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - D Eadie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - A M MacKintosh
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - C Best
- School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - M Miller
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| | - F Haseen
- Child and Adolescent Health Research Unit (CAHRU), School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews KY16 9TF, UK.
| | - J R Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, EH8 9XP, UK.
| | - C Tisch
- Institute of Geography, University of Edinburgh, Drummond Street, Edinburgh EH8 9XP, UK.
| | - L Macdonald
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - A MacGregor
- ScotCen Social Research, Scotiabank House (2nd Floor), 6 South Charlotte Street, Edinburgh EH2 4AW, UK.
| | - A Amos
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| | - W van der Sluijs
- Child and Adolescent Health Research Unit (CAHRU), School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews KY16 9TF, UK.
| | - J W Frank
- University of Edinburgh, 30 West Richmond Street, Edinburgh EH8 9DX, UK.
| | - S Haw
- School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
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17
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Best C. (474) Use of radiofrequency ablation of dorsal root ganglion technique for precision diagnosis and treatment of intercostal neuralgia. The Journal of Pain 2016. [DOI: 10.1016/j.jpain.2016.01.451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Best C, van der Sluijs W, Haseen F, Eadie D, Stead M, MacKintosh AM, Pearce J, Tisch C, MacGregor A, Amos A, Miller M, Frank J, Haw S. Does exposure to cigarette brands increase the likelihood of adolescent e-cigarette use? A cross-sectional study. BMJ Open 2016; 6:e008734. [PMID: 26908512 PMCID: PMC4769402 DOI: 10.1136/bmjopen-2015-008734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/17/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the relationship between tobacco cigarette brand recognition, and e-cigarette use in adolescents. DESIGN Cross-sectional observational study. SETTING High schools in Scotland. PARTICIPANTS Questionnaires were administered to pupils in Secondary 2 (S2 mean age: 14.0 years) and Secondary 4 (S4 mean age: 15.9 years) across 4 communities in Scotland. An 86% response rate with a total sample of 1404 pupils was achieved. MAIN OUTCOME MEASURES Self-reported previous use of e-cigarettes and self-reported intention to try e-cigarettes in the next 6 months. RESULTS 75% (1029/1377) of respondents had heard of e-cigarettes (69.5% S2, 81.1% S4), and of these, 17.3% (10.6% S2, 24.3% S4 n=1020) had ever tried an e-cigarette. 6.8% (3.7% S2, 10.0% S4 n=1019) reported that they intended to try an e-cigarette in the next 6 months. Recognition of more cigarette brands was associated with greater probability of previous e-cigarette use (OR 1.20, 99% CI 1.05 to 1.38) as was having a best friend who smoked (OR 3.17, 99% CI 1.42 to 7.09). Intention to try e-cigarettes was related to higher cigarette brand recognition (OR 1.41, 99% CI 1.07 to 1.87), hanging around in the street or park more than once a week (OR 3.78, 99% CI 1.93 to 7.39) and living in areas of high tobacco retail density (OR 1.20, 99% CI 1.08 to 1.34). Never having smoked was a protective factor for both future intention to try, and past e-cigarette use (OR 0.07, 99% CI 0.02 to 0.25; and OR 0.10, 99% CI 0.07 to 0.16, respectively). CONCLUSIONS Higher cigarette brand recognition was associated with increased probability of previous use and of intention to use e-cigarettes. The impact of tobacco control measures such as restricting point-of-sale displays on the uptake of e-cigarettes in young people should be evaluated.
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Affiliation(s)
- C Best
- School of Health Sciences, University of Stirling, Stirling, UK
| | - W van der Sluijs
- Child and Adolescent Health Research Unit, University of St Andrews, St Andrews, UK
| | - F Haseen
- Child and Adolescent Health Research Unit, University of St Andrews, St Andrews, UK
| | - D Eadie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - M Stead
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - AM MacKintosh
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK
| | - J Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - C Tisch
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | | | - A Amos
- Usher Institute of Population Health Sciences and Informatics, School of Medicine, University of Edinburgh, Edinburgh, UK
| | - M Miller
- Usher Institute of Population Health Sciences and Informatics, School of Medicine, University of Edinburgh, Edinburgh, UK
| | - J Frank
- Public Health Research and Policy, The Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - S Haw
- School of Health Sciences, University of Stirling, Stirling, UK
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Best C, Struthers H, Laciny E, Royal M, Reeds DN, Yarasheski KE. Sitagliptin Reduces Inflammation and Chronic Immune Cell Activation in HIV+ Adults With Impaired Glucose Tolerance. J Clin Endocrinol Metab 2015; 100:2621-9. [PMID: 25938633 PMCID: PMC4490301 DOI: 10.1210/jc.2015-1531] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
CONTEXT HIV infection is associated with a greater risk for fasting hyperinsulinemia, impaired glucose tolerance, and higher incidence rates for vascular disease, myocardial infarction, or stroke despite effective combination antiretroviral therapy (cART). The underlying mechanism(s) may involve chronic low-grade systemic inflammation and immune cell activation. Dipeptidyl peptidase-4 inhibitors (sitagliptin) improve glucose tolerance and may possess immunomodulatory effects because leukocyte CD26 cell surface receptors express dipeptidyl peptidase-4 activity. OBJECTIVE Sitagliptin will reduce inflammatory and immune cell activation markers known to be elevated in cART-treated HIV-infected (HIV+) adults with impaired glucose tolerance. DESIGN This was designed as a prospective, randomized, placebo-controlled, double-blind trial of sitagliptin in HIV+ adults. SETTING The setting was an academic medical center. PATIENTS Patients were cART-treated HIV+ men and women (n = 36) with stable HIV disease and impaired glucose tolerance. INTERVENTIONS Interventions included sitagliptin 100 mg/d or placebo for 8 weeks. MAIN OUTCOME MEASURES At baseline and week 8, plasma high-sensitivity C-reactive protein and C-X-C motif chemokine 10 concentrations (ELISA), oral glucose tolerance, and abdominal sc adipose mRNA expression for M1 macrophage markers (monocyte chemotactic protein-1, EGF-like module-containing, mucin-like hormone receptor 1). RESULTS Sitagliptin reduced glucose area under the curve (P = .002) and improved oral glucose insulin sensitivity index (P = .04) more than placebo. Sitagliptin reduced plasma high-sensitivity C-reactive protein and C-X-C motif chemokine 10 levels more than placebo (P < .009). Adipose tissue monocyte chemotactic protein-1 mRNA abundance declined significantly more (P = .01), and adipose EGF-like module-containing, mucin-like hormone receptor 1 mRNA expression tended to decline more (P = .19) in sitagliptin than placebo. CONCLUSION Sitagliptin had beneficial systemic and adipose anti-inflammatory effects in cART-treated HIV+ adults with impaired glucose tolerance. Large-scale, long-term studies should determine whether sitagliptin reduces cardiovascular risk and events in HIV+ adults.
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Affiliation(s)
- Conor Best
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110
| | - Heidi Struthers
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110
| | - Erin Laciny
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110
| | - Michael Royal
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110
| | - Dominic N Reeds
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110
| | - Kevin E Yarasheski
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110
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Döring K, Best C, Birklein F, Krämer H. Zolmitriptan inhibits neurogenic inflammation and pain during electrical stimulation in human skin. Eur J Pain 2014; 19:966-72. [DOI: 10.1002/ejp.622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2014] [Indexed: 01/03/2023]
Affiliation(s)
- K. Döring
- Department of Neurology; Justus-Liebig-University; Giessen Germany
| | - C. Best
- Department of Neurology; Philipps-University; Marburg Germany
| | - F. Birklein
- Department of Neurology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - H.H. Krämer
- Department of Neurology; Justus-Liebig-University; Giessen Germany
- Department of Neurology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
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Lautenschläger G, Kaps M, Kathrin D, Best C, Birklein F, Elam M, Krämer HH. Zusammenhang zwischen muscle sympathetic nerve activity (MSNA) und Stress-induzierter Analgesie – eine Mikroneurografie Studie. KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1371307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schirner WP, Döring K, Dassinger B, Best C, Kaps M, Gizewski ER, Krämer HH. Gibt es eine Lateralisierung bei der Schmerzverarbeitung von Hitze- und Kälteschmerz? KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1371308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Best C, Lange E, Buchholz HG, Bausbacher N, Kronfeld A, Schreckenberger M, Dieterich M, Reuss S. Kompensationsmechanismen nach Läsionierung vestibulär eloquenter Thalamuskerne im Rattenmodel: Eine funktionelle FDG-PET-Studie. KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1371191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
As individuals age a number of physical and cognitive changes affect their nutritional intake. Sensory losses affect the ability to obtain food or eat independently, while cognitive changes, such as dementia, may affect a person's understanding of how to eat. This article aims to familiarise readers with the main concerns associated with caring for older people's nutritional needs while they are in hospital. Strategies to address these challenges are presented. If they are not addressed, they can have major implications for patient recovery and discharge planning.
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Affiliation(s)
- C Best
- Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust.
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25
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Döring K, Schirner W, Dassinger B, Best C, Birklein F, Kaps M, Gizewski ER, Krämer HH. Schmerzhemmung und Allodynie durch unmyelinisierte Afferenzen – ein Widerspruch? KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337203] [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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26
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Best C, Kreitner L, Rausch P, zu Eulenburg P, Baier B, Thömke F, Dieterich M. Neuritis vestibularis mit Beteiligung des inferioren Nervanteils: Risikofaktor für ein schlechteres Outcome? KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337182] [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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Rivera S, Best C, Yim H, Walther D, Sloutsky V, Martinez A. Automatic selection of eye tracking variables uncovers similar mechanisms for visual categorization in adults and infants. J Vis 2012. [DOI: 10.1167/12.9.1258] [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] Open
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Best C, van Wijck F, Dennis J, Smith M, Donaghy M, Fraser H, Dinan-Young S, Mead G. A survey of community exercise programmes for stroke survivors in Scotland. Health Soc Care Community 2012; 20:400-411. [PMID: 22085087 DOI: 10.1111/j.1365-2524.2011.01043.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Stroke is the most common cause of complex disability in the community. Physical fitness is often reduced after stroke, but training can improve fitness and function. UK and international stroke clinical guidelines recommend long-term exercise participation for stroke survivors. However, there has been no previous research into what services are available to support this. In 2009, we conducted the first European survey of community Exercise after Stroke services. A link to our web-based survey was emailed to health, leisure service and stroke charity contacts in Scotland with email and telephone follow-up to non-respondents. The overall response rate was 64% (230/361). A total of 14 Exercise after Stroke services were identified, the majority of which were run by charity collaborations (7/14), followed by leisure centre services (4/14) and health services (3/14). We sought information on session content, referral and assessment processes, and the qualifications of exercise instructors. This information was cross-referenced with current clinical and exercise guidelines to determine whether existing resources were sufficient to meet stroke survivors' needs for safe, effective and sustainable access to exercise. The results indicated a shortage of stroke-specific community exercise programmes. Further service development is required to ensure appropriate instructor training and referral pathways are in place to enable stroke survivors to access exercise services in accordance with current guidelines.
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Affiliation(s)
- C Best
- University of Stirling, UK.
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Best C, Gawehn J, Thömke F, Müller-Forell W, Dieterich M. Hochauflösende MRT und Neurophysiologie bei Vestibularisparoxysmie: Widerspruch oder Zusammenhang? KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301536] [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: 10/28/2022]
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Velankar S, Alhroub Y, Best C, Caboche S, Conroy MJ, Dana JM, Fernandez Montecelo MA, van Ginkel G, Golovin A, Gore SP, Gutmanas A, Haslam P, Hendrickx PMS, Heuson E, Hirshberg M, John M, Lagerstedt I, Mir S, Newman LE, Oldfield TJ, Patwardhan A, Rinaldi L, Sahni G, Sanz-García E, Sen S, Slowley R, Suarez-Uruena A, Swaminathan GJ, Symmons MF, Vranken WF, Wainwright M, Kleywegt GJ. PDBe: Protein Data Bank in Europe. Nucleic Acids Res 2011; 40:D445-52. [PMID: 22110033 PMCID: PMC3245096 DOI: 10.1093/nar/gkr998] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The Protein Data Bank in Europe (PDBe; pdbe.org) is a partner in the Worldwide PDB organization (wwPDB; wwpdb.org) and as such actively involved in managing the single global archive of biomacromolecular structure data, the PDB. In addition, PDBe develops tools, services and resources to make structure-related data more accessible to the biomedical community. Here we describe recently developed, extended or improved services, including an animated structure-presentation widget (PDBportfolio), a widget to graphically display the coverage of any UniProt sequence in the PDB (UniPDB), chemistry- and taxonomy-based PDB-archive browsers (PDBeXplore), and a tool for interactive visualization of NMR structures, corresponding experimental data as well as validation and analysis results (Vivaldi).
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Affiliation(s)
- S Velankar
- Protein Data Bank in Europe, EMBL-EBI, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SD, UK
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Best C, zu Eulenburg P, Krämer H, Bauermann T, Stoeter P, Dieterich M. Gesteigerte und asymmetrische kortikale Erregbarkeit bei Patienten mit vestibulärer Migräne - eine fMRT-Studie-. KLIN NEUROPHYSIOL 2011. [DOI: 10.1055/s-0031-1272786] [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: 10/18/2022]
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Abstract
Nearly 50% of the patients in general medicine practice suffer from vertigo. In specialized vertigo clinics approximately 50% of the patients have either a primary or secondary somatoform vertigo, which develops after a peripheral vestibular disorder (in nearly 30%). The different subgroups of somatoform vertigo and a pathogenetic model for the two forms of somatoform vertigo are presented. Interesting interactions between neuro-anatomical, neurophysiological and psychological mechanisms concerning anxiety and vertigo are described. Therapeutic principles which are important for the treatment of patients with complex somatoform vertigo disorders are described.
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Affiliation(s)
- A Eckhardt-Henn
- Klinik für Psychosomatische Medizin und Psychotherapie/ Medizinische Klinik 2, Bürgerhospital Klinikum Stuttgart, Tunzhoferstrasse 14-16, 70901 Stuttgart.
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Velankar S, Best C, Beuth B, Boutselakis CH, Cobley N, Sousa Da Silva AW, Dimitropoulos D, Golovin A, Hirshberg M, John M, Krissinel EB, Newman R, Oldfield T, Pajon A, Penkett CJ, Pineda-Castillo J, Sahni G, Sen S, Slowley R, Suarez-Uruena A, Swaminathan J, van Ginkel G, Vranken WF, Henrick K, Kleywegt GJ. PDBe: Protein Data Bank in Europe. Nucleic Acids Res 2009; 38:D308-17. [PMID: 19858099 PMCID: PMC2808887 DOI: 10.1093/nar/gkp916] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Protein Data Bank in Europe (PDBe) (http://www.ebi.ac.uk/pdbe/) is actively working with its Worldwide Protein Data Bank partners to enhance the quality and consistency of the international archive of bio-macromolecular structure data, the Protein Data Bank (PDB). PDBe also works closely with its collaborators at the European Bioinformatics Institute and the scientific community around the world to enhance its databases and services by adding curated and actively maintained derived data to the existing structural data in the PDB. We have developed a new database infrastructure based on the remediated PDB archive data and a specially designed database for storing information on interactions between proteins and bound molecules. The group has developed new services that allow users to carry out simple textual queries or more complex 3D structure-based queries. The newly designed 'PDBeView Atlas pages' provide an overview of an individual PDB entry in a user-friendly layout and serve as a starting point to further explore the information available in the PDBe database. PDBe's active involvement with the X-ray crystallography, Nuclear Magnetic Resonance spectroscopy and cryo-Electron Microscopy communities have resulted in improved tools for structure deposition and analysis.
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Affiliation(s)
- S Velankar
- Protein Databank in Europe, EMBL-EBI, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SD, UK.
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Best C, Tschan R, Eckhardt-Henn A, Dieterich M. Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder? Neuroscience 2009; 164:1579-87. [PMID: 19828125 DOI: 10.1016/j.neuroscience.2009.09.034] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/03/2009] [Accepted: 09/16/2009] [Indexed: 11/17/2022]
Abstract
Patients with vestibular vertigo syndromes often suffer from anxiety and depression, whereas patients with psychiatric disorders often experience subjective unsteadiness, dizziness, or vertigo. Thus, it has been hypothesized that the vestibular system may be interlinked with the emotion processing systems. The aim of the current study was to evaluate this hypothesis by correlating vestibular and psychiatric symptoms with the course of the disease over 1 year. This interdisciplinary, prospective, longitudinal study included a total of 68 patients with acute vestibular vertigo syndromes. Four subgroups of patients with benign paroxysmal positioning vertigo (BPPV, n=19), acute vestibular neuritis (VN, n=14), vestibular migraine (VM, n=27), or Menière's disease (MD, n=8) were compared. All patients underwent neurological and neuro-otological examinations and filled out standardized self-report inventories including the Vertigo Symptom Scale (VSS), the Vertigo Handicap Questionnaire (VHQ) and the Symptom Checklist 90R (GSI, SCL-90R) at five different times (T0-T4) in the course of 1 year. VM patients experienced significantly more "vertigo and related symptoms" (VSS-VER), "somatic anxiety and autonomic arousal" (VSS-AA), and "vertigo induced handicap" (VHQ) than all other patients (P<0.001-P=0.006). Patients with a positive history of psychiatric disorders had significantly more emotional distress (GSI, SCL-90R), regardless of the specific phenomenology of the four diagnostic subgroups. Finally, fluctuations of vestibular excitability correlated positively with the extent of subjectively perceived vertigo. VM patients are significantly more handicapped by vertigo and related symptoms. They show significantly elevated fluctuations of vestibular excitability, which correlate with the (subjective) severity of vertigo symptoms.
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Affiliation(s)
- C Best
- Department of Neurology, Johannes Gutenberg-University, Mainz, Germany.
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Best C, Lange E, Buchholz HG, Bausbacher N, Schreckenberger M, Reuss S, Dieterich M. Ipsilaterale Dominanz vestibulärer kortikaler Prozessierung im Rattenhirn – Eine F-18-FDG Tier-PET-Studie. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0029-1216157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Best C, Tschan R, Dellani P, Stieber N, Beutel M, Eckhardt-Henn A, Dieterich M. Improved Postural Control after Behavioural Short Term Intervention in Patients with Psychiatric Dizziness. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)71273-8] [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: 11/16/2022] Open
Abstract
Background:Patients with psychiatric dizziness often report subjective instability of stance and gait and fear of falls. They showed increased activity of their body sway in static posturography compared to normals (1, 2). Aim of the present study was to evaluate the efficiency of a behavioural therapy by static posturography.Methods:14 patients with psychiatric dizziness were included in the prospective study on static posturography to quantify the postural sway (sway path) during upright stance under different conditions. the psychosomatic examination comprised of standardized interviews (SCID-Interview) and a psychometric examination battery (SCL-90, VSS, VHQ). Results of static posturography were compared to those of an age-matched control group (n=23), baseline measurements were compared to the results after behavioural short term intervention.Results:At baseline patients revealed significantly lower sway-path values in the anterior-posterior and lateral planes (p< 0.001 - p=0.042) but significantly elevated values in the vertical plane (p=0.015 - p=0.042). They had to be supported more often in the examination setting to prevent falls (p< 0.001). after the short term intervention therapy a normalization of sway path values was present, especially the increased vertical sway activity was reduced (p=0.028).Conclusion:Patients with psychiatric dizziness activate significantly more anti-gravity muscles which reflects a change in postural strategy with an increased “stiffness” and a consecutively higher rate of “falls”. the patient's conscious control of stance augments coactivation of anti-gravity muscles. This typical pattern of postural control could be normalized by a short term behavioural therapy.1. Krafczyk, 1999; 2. Querner, 2000.
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Best C, Tschan R, Dellani P, Stieber N, Eckhardt-Henn A, Dieterich M. Verbesserung der Haltungsregulation bei Patienten mit somatoformen Schwindelsyndromen mittels verhaltenstherapeutischer Kurzzeitintervention. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tschan R, Wiltink J, Best C, Bense S, Dieterich M, Beutel ME, Eckhardt-Henn A. Validation of the German version of the Vertigo Symptom Scale (VSS) in patients with organic or somatoform dizziness and healthy controls. J Neurol 2008; 255:1168-75. [DOI: 10.1007/s00415-008-0863-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 12/03/2007] [Accepted: 01/08/2008] [Indexed: 11/24/2022]
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Best C, Bense S, Buchholz H, Schlindwein P, Brandt T, Bartenstein P, Dieterich M. P13. Compensation processes for central vestibular dysfunction in patients with acute medullary infarctions (FDG-PET study). Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2007.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Best C, Bense S, Dieterich M. Vestibular dysfunction in major depression. Neuroscience 2007; 147:865-6. [PMID: 17566664 DOI: 10.1016/j.neuroscience.2007.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 05/03/2007] [Accepted: 05/06/2007] [Indexed: 10/23/2022]
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Hundt B, Best C, Schlawin N, Kassner H, Genzel Y, Reichl U. Establishment of a mink enteritis vaccine production process in stirred-tank reactor and Wave® Bioreactor microcarrier culture in 1–10L scale. Vaccine 2007; 25:3987-95. [PMID: 17391818 DOI: 10.1016/j.vaccine.2007.02.061] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 02/08/2007] [Accepted: 02/16/2007] [Indexed: 11/17/2022]
Abstract
A scale-up and process optimization scheme for the growth of adherent embryonic feline lung fibroblasts (E-FL) on microcarriers and the propagation of a mink enteritis virus (MEV) strain for the production of an inactivated vaccine is shown. Stirred-tank cultivations are compared with results obtained from Wave Bioreactors. Transfer from a roller bottle-based production process into large-scale microcarrier culture with starting concentrations of 2g/L Cytodex 1 microcarriers and 2.0 x 10(5)cells/mL was successful. A maximum cell yield of 1.2 x 10(6)cells/mL was obtained in stirred-tank microcarrier batch culture while cell numbers in the Wave Bioreactor could not be determined accurately due to the fast sedimentation of microcarriers under non-rocking conditions required for sampling. Detailed off-line analysis was carried out to understand the behaviour of the virus-host cell system in both cultivation systems. Metabolic profiles for glucose, lactate, glutamine, and ammonium showed slight differences for both systems. E-FL cell growth was on the same level in stirred-tank and Wave Bioreactor with a higher volumetric cell yield compared to roller bottles. Propagation of MEV, which can only replicate efficiently in mitotic cells, was characterized in the Wave Bioreactor using a multiple harvest strategy. Maximum virus titres of 10(6.6) to 10(6.8) TCID(50)/mL were obtained, which corresponds to an increase in virus yield by a factor of about 10 compared to cultivations in roller bottles. As a consequence, a single Wave Bioreactor cultivation of appropriate scale can replace hundreds of roller bottles. Thus, the Wave Bioreactor proved to be a suitable system for large-scale production of an inactivated MEV vaccine.
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Affiliation(s)
- B Hundt
- Impfstoffwerk Dessau-Tornau GmbH, PF 400214, 06855 Rosslau, Germany.
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Bense S, Best C, Buchholz H, Janzen J, Brandt T, Schreckenberger M, Cohen B, Dieterich M. Funktionelle Bildgebung der Bewegungskrankheit (FDG-PET). KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Best C, Tschan R, Schlindwein P, Eckhardt-Henn A, Bense S, Dieterich M. Die Rolle vorbestehender psychiatrischer Morbiditäten für den Verlauf nach primär organischen Schwindelsyndromen -Ergebnisse einer Longitudinalstudie-. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Best C, Stefan H, Hopfengärtner R, Bense S, Dieterich M. Elektrische Stimulation des Gyrus temporalis superior induziert konjugierte ipsiversive Nystagmen -Klinische Evidenz für die Lokalisation des vestibulären Kortex-. Akt Neurol 2007. [DOI: 10.1055/s-2007-987575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Menzin J, Brown J, Guadagno L, Friedman M, Kitch B, Marton J, Best C, Boulanger L, Xuan J. CARE-SEEKING BEHAVIOR AMONG SUBJECTS WITH EARLY CHRONIC OBSTRUCTIVE LUNG DISEASE IDENTIFIED THROUGH A COMMUNITY SPIROMETRY SCREENING PROGRAM: FINDINGS FROM THE RESPIRATORY HEALTH PROMOTION STUDY (RHPS). Chest 2006. [DOI: 10.1378/chest.130.4_meetingabstracts.170s-a] [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: 11/01/2022] Open
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Abstract
BACKGROUND The high coincidence of organic vestibular and somatoform vertigo syndromes has appeared to support pathogenic models showing a strong linkage between them. It was hypothesised that a persisting vestibular dysfunction causes the development of anxiety disorders. OBJECTIVE To determine the relation between vestibular deficits and somatoform vertigo disorders in an interdisciplinary prospective study. METHODS Participants were divided into eight diagnostic groups: healthy volunteers (n=26) and patients with benign paroxysmal positioning vertigo (BPPV, n=11), vestibular neuritis (n=11), Menière's disease (n=7), vestibular migraine (n=15), anxiety (n=23), depression (n=12), or somatoform disorders (n=22). Neuro-otological diagnostic procedures included electro-oculography with rotatory and caloric testing, orthoptic examination with measurements of subjective visual vertical (SVV) and ocular torsion, and a neurological examination. Psychosomatic diagnostic procedures comprised interviews and psychometric instruments. RESULTS Patients with BPPV (35.3%) and with vestibular neuritis (52.2%) had pathological test values on caloric irrigation (p<0.001). Otolith dysfunction with pathological tilts of SVV and ocular torsion was found only in patients with vestibular neuritis (p<0.001). Patients with Menière's disease, vestibular migraine, and psychiatric disorders showed normal parameters for vestibular testing but pathological values for psychometric measures. There was no correlation between pathological neurological and pathological psychometric parameters. CONCLUSIONS High anxiety scores are not a result of vestibular deficits or dysfunction. Patients with Menière's disease and vestibular migraine but not vestibular deficits showed the highest psychiatric comorbidity. Thus the course of vertigo syndromes and the possibility of a pre-existing psychopathological personality should be considered pathogenic factors in any linkage between organic and psychometric vertigo syndromes.
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Affiliation(s)
- C Best
- Department of Neurology, Johannes-Gutenberg University, Langenbeckstrasse 1, 55101 Mainz, Germany.
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Best C, Eckhardt-Henn A, Tschan R, Breuer P, Schlindwein P, Bense S, Dieterich M. Psychiatric comorbidity in patients with bilateral vestibulopathy. Akt Neurol 2006. [DOI: 10.1055/s-2006-953060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Best C, Koehler J, Werhahn K, Dieterich M. Symptoms improve in a patient with Cogan's syndrome after escalation therapy with intravenous ultra high-dosage glucocorticoids. Akt Neurol 2006. [DOI: 10.1055/s-2006-953062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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