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Ramya R, Noordeen S, Fleming C, Sivanandan MH. Evaluating the Efficacy and Safety of Combined Administration of Systemic and Topical Tranexamic Acid in Total Knee Arthroplasty. J Orthop Case Rep 2024; 14:187-193. [PMID: 38681937 PMCID: PMC11043995 DOI: 10.13107/jocr.2024.v14.i04.4406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/10/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Tranexamic acid (TXA) is an antifibrinolytic agent, thatagent that reduces substantial blood loss in total knee arthroplasty (TKA) surgeries without increasing the risk of thromboembolic complications. The purpose of our study was to assess the effectiveness and safety of the combined use of intravenousIV and topical TXAtranexamic acid in uncomplicated primary Total knee Arthroplasty (TKA) without complications. Materials and Methods In this prospective study, we enrolled 61 patients who underwent unilateral primary TKR and were randomly divided into two groups: Group I received intravenous (IV) TXA and Group II received both IV and intraarticular (IA) TXA. Patients assigned to Group I received IV TXA preoperatively 30 mins before surgery and postoperatively at 3 and 6 hours after surgery, whereas in the combined group, in addition to IV doses, topical TXA was applied as mop 2 g of TXA diluted in 30 mL of isotonic sodium chloride solution) intraarticularly for about 5 minutes before closing the arthrotomy. We measured total blood loss (TBL), ) and mean reduction in haemoglobin (Hb) levels as primary outcomes. Transfusion rates, incidence of thromboembolic events (TE), and other adverse effects as secondary outcomes. Total blood loss TBL and Hb drops was were noted on the 3rd post-operative day. All the patients were followed-up for 6 months to note the incidence of deep venous thrombosisDVT and Thromboembolic Events (TE). An Iindependent t-test was used to evaluate between--group differences. P < 0.05 as is the cut-off for statistically significant differences. Results The Total blood loss (TBL) in Group I was 780.05 ± 158.05 mL, compared to 660.80 ± 156.45 mL in Group II. (P < 0.001). The Hb drop was significantly lower in IV TXA group (2.3 ± 0.37) than the combined TXA group (1.40 ± 0.32). Furthermore, both groups required no transfusions. No thromboembolic complications was were noted postoperatively and at 6 6-month follow-up. Conclusion TXATranexamic acid in total knee replacement surgery effectively decreases blood loss and significantly reduces the need for blood transfusions. Based on our study, the combined use of intravenous (IV) and IAintraarticular TXA in total knee replacement was found to be superior in reducing blood loss and significantly reducing the need for blood transfusions in TKA.
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Affiliation(s)
- R Ramya
- Department of Pharmacology, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Vinayaka Mission’s Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
| | - S Noordeen
- Department of Orthopedics, Srinivasan Medical College and Hospital, Dhanalakshmi Srinivasan University, Trichy, Tamil Nadu, India
| | - C Fleming
- Department of Orthopedics, Srinivasan Medical College and Hospital, Dhanalakshmi Srinivasan University, Trichy, Tamil Nadu, India
| | - M Hari Sivanandan
- Department of Orthopaedics, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Vinayaka Mission’s Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
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Noordeen S, Fleming C, Gokulakrishnan R, Sivanandan MH. The Functional Outcome of Surgical Management of Spondylolisthesis with Posterior Stabilization and Fusion. J Orthop Case Rep 2024; 14:119-124. [PMID: 38292104 PMCID: PMC10823822 DOI: 10.13107/jocr.2024.v14.i01.4170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/02/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Spondylolisthesis is a spinal condition characterized by the forward displacement of one vertebra over another, leading to instability and associated symptoms. Surgical intervention is often recommended for patients with symptomatic spondylolisthesis unresponsive to conservative treatment. The objective of this study was to analyze the functional outcomes of surgical management utilizing posterior stabilization and fusion techniques in patients with spondylolisthesis. Materials and Methods This is a prospective study conducted on 30 patients who underwent surgical treatment for spondylolisthesis with posterior trans-pedicular screw fixation with conventional or reduction screws and fusion. Meyerding's grade of listhesis, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI) score and pain scores such as visual analog scale (VAS), numerical rating scale 11 (NRS-11), and pain relief rate were used to analyze the functional outcome. Results Postoperatively, Meyerding's grade of listhesis and the JOA score had improved significantly. The ODI score and pain scores such as VAS, NRS-11, and pain relief rate were better after surgical interventions. There was full motor recovery in 13 patients and 14 patients had full sensory recovery, while six patients had sensory blunting at the time of the time of the last follow-up. Twenty-six (80.7%) patients had clinically successful results and radiological/clinical fusion while four of the patients did not achieve a clinically successful result and radiological/clinical fusion. The average time for bony fusion was 5.58 months with the earliest being 4 months and the latest 12 months. Intraoperatively, one patient had screw slippage and one had a dural tear. Postoperatively, four patients had infection, two patients were presented with deep infection, and the instrumentation had been removed. Conclusion This study demonstrated favorable functional outcomes and improvements in pain, disability, and quality of life measures following surgical intervention.
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Affiliation(s)
- S Noordeen
- Department of Orthopedics, Srinivasan Medical College and Hospital, Trichy, Tamil Nadu, India
| | - C Fleming
- Department of Orthopedics, Srinivasan Medical College and Hospital, Trichy, Tamil Nadu, India
| | - R Gokulakrishnan
- Department of Orthopaedics, KAPV Government Medical College and Hospital, Trichy, Tamil Nadu, India
| | - M Hari Sivanandan
- Department of Orthopaedics, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Vinayaka Mission’s Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
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Xu J, Mohan HM, Fleming C, Larach JT, Apte SS, Cohen LCL, Miskovic D, Jiang W, Heriot AG, Warrier SK. Complete mesocolic excision versus standard resection for colon cancer: a systematic review and meta-analysis of perioperative safety and an evaluation of the use of a robotic approach. Tech Coloproctol 2023; 27:995-1005. [PMID: 37414915 DOI: 10.1007/s10151-023-02838-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Complete mesocolic excision (CME) has been associated with improved oncological outcomes in treatment of colon cancer. However, widespread adoption is limited partly because of the technical complexity and perceived risks of the approach. The aim of out study was to evaluate the safety of CME compared to standard resection and to compare robotic versus laparoscopic approaches. METHODS Two parallel searches were undertaken in MEDLINE, Embase and Web of Science databases 12 December 2021. The first was to evaluate IDEAL stage 3 evidence to compare complication rates as a surrogate marker of perioperative safety between CME and standard resection. The second independent search compared lymph node yield and survival outcomes between minimally invasive approaches. RESULTS There were four randomized control trials (n = 1422) comparing CME to standard resection, and three studies comparing laparoscopic (n = 164) to robotic (n = 161) approaches. Compared to standard resection, CME was associated with a reduction in Clavien-Dindo grade 3 or higher complication rates (3.56% vs. 7.24%, p = 0.002), reduced blood loss (113.1 ml vs. 137.6 ml, p < 0.0001) and greater mean lymph node harvest (25.6 vs. 20.9 nodes, p = 0.001). Between the robotic and laparoscopic groups, there were no significant differences in complication rates, blood loss, lymph node yield, 5-year disease-free survival (OR 1.05, p = 0.87) and overall survival (OR 0.83, p = 0.54). CONCLUSIONS Our study demonstrated improved safety with CME. There was no difference in safety or survival outcomes between robotic and laparoscopic CME. The advantage of a robotic approach may lie in the reduced learning curve and an increased penetration of minimally invasive approach to CME. Further studies are required to explore this. PROSPERO ID CRD42021287065.
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Affiliation(s)
- J Xu
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia.
| | - H M Mohan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Austin Health, Melbourne, VIC, Australia
| | - C Fleming
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - J T Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S S Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | - L C L Cohen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | | | - W Jiang
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | - A G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - S K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, 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Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Yabunaka S, Fleming C, Delamotte B. Incompleteness of the large-N analysis of the O(N) models: Nonperturbative cuspy fixed points and their nontrivial homotopy at finite N. Phys Rev E 2022; 106:054105. [PMID: 36559345 DOI: 10.1103/physreve.106.054105] [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] [Received: 08/04/2021] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
We summarize the usual implementations of the large-N limit of O(N) models and show in detail why and how they can miss some physically important fixed points when they become singular in the limit N→∞. Using Wilson's renormalization group in its functional nonperturbative versions, we show how the singularities build up as N increases. In the Wilson-Polchinski version of the nonperturbative renormalization group, we show that the singularities are cusps, which become boundary layers for finite but large values of N. The corresponding fixed points being never close to the Gaussian, are out of reach of the usual perturbative approaches. We find four new fixed points and study them in all dimensions and for all N>0 and show that they play an important role for the tricritical physics of O(N) models. Finally, we show that some of these fixed points are bivalued when they are considered as functions of d and N thus revealing important and nontrivial homotopy structures. The Bardeen-Moshe-Bander phenomenon that occurs at N=∞ and d=3 is shown to play a crucial role for the internal consistency of all our results.
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Affiliation(s)
- S Yabunaka
- Advanced Science Research Center, Japan Atomic Energy Agency, Tokai, 319-1195, Japan
| | - C Fleming
- Sorbonne Université, CNRS, Laboratoire de Physique Théorique de la Matière Condensée, F-75005, Paris, France
| | - B Delamotte
- Sorbonne Université, CNRS, Laboratoire de Physique Théorique de la Matière Condensée, F-75005, Paris, France
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Corghan S, Fullard A, Fleming C. DD-08 RETAINER II – DEVELOPMENT AND VALIDATION OF A PATIENT REPORTED OUTCOME MEASURE (PROM) FOR INGUINAL HERNIA REPAIR. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Outcome reporting following inguinal hernia repair is heterogenous. We aim to develop an inguinal hernia repair PROM.
Methods
The evaluation and development of a disease-specific instrument will be performed in accordance with FDA guidelines for developing PROMs in three phases
Item Generation: An systematic review(PROSPERO ID CRD42021271735) and narrative analysis will be undertaken to identify health related quality of life(HrQoL) issues relevant to patients with inguinal hernia, this will be used to identify themes and concepts to help inform the interview guide.
Pre-Testing: A pre-test questionnaire will be developed based on the conceptual framework devised in Phase I and tested with a sample of 20–30 patients to reach consensus regarding the questionnaire format and structure to confirm that instructions and items are clear, understandable, relevant, and applicable. Quantitative assessment of face validity of the measure will be undertaken using the QQ-10 and data fanalysed both quantitatively and qualitatively.
PROM Evaluation: A field test will be undertaken to evaluate the RETAINER II tool for reliability and validity using psychometric techniques from Classical Test Theory. Each patient will complete:
An approximate sample of 50–100 patients will be purposively sampled ensuring representation of all subgroups. Qualitative analysis, using NVIVO 12 for Windows(QSR International Pty Ltd., Australia) will be performed independently. A test-retest will be undertaken. Consenting participants will complete a second questionnaire pack 5–7 days after inital questionnaires (approximately 50 patients).
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Affiliation(s)
- S Corghan
- Irish Surgical Research Collaborative, Royal College of Surgeons Ireland , Dublin , Republic of Ireland
| | - A Fullard
- Irish Surgical Research Collaborative, Royal College of Surgeons Ireland , Dublin , Republic of Ireland
| | - C Fleming
- Irish Surgical Research Collaborative, Royal College of Surgeons Ireland , Dublin , Republic of Ireland
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9
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Croghan S, Fullard A, Fleming C. OC-040 RETAINER I (RETENTION OF URINE AFTER INGUINAL HERNIA ELECTIVE REPAIR), A PROSPECTIVE, INTERNATIONAL, MULTICENTRE COHORT STUDY. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.052] [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: 11/14/2022]
Abstract
Abstract
Aim
Post-operative urinary retention (POUR) is a recognised complication of inguinal hernia repair (IHR). Reported incidence is variable, and reporting of risk factors, contradictory. We aimed to report the rate, risk factors and impact of POUR post IHR.
Methods
A prospective international observational study was performed with 4 week data collection from each centre (March-November 2021). Patients undergoing elective open/minimally-invasive IHR were eligible. Exclusion criteria included a urethral catheter at baseline. Preoperative/intraoperative/postoperative variables were analysed and data recorded via REDCap. Multivariate analysis was performed with a primary outcome of development of POUR. Secondary outcomes were risk factors for, and implications of, POUR.
Results
4,153 patients (205 centres; 35 countries) were registered. Mean age was 54.7 years (18–95) and BMI 26.5 (16–6). 80.4% (n=3167) were performed open and 17% (n=674) minimally-invasively. The overall rate of POUR was 5.8% (n=225) and increasd >9% in male patients aged >65 years old. Risk factors associated with POUR included: higher preoperative IPSS scores (mean 9.4 vs 5.6 in non-POUR cohort, p<0.001), diagnosis of BPH (p<0.001), pre-operative constipation (p=0.009) defined as no bowel opening for two days pre-operatively and pre-operative post void residual volumes (<0.001). 37% of patients developing POUR required an unplanned hospital admission.
Conclusion
This study suggests a global POUR rate of approximately 5% following elective IHR and confirm a significant impact of POUR on patients and hospital services. Findings highlight several risk factors and confirm the IPSS score as a potential risk stratification tool.
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Affiliation(s)
- S Croghan
- Irish Surgical Research Collaborative, Royal College of Surgeons Ireland , Dublin , Republic of Ireland
| | - A Fullard
- Irish Surgical Research Collaborative, Royal College of Surgeons Ireland , Dublin , Republic of Ireland
| | - C Fleming
- Irish Surgical Research Collaborative, Royal College of Surgeons Ireland , Dublin , Republic of Ireland
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10
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Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
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Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
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11
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Wilkinson G, Fleming C, Brannigan A. 679 Introduction of A Robotic Rectopexy Programme with Benchmarking to International Standards in Published Randomised Controlled Trials. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.786] [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: 11/15/2022]
Abstract
Abstract
Aim
With the evolution of robotic surgery, the adoption of a robotic approach to perform rectopexy, in particular ventral mesh repair (VMR), is gaining popularity. We aimed to audit clinical outcomes following introduction of a robotic rectopexy (RR) programme and compare outcomes to internationally published randomised controlled trials (RCTs).
Method
Consecutive patients undergoing RR from July to December were included. The daVinci Xi surgical system (Intuitive, California) was used for all procedures using a modified left lower abdominal approach. Where VMR was performed, a 4 x 18cm Permacol mesh was used as standard and posterior fixation using ethibond. We compared operative times and 30-day clinical outcomes to international data.
Results
Over a six-month period, thirteen RR were performed (n = 1 sutured, n = 2 resection sutured, n = 10 VMR). All patients were female with a mean age of 60.4 years (SD 14.12). Mean time from 1st consultation to surgery was 10.7 months. Three patients had an external rectal prolapse and ten patients a rectocoele confirmed on dynamic MRI. Seven patients had co-existing urinary symptoms impacting on quality of life. Median docking time was 23 minutes and median robotic operative time was 194 minutes (156 minutes reported). There were no conversions (2.5% reported). Average length of stay was 5 days (4 days reported) and there were no 30-day morbidities (8.6% reported) or readmissions.
Conclusions
Robotic rectopexy can be performed with appropriate operative times and clinical outcomes and offers a superior operative platform for critical operative steps including rectal mobilisation and VMR mesh placement and suturing.
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Affiliation(s)
- G Wilkinson
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - C Fleming
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - A Brannigan
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
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12
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Wa Katolo H, Fleming C, Wilkinson G, Brannigan A. 1057 Outcome Reporting Following Rectopexy Requires Standardisation for Reproducibility and Transparent Outcome Analysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.418] [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: 11/12/2022]
Abstract
Abstract
Aim
Rectopexy is a surgical procedure commonly used to correct rectal prolapse. Several studies have investigated different approaches (abdominal, perineal) and techniques (open, laparoscopic, robotic) in this field however reporting outcomes vary significantly among studies impeding comparison of techniques. We aimed to comprehensively analyse primary outcome reporting methods following rectopexy in published literature.
Method
A systematic search was performed in keeping with PRISMA guidelines and search protocol registered with PROSPERO. Published databases were searched using the following terms: “rectopexy”, “abdominal rectopexy” and “rectopexy outcomes”. Randomised controlled trials, comparative and non-comparative prospective and retrospective studies published between 1992 and 2019 were included for analysis. Review articles, letters, editorials, abstracts, and non-English language studies were excluded. A narrative description of outcomes was reported.
Results
A total of 1089 articles were screened, and 32 articles were identified as suitable for inclusion, reporting on 1780 patients who underwent rectopexy surgery. Over 30 unique methods of reporting outcomes were recorded, with the most common being the rate of recurrence (n = 15), Cleveland Clinic Faecal Incontinence score (CCIS) (n = 11), and customised symptom questionnaires (n = 10). Many studies recognised the impact of symptoms of rectal prolapse on patients’ quality of life (QoL) however, few utilised standardised quality of life scores to evaluate the outcome of the procedures.
Conclusions
As surgical technique evolves in rectopexy, incorporating minimally invasive surgery and robotic surgery, it is important that outcome reporting is standardised to facilitate transparent comparison. Improving patient QoL is the mainstay of surgical intervention and it is important that QoL outcome measures are incorporated.
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Affiliation(s)
- H Wa Katolo
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Fleming
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - G Wilkinson
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Brannigan
- Mater Misericordiae University Hospital, Dublin, Ireland
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13
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Choi JY, Owusu-Ayim M, Dawe R, Ibbotson S, Fleming C, Foerster J. Narrowband ultraviolet B phototherapy is associated with a reduction in topical corticosteroid and clinical improvement in atopic dermatitis: a historical inception cohort study. Clin Exp Dermatol 2021; 46:1067-1074. [PMID: 33837558 DOI: 10.1111/ced.14676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Despite decades of use, the magnitude of efficacy of narrowband ultraviolet B (NB-UVB) phototherapy for atopic dermatitis (AD) beyond industry-sponsored trials remains unclear. AIM To evaluate the clinical efficacy of NB-UVB in AD under real-world conditions. METHODS We conducted a historical inception cohort study using automated recording of dispensed drugs to provide an objective treatment outcome in a large population catchment of 420 000 people over 15 years. We analysed clinical treatment outcomes, recorded multicentre and prospectively over 15 years, of a large AD treatment cohort (n = 844), along with the drugs dispensed to this cohort. RESULTS The majority (70%) of patients with AD received significantly fewer topical corticosteroids (TCS) during the 12-month window after finishing NB-UVB compared with the 12-month window before starting the treatment (median reduction from 37.5 to 19.7 g/month). The number of patients dispensed with oral corticosteroids and antihistamines also dropped significantly (from 20% to 10% and from 69% to 31%, respectively), while all AD-unrelated drugs dispensed remained unchanged. Clinically, NB-UVB treatment achieved a 'clear' or 'almost clear' status in 48.7% of patients, while 20.4% achieved 'moderate clearance'. Treatment outcomes scores were validated by a strong correlation with reduction in AD-specific drug treatment. CONCLUSION Our data confirm the significant efficacy of NB-UVB for AD under conditions of routine care.
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Affiliation(s)
- J Y Choi
- University of Dundee, Medical School, Dundee, UK
| | - M Owusu-Ayim
- University of Dundee, Medical School, Dundee, UK
| | - R Dawe
- University of Dundee, Medical School, Dundee, UK.,National Managed Clinical Network for Phototherapy (Photonet), NHS Tayside, UK
| | - S Ibbotson
- University of Dundee, Medical School, Dundee, UK
| | - C Fleming
- University of Dundee, Medical School, Dundee, UK
| | - J Foerster
- University of Dundee, Medical School, Dundee, UK
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14
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Johnson P, Thompson S, Adamo D, Fleming C, Bancos I, McKenzie T, Cheville J, Young W, Andrews J. Abstract No. 191 Adrenal venous sampling for lateralization of cortisol hypersecretion in patients with adrenocorticotropic hormone–independent Cushing syndrome and bilateral adrenal masses. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Evers SH, Delaby L, Fleming C, Pierce KM, Horan B. Effect of 3 autumn pasture management strategies applied to 2 farm system intensities on the productivity of spring-calving, pasture-based dairy systems. J Dairy Sci 2021; 104:6803-6819. [PMID: 33741168 DOI: 10.3168/jds.2020-19246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022]
Abstract
The objective of this study was to investigate the effect of altering autumn pasture availability and farm system intensity on the productivity of spring-calving dairy cows during autumn. A total of 144 Holstein-Friesian and Holstein-Friesian × Jersey crossbred dairy cows were randomly assigned to 2 whole farm system (FS) intensities and 3 autumn pasture availability (PA; measured above 3.5 cm) treatments in a 2 × 3 factorial arrangement. The 2 farm systems consisted of a medium intensity (MI: 2.75 cows/ha, target postgrazing sward height of 4.0-4.5 cm) and high intensity system (HI: 3.25 cows/ha, target postgrazing sward height of 3.5-4.0 cm, + 1.8 kg of concentrate dry matter [(DM)/cow per day]. Within each farm system treatment, cows were further subdivided into 3 different PA management strategies: high PA (HPA), medium PA (MPA), and low PA (LPA). The experimental period lasted for 11 wk from September 1 to housing of all animals on November 20 (±2 d) over 3 yr (2017-2019, inclusive). To establish the different average pasture covers for each PA treatment during autumn and in particular at the end of the grazing season, grazing rotation length was extended by +13 and +7 d for HPA and MPA, respectively, beyond that required by LPA (37 d). There were no significant FS × PA interactions for any of the pasture, dry matter intake, or milk production and composition variables analyzed. There were also no differences in pregrazing sward characteristics or sward nutritive value between FS with the exception of daily herbage allowance, which was reduced for HI system (12.2 vs. 14.2 kg of DM/cow). Milk and milk solid yield were greater for HI groups (15.9 and 1.55 kg/cow per day, respectively) compared with MI (15.4 and 1.50 kg/cow per day, respectively). Mean paddock pregrazing herbage mass was significantly higher with increased PA ranging from a mean of 1,297 kg of DM/ha for LPA to 1,718 and 2,111 kg of DM/ha of available pasture for MPA and HPA, respectively. Despite large differences in pregrazing herbage mass, there was no difference in cumulative pasture production and only modest differences in grazing efficiency and sward nutritive value between PA treatments. On average, closing pasture covers were 420, 650, and 870 kg of DM/ha for LPA, MPA, and HPA, respectively, on December 1. In addition to maintaining similar grazing season lengths and achieving big differences in availability of pasture on farm into late autumn, PA treatment had no significant effect on dry matter intake, milk production, and body condition score during the study period. The results of this study indicate that greater cow performance and pasture utilization can be achieved through a greater daily concentrate allocation along with an increased stocking rate. Moreover, the potential to adapt grazing management practices to increase the average autumn pasture cover in intensive grazing systems is highlighted. In addition, a high dependence on high-quality grazed pasture during late autumn can be ensured without compromising grazing season length while also allowing additional pasture to be available for the subsequent spring.
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Affiliation(s)
- S H Evers
- Animal and Grassland Research and Innovation Centre, Teagasc Moorepark, Fermoy, Co. Cork, P61 C996, Ireland; School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - L Delaby
- INRAE, L'institut Agro, Physiologie, Environnement et Génétique pour l'Animal et les Systèmes d'Elevage, F-35590 Saint-Gilles, France
| | - C Fleming
- Animal and Grassland Research and Innovation Centre, Teagasc Moorepark, Fermoy, Co. Cork, P61 C996, Ireland
| | - K M Pierce
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - B Horan
- Animal and Grassland Research and Innovation Centre, Teagasc Moorepark, Fermoy, Co. Cork, P61 C996, Ireland
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Hare D, Doyle D, Doherty A, Creedon M, Houlihan E, Harrison M, Sheppard D, Fleming C, Fitzpatrick F, Cormican M. Spontaneous Escherichia coli Meningitis and Pyogenic Ventriculitis in an Adult Receiving Anti-Tumour Necrosis Factor Alpha Therapy. Ir Med J 2021; 114:277. [PMID: 36331959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Presentation A 60-year-old male taking etanercept for ankylosing spondylitis was admitted to hospital with confusion and reduced level of consciousness over the preceding 24 hours. Diagnosis Magnetic Resonance Imaging (MRI) of his brain revealed pyogenic ventriculitis, and Escherichia coli was cultured from CSF. Treatment He required placement of an external ventricular drain and was treated with a prolonged course of intravenous ceftriaxone. Conclusion To our knowledge, this is the first reported case of spontaneous Gram-negative bacillary meningitis in a patient on anti-tumour necrosis factor (TNF)-alpha therapy, highlighting the risk of rare but serious infections associated with this class of medication.
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Affiliation(s)
- D Hare
- Department of Clinical Microbiology, Galway University Hospital, Galway, Ireland
| | - D Doyle
- Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - A Doherty
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - M Creedon
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - E Houlihan
- Department of Clinical Microbiology, Galway University Hospital, Galway, Ireland
| | - M Harrison
- Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - D Sheppard
- Department of Radiology, Galway University Hospital, Galway, Ireland
| | - C Fleming
- Department of Infectious Diseases, Galway University Hospital, Galway, Ireland
| | - F Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Cormican
- Department of Clinical Microbiology, Galway University Hospital, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
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Ratjen A, Morrissy D, Fleming C, McCarthy M, Gunaratnam C, McKone E, Plant B. P071 Real-world pregnancy data and outcomes in an era post-CFTR modulation therapies: an Irish centre's perspective. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vagg T, Ronan N, Morrissy D, McCarthy M, Fleming C, McCarthy Y, Tabirca S, Plant B. P097 Who's talking about cystic fibrosis? The changing landscape of internet postings related to cystic fibrosis: a two-year comparative study. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01123-1] [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: 10/21/2022]
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Morrissy D, McCarthy Y, McCarthy M, Dorgan J, Fleming C, Howlett C, Vagg T, Twohig S, Murphy D, Plant B. P040 Compassionate use triple therapy CFTR modulation (Kaftrio®) in severe disease. Single-centre, real-world clinical outcomes, safety and tolerability. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eisaman D, Geyer S, McFarland J, Fleming C, Suyama J. 60 The Value of an Integrated Sexual Assault Nurse Examiner Program at Trauma Centers: Comparing the Quality of Documentation. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.070] [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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21
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Morrissy D, Eustace J, Fleming C, McCarthy M, Cronin K, Howlett C, Madden E, Meade C, McCarthy Y, Murphy D, Plant B. P212 Real world Orkambi Long-term Leavers (ROLL) study - a prospective 6-month descriptive analysis to understand factors influencing choice of dual CFTR modulator therapy in patients with cystic fibrosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30546-4] [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: 10/24/2022]
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22
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Choi J, Dawe R, Ibbotson S, Fleming C, Doney A, Foerster J. 湿疹患者使用多少润肤剂和类固醇乳膏,以及抑郁症和类固醇乳膏使用之间的联系. Br J Dermatol 2020. [DOI: 10.1111/bjd.18929] [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: 11/27/2022]
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Choi J, Dawe R, Ibbotson S, Fleming C, Doney A, Foerster J. How much emollient and steroid cream do eczema patients use, and the link between depression and steroid cream use. Br J Dermatol 2020. [DOI: 10.1111/bjd.18910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Celarier S, Monziols S, Francois MO, Assenat V, Carles P, Capdepont M, Fleming C, Rullier E, Napolitano G, Denost Q. Randomized trial comparing low-pressure versus standard-pressure pneumoperitoneum in laparoscopic colectomy: PAROS trial. Trials 2020; 21:216. [PMID: 32087762 PMCID: PMC7036186 DOI: 10.1186/s13063-020-4140-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/04/2020] [Indexed: 01/07/2023] Open
Abstract
Background Laparoscopy, by its minimally invasive nature, has revolutionized digestive and particularly colorectal surgery by decreasing post-operative pain, morbidity, and length of hospital stay. In this trial, we aim to assess whether low pressure in laparoscopic colonic surgery (7 mm Hg instead of 12 mm Hg) could further reduce pain, analgesic consumption, and morbidity, resulting in a shorter hospital stay. Methods and analysis The PAROS trial is a phase III, double-blind, randomized controlled trial. We aim to recruit 138 patients undergoing laparoscopic colectomy. Participants will be randomly assigned to either a low-pressure group (7 mm Hg) or a standard-pressure group (12 mm Hg). The primary outcome will be a comparison of length of hospital stay between the two groups. Secondary outcomes will compare post-operative pain, consumption of analgesics, morbidity within 30 days, technical and oncological quality of the surgical procedure, time to passage of flatus and stool, and ambulation. All adverse events will be recorded. Analysis will be performed on an intention-to-treat basis. Trial registration This research received the approval from the Committee for the Protection of Persons and was the subject of information to the ANSM. This search is saved in the ID-RCB database under registration number 2018-A03028–47. This research is retrospectively registered January 23, 2019, at http://clinicaltrials.gov/ed under the name “LaPAroscopic Low pRessure cOlorectal Surgery (PAROS)”. This trial is ongoing.
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Affiliation(s)
- S Celarier
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - S Monziols
- Department of Anesthesia ans Critical Care, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - M O Francois
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - V Assenat
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - P Carles
- Department of Anesthesia ans Critical Care, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - M Capdepont
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - C Fleming
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - E Rullier
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - G Napolitano
- Department of Anesthesia ans Critical Care, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - Q Denost
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France. .,Department of digestive Surgery, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France.
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Choi JY, Dawe R, Ibbotson S, Fleming C, Doney A, Foerster J. Quantitative analysis of topical treatments in atopic dermatitis: unexpectedly low use of emollients and strong correlation of topical corticosteroid use both with depression and concurrent asthma. Br J Dermatol 2019; 182:1017-1025. [PMID: 31257575 DOI: 10.1111/bjd.18265] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite decades of use, the actual amounts of topical corticosteroids (TCS) and emollients used in moderate-to-severe atopic dermatitis (AD) under real-world conditions are unknown. Thus, it remains unclear whether inadequate use is widespread. OBJECTIVES To quantify the use of TCS and emollients in moderate-to-severe AD. METHODS Double-blinded drug prescribing was recorded prospectively at the point of drug dispensing within a catchment area of approximately 450 000 people over a 31-year period in a population-based cohort marked by failure of disease control in primary care (n = 844). For each patient, prescribing was recorded over a 12-month period in order to minimize fluctuations. RESULTS This approach resulted in a near-complete dataset, which was essentially free of reporting bias and recording bias. Atopic comorbidities matched expected frequencies. Median use of TCS was statistically significantly higher in juvenile patients (age < 16 years) compared with adult patients (49·2 vs. 38·1 g per month), in male vs. female patients (46·8 vs. 29·7 g per month) and in patients receiving concurrent asthma treatment (40·4 vs. 26·7 g per month). TCS use was strongly associated with antidepressant treatment. Emollient use was unexpectedly low with a median of 9·6 g per day (range 1·4-30·1). Results were replicated in an independent validation cohort. CONCLUSIONS Deficient use of emollients may be a factor contributing to AD severity. Our analysis showed that the use of TCS does not exceed current guidelines. Accurate quantification of topical treatments provides a widely accessible strategy to measure the real-world impact of novel AD treatments. What's already known about this topic? Both emollient and topical corticosteroid (TCS) use have been a mainstay of atopic dermatitis (AD) treatment for over 60 years. The actual quantities used by patients under real-world conditions are unknown. What does this study add? The real-world use of emollients is fourfold lower than the amount recommended in current guidelines. Underuse of emollients may be a significant factor in disease exacerbation. The use of TCS is significantly higher in male patients and is higher in patients with AD who also have asthma. The use of TCS is strongly associated with concurrent antidepressant treatment.
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Affiliation(s)
- J Y Choi
- School of Medicine, University of Dundee, Dundee, U.K
| | - R Dawe
- School of Medicine, University of Dundee, Dundee, U.K
| | - S Ibbotson
- School of Medicine, University of Dundee, Dundee, U.K
| | - C Fleming
- School of Medicine, University of Dundee, Dundee, U.K
| | - A Doney
- School of Medicine, University of Dundee, Dundee, U.K
| | - J Foerster
- School of Medicine, University of Dundee, Dundee, U.K
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Vagg T, Morrissy D, Shortt C, Fleming C, Daly M, Tabirca S, Plant B. P235 Using virtual reality to enhance the transition process. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30528-4] [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: 11/28/2022]
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Thompson S, Mugu V, Fleming C, Yohanathan L, Truty M, Kendrick M, Andrews J. 04:03 PM Abstract No. 80 Technical success, efficacy, and safety of portomesenteric venous intervention following non-transplant hepatobiliary or pancreatic surgery. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.123] [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] Open
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28
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Fleming C, Kunapareddy G, Yu N, Tendulkar R, Cherian S, Budd G, Colier P, Shah C. Assessment of Cardiac Dosimetry and Additional Cardiac Risk Factors in Patients Undergoing Modern Breast Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Boswell K, Cameron H, West J, Fleming C, Ibbotson S, Dawe R, Foerster J. Cost of narrowband ultraviolet B for psoriasis. Br J Dermatol 2018. [DOI: 10.1111/bjd.17210] [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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30
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Boswell K, Cameron H, West J, Fleming C, Ibbotson S, Dawe R, Foerster J. 窄波 UVB 用于银屑病治疗的费用. Br J Dermatol 2018. [DOI: 10.1111/bjd.17224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Oakeshott P, Kerry-Barnard S, Fleming C, Phillips R, Drennan VM, Adams EJ, Majewska W, Harding-Esch EM, Cousins EC, Planche T, Green A, Bartholomew RI, Sadiq ST, Reid F. 'Test n Treat' (TnT): a cluster randomized feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges. Clin Microbiol Infect 2018; 25:865-871. [PMID: 30391581 DOI: 10.1016/j.cmi.2018.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We conducted a cluster-randomized feasibility trial of 90-minute Chlamydia trachomatis tests and same day on-site treatment ('Test n Treat/TnT') in six technical colleges in London, England, to assess TnT uptake rates; follow-up rates; prevalence of C. trachomatis at baseline and 7 months; time to treatment; acceptability of TnT. METHODS Participants completed questionnaires and provided genitourinary samples at baseline and 7 months. Participants were informed that baseline samples would not be tested for 7 months and were advised to get screened independently. Colleges were randomly allocated 1:1 to intervention (TnT) or control (no TnT). One month and 4 months post recruitment, participants at intervention colleges were texted invitations for on-site free C. trachomatis tests. A purposive sample of students who did/did not attend for screening were interviewed (n = 26). RESULTS Five hundred and nine sexually active students were recruited: median age 17.9 years, 47% male, 50% black ethnicity, 55% reporting two or more sexual partners in the previous year. TnT uptake was 13% (33/259; 95% CI 8.9-17.4%) at 1 month and 10% (26/259; 6.7-14.4%) at 4 months with overall C. trachomatis positivity 5.1% (3/59; 1.1-14.2%). Follow-up at 7 months was 62% (317/509) for questionnaires and 52% (264/509) for samples. C. trachomatis prevalence was 6.2% (31/503) at baseline and 6.1% (16/264) at 7 months. Median time from test to treatment was 15 h. Interviews suggested low test uptake was associated with not feeling at risk, perceptions of stigma, and little knowledge of sexually transmitted infections (STIs). CONCLUSIONS Despite high C. trachomatis rates at baseline and follow-up, uptake of testing was low. Like many countries, England urgently needs better sex education, including making STI testing routine/normal. Trial registration ISRCTN58038795.
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Affiliation(s)
- P Oakeshott
- Population Health Research Institute, St George's, University of London, London UK.
| | - S Kerry-Barnard
- Population Health Research Institute, St George's, University of London, London UK
| | - C Fleming
- Population Health Research Institute, St George's, University of London, London UK
| | - R Phillips
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - V M Drennan
- Centre for Health & Social Care Research, Kingston University & St George's, University of London, London, UK
| | - E J Adams
- Aquarius Population Health Limited, London, UK
| | | | - E M Harding-Esch
- Institute for Infection and Immunity, St George's, University of London, London, UK; Public Health England, London, UK
| | - E C Cousins
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - T Planche
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - A Green
- Population Health Research Institute, St George's, University of London, London UK
| | - R I Bartholomew
- Population Health Research Institute, St George's, University of London, London UK; Institute for Infection and Immunity, St George's, University of London, London, UK
| | - S T Sadiq
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - F Reid
- School of Population Health and Environmental Sciences, King's College London, London, UK
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Stavrakis S, Zhou L, Filiberti A, Fleming C, Humphrey MB, Po S. P1835Transcutaneous vagus nerve stimulation attenuates cardiac remodeling in a rat model of heart failure with preserved ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - L Zhou
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - A Filiberti
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - C Fleming
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - M B Humphrey
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - S Po
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
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Boswell K, Cameron H, West J, Fleming C, Ibbotson S, Dawe R, Foerster J. Narrowband ultraviolet B treatment for psoriasis is highly economical and causes significant savings in cost for topical treatments. Br J Dermatol 2018; 179:1148-1156. [PMID: 29901862 DOI: 10.1111/bjd.16716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Narrowband ultraviolet B (NB-UVB) treatment for psoriasis is considered expensive. However, existing data are based on estimates and do not consider indirect cost savings. OBJECTIVES To define the actual costs of NB-UVB incurred by the service provider, as well as treatment-associated cost savings. METHODS We performed data linkage of (i) comprehensive treatment records and (ii) prescribing data for all NB-UVB treatment episodes spanning 6 years in a population of 420 000. We minimized data fluctuation by compiling data from four independent treatment sites, and using drug prescriptions unrelated to psoriasis as a negative control. RESULTS National Health Service Tayside spent an average of £257 per NB-UVB treatment course (mean 257 ± 63, range 150-286, across four independent treatment sites), contrasting sharply with the estimate of £1882 used by the U.K. National Institute for Health and Care Excellence. The cost of topical treatments averaged £128 per patient in the 12 months prior to NB-UVB, accounting for 42% of the overall drug costs incurred by these patients. This was reduced by 40% to £53 per patient over the 12-month period following NB-UVB treatment, while psoriasis-unrelated drug prescription remained unchanged, suggesting disease-specific effects of NB-UVB. The data were not due to site-specific factors, as confirmed by highly similar results observed between treatment sites operated by distinct staff. Finally, we detail all staff hours directly and indirectly involved in treatment, allowing direct translation of cost into other healthcare systems. CONCLUSIONS NB-UVB is a low-cost treatment; cost figures currently used in health technology appraisals are an overestimate based on the data presented here. Creating or extending access to NB-UVB is likely to offer additional savings by delaying or avoiding costly third-line treatments for many patients.
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Affiliation(s)
- K Boswell
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - H Cameron
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - J West
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - C Fleming
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - S Ibbotson
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - R Dawe
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K.,National Managed Clinical Network for Phototherapy (Photonet), NHS Scotland, Dundee, U.K
| | - J Foerster
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
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Hash J, Fleming C, Oxford M. 0825 Sleep and Social Emotional Functioning among Children from Families with Child Protective Services Involvement. Sleep 2018. [DOI: 10.1093/sleep/zsy061.824] [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: 11/12/2022] Open
Affiliation(s)
- J Hash
- University of Washington, School of Nursing, Seattle, WA
| | - C Fleming
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - M Oxford
- University of Washington, School of Nursing, Seattle, WA
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Haddad M, Reisenauer C, Parvinian A, Thompson S, Toskich B, Andrews J, Fleming C. 3:00 PM Abstract No. 361 ■ FEATURED ABSTRACT Comparison of bleeding complications between transplenic versus transhepatic access of the portal venous system. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.401] [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: 10/17/2022] Open
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Coffey E, Delaby L, Fleming C, Pierce K, Horan B. Multi-year evaluation of stocking rate and animal genotype on milk production per hectare within intensive pasture-based production systems. J Dairy Sci 2018; 101:2448-2462. [DOI: 10.3168/jds.2017-13632] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/27/2017] [Indexed: 11/19/2022]
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Cagney DN, Thirion PG, Dunne MT, Fleming C, Fitzpatrick D, O'Shea CM, Finn MA, O'Sullivan S, Booth C, Collins CD, Buckney SJ, Shannon A, Armstrong JG. A Phase II Toxicity End Point Trial (ICORG 99-09) of Accelerated Dose-escalated Hypofractionated Radiation in Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2017; 30:30-38. [PMID: 29097074 DOI: 10.1016/j.clon.2017.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 12/25/2022]
Abstract
AIMS The objective of this phase II clinical trial was to prospectively evaluate the safety and efficacy of accelerated hypofractionated three-dimensional conformal radiation therapy (3DCRT) in localised non-resectable/non-operable non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Sixty patients with stage I-III NSCLC were enrolled in a prospective single-arm All Ireland Co-operative Oncology Research Group (ICORG 99-09) toxicity end point phase II trial. The protocol allocated patients between three radiation schedule dose levels (60, 66 or 72 Gy, in 20, 22 and 24 fractions, respectively, 3 Gy daily, five fractions per week) according to combined lung V25Gy (V25Gy ≤ 30%) with built-in early stopping toxicity rules. The primary end point was toxicity with evaluation of dose-limiting toxicity. The secondary objectives included radiological tumour response rate at 3 months after the completion of radiation therapy and the thoracic progression-free survival time. RESULTS Sixty patients were recruited from August 1999 to June 2009. Forty-nine patients were included in the primary per-protocol analysis. Eleven patients were not evaluable. In the first 30 evaluable patient cohort, severe oesophageal toxicity was reported in two patients (2/49; 4% experiencing grade 5 oesophageal late toxicity, related to the 97% oesophageal length). The trial was temporarily closed and was then reopened to validate an oesophageal dose volume constraint (DVC) of limiting the length of oesophagus fully encompassed by the 97% isodose to less than 1 cm (applied to 21 patients). The trial prospectively showed the safety of the oesophageal DVC, with no oesophageal toxicity above grade 3 thereafter. Thirty-nine per cent of patients had disease progression at 3-4 months after radiotherapy, 22% had stable disease, 20% had a complete response and 14% had a partial response. The median overall survival was 13.6 months (95% confidence interval 10.5-16.7) and overall survival at 1 and 3 years was 57% and 29%, respectively. CONCLUSION A strategy using accelerated hypofractionated 3DCRT is feasible and reasonably safe for patients with inoperable NSCLC. It is safe to deliver for centrally located tumours if DVCs are applied to the oesophagus, which is the primary dose-limiting toxicity. Further studies are required to assess the efficacy of hypofractionated regimens for centrally located tumours using an oesophageal DVC and monitoring for oesophageal toxicity.
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Affiliation(s)
- D N Cagney
- St Luke's Radiation Oncology Network, Dublin, Ireland.
| | - P G Thirion
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - M T Dunne
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - C Fleming
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - D Fitzpatrick
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - C M O'Shea
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - M A Finn
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - S O'Sullivan
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - C Booth
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - C D Collins
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - S J Buckney
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - A Shannon
- Cancer Trials Ireland (formerly ICORG), Dublin, Ireland
| | - J G Armstrong
- St Luke's Radiation Oncology Network, Dublin, Ireland; Cancer Trials Ireland (formerly ICORG), Dublin, Ireland
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Ronan N, McCarthy Y, James K, Arooj P, Hunt E, Shortt C, Fleming C, McCarthy M, Howlett C, Hickey C, Flanagan E, Daly M, Eustace J, Maher M, Plant B. 232 Lumacaftor/Ivacaftor is associated with a significant improvement in walk test and reduction in sweat chloride in a cohort of homozygous F508del CF patients with severe disease – a single centre experience. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30577-5] [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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Fouhy F, Ronan N, McCarthy Y, Arooj P, Daly M, Flanagan E, Deane J, O'Sullivan O, Murphy K, Fleming C, McCarthy M, Shortt C, Eustace J, Shanahan F, Rea M, Ross R, Floto R, Harrison M, Haworth C, Dupont L, Stanton C, Plant B. WS03.3 A longitudinal, multi-centre investigation into the gut microbiota of adult CF patients – the CFMATTERS perspective. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30170-4] [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: 11/30/2022]
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West J, Ogston S, Berg J, Palmer C, Fleming C, Kumar V, Foerster J. HLA-Cw6-positive patients with psoriasis show improved response to methotrexate treatment. Clin Exp Dermatol 2017; 42:651-655. [DOI: 10.1111/ced.13100] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 01/22/2023]
Affiliation(s)
- J. West
- University of Dundee; College of Medicine, Dentistry, and Nursing; Dundee UK
| | - S. Ogston
- University of Dundee; College of Medicine, Dentistry, and Nursing; Dundee UK
| | - J. Berg
- University of Dundee; College of Medicine, Dentistry, and Nursing; Dundee UK
| | - C. Palmer
- University of Dundee; College of Medicine, Dentistry, and Nursing; Dundee UK
| | - C. Fleming
- Department of Dermatology and Photobiology; Ninewells Hospital; Dundee UK
| | - V. Kumar
- Department of Rheumatology; Ninewells Hospital; Dundee UK
| | - J. Foerster
- University of Dundee; College of Medicine, Dentistry, and Nursing; Dundee UK
- Department of Dermatology and Photobiology; Ninewells Hospital; Dundee UK
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Hash J, Fleming C, Oxford M. 0996 SLEEP PROBLEMS AMONG INFANTS AND TODDLERS UNDER MALTREATMENT INVESTIGATION. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.995] [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: 11/13/2022] Open
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Hussain W, Affleck A, Al-Niaimi F, Cooper A, Craythorne E, Fleming C, Ghura V, Langtry J, Lawrence C, Loghdey S, Naysmith L, Oliphant T, Rahim R, Rice S, Sivaramkrishan M, Stables G, Varma S, Mallipeddi R. Safety, complications and patients' acceptance of Mohs micrographic surgery under local anaesthesia: results from the U.K. MAPS (Mohs Acceptance and Patient Safety) Collaboration Group. Br J Dermatol 2017; 176:806-808. [PMID: 27377192 DOI: 10.1111/bjd.14843] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- W Hussain
- Dermatology Surgical & Laser Unit (C4), Leeds Centre for Dermatology, Chapel Allerton Hospital, Leeds, LS7 4SA, U.K
| | - A Affleck
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K
| | - F Al-Niaimi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, SE1 7EH, U.K
| | - A Cooper
- Dermatology Department, East Kent Hospitals University NHS Foundation Trust, Canterbury, CT1 3NG, U.K
| | - E Craythorne
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, SE1 7EH, U.K
| | - C Fleming
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K
| | - V Ghura
- Department of Dermatology, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, U.K
| | - J Langtry
- Dermatology Department, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, U.K
| | - C Lawrence
- Dermatology Department, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, U.K
| | - S Loghdey
- Department of Dermatology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, U.K
| | - L Naysmith
- Department of Dermatology, Lauriston Building, Edinburgh, EH3 9HA, U.K
| | - T Oliphant
- Dermatology Department, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, U.K
| | - R Rahim
- Dermatology Department, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, U.K
| | - S Rice
- Dermatology Department, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, U.K
| | - M Sivaramkrishan
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K
| | - G Stables
- Dermatology Surgical & Laser Unit (C4), Leeds Centre for Dermatology, Chapel Allerton Hospital, Leeds, LS7 4SA, U.K
| | - S Varma
- Department of Dermatology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, U.K
| | - R Mallipeddi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, SE1 7EH, U.K
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Burke DG, Harrison MJ, Fleming C, McCarthy M, Shortt C, Sulaiman I, Murphy DM, Eustace JA, Shanahan F, Hill C, Stanton C, Rea MC, Ross RP, Plant BJ. Clostridium difficile carriage in adult cystic fibrosis (CF); implications for patients with CF and the potential for transmission of nosocomial infection. J Cyst Fibros 2016; 16:291-298. [PMID: 27908697 DOI: 10.1016/j.jcf.2016.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/18/2016] [Accepted: 09/22/2016] [Indexed: 01/29/2023]
Abstract
Clostridium difficile is an anaerobic Gram-positive, spore-forming, toxin-producing bacillus transmitted among humans through the faecal-oral route. Despite increasing carriage rates and the presence of C. difficile toxin in stool, patients with CF rarely appear to develop typical manifestations of C. difficile infection (CDI). In this study, we examined the carriage, toxin production, ribotype distribution and antibiotic susceptibility of C. difficile in a cohort of 60 adult patients with CF who were pre-lung transplant. C. difficile was detected in 50% (30/60) of patients with CF by culturing for the bacteria. C. difficile toxin was detected in 63% (19/30) of C. difficile-positive stool samples. All toxin-positive stool samples contained toxigenic C. difficile strains harbouring toxin genes, tcdA and tcdB. Despite the presence of C. difficile and its toxin in patient stool, no acute gastrointestinal symptoms were reported. Ribotyping of C. difficile strains revealed 16 distinct ribotypes (RT), 11 of which are known to be disease-causing including the hyper-virulent RT078. Additionally, strains RT002, RT014, and RT015, which are common in non-CF nosocomial infection were described. All strains were susceptible to vancomycin, metronidazole, fusidic acid and rifampicin. No correlation was observed between carriage of C. difficile or any characteristics of isolated strains and any recorded clinical parameters or treatment received. We demonstrate a high prevalence of hypervirulent, toxigenic strains of C. difficile in asymptomatic patients with CF. This highlights the potential role of asymptomatic patients with CF in nosocomial transmission of C. difficile.
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Affiliation(s)
- D G Burke
- APC Microbiome Institute, University College Cork, Ireland
| | - M J Harrison
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - C Fleming
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - M McCarthy
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - C Shortt
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - I Sulaiman
- Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - D M Murphy
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - J A Eustace
- Health Research Board, Clinical Research Facility, University College Cork, Ireland
| | - F Shanahan
- APC Microbiome Institute, University College Cork, Ireland
| | - C Hill
- School of Microbiology, University College Cork, Ireland
| | - C Stanton
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
| | - M C Rea
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
| | - R P Ross
- APC Microbiome Institute, University College Cork, Ireland
| | - B J Plant
- Cork Adult CF Centre, Dept. of Medicine, Cork University Hospital, University College Cork, Ireland.
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Ni Riain U, Tierney M, Doyle C, Vellinga A, Fleming C, Cormican M. Targeted de-escalation rounds may effectively and safely reduce meropenem use. Ir J Med Sci 2016; 186:729-732. [PMID: 27686471 DOI: 10.1007/s11845-016-1504-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/17/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Use of meropenem in our hospital has doubled in recent years. An audit in 2013 showed that although initiation of therapy with meropenem was generally appropriate, therapy was rarely subsequently reviewed and de-escalated where appropriate. Therefore, a structured stewardship initiative focussed on meropenem de-escalation was developed. METHODS A local guideline for review and de-escalation of meropenem was developed and approved by the Antimicrobial Stewardship Team. The guideline outlined clinical and microbiological criteria which when met should lead to recommendation for meropenem de-escalation. Implementation of the guideline was piloted for a period of 4 weeks by a consultant microbiologist and an antimicrobial pharmacist. Days of meropenem use and crude mortality in those in whom de-escalation was implemented were compared with those where de-escalation was not recommended or was recommended but not implemented. RESULTS Thirty-three patients were reviewed. Overall, a recommendation to de-escalate from meropenem to a specified alternative antibiotic was made for 18 (55 %) patients. This advice was followed for 12 (36 %) patients. The median days of meropenem use in patients where meropenem was de-escalated was 4.5 days (range 2-19) compared with 14 days (range 6-84) where de-escalation was not recommended or the recommendation was not implemented. There was no statistically significant difference in crude mortality between patients de-escalated from meropenem and those where meropenem was continued. CONCLUSION This pilot study suggests that targeted carbapenem de-escalation stewardship activity based on pre-determined criteria, while labour intensive, can effectively and safely reduce meropenem use in the acute hospital setting.
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Affiliation(s)
- U Ni Riain
- Department of Medical Microbiology, University Hospital Galway, Newcastle Rd, Galway, Ireland.
| | - M Tierney
- Pharmacy Department, University Hospital Galway, Galway, Ireland
| | - C Doyle
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
| | - A Vellinga
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
| | - C Fleming
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
| | - M Cormican
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
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McCarthy B, Delaby L, Pierce K, McCarthy J, Fleming C, Brennan A, Horan B. The multi-year cumulative effects of alternative stocking rate and grazing management practices on pasture productivity and utilization efficiency. J Dairy Sci 2016; 99:3784-3797. [DOI: 10.3168/jds.2015-9763] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 12/02/2015] [Indexed: 11/19/2022]
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West J, Ogston S, Palmer C, Fleming C, Dawe R, Kumar V, Waterston S, Foerster J. Methotrexate in psoriasis under real‐world conditions: long‐term efficacy and tolerability. Br J Dermatol 2016; 174:1407-10. [DOI: 10.1111/bjd.14452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. West
- Medical School University of Dundee Dundee U.K
| | - S. Ogston
- Medical School University of Dundee Dundee U.K
| | - C. Palmer
- Medical School University of Dundee Dundee U.K
| | - C. Fleming
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
| | - R. Dawe
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
| | - V. Kumar
- Department of Rheumatology University of Dundee Dundee U.K
| | - S. Waterston
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
| | - J. Foerster
- Medical School University of Dundee Dundee U.K
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
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Fleming C, O'Keeffe S, Armstrong J, McClean B. EP-1712: Increased tumour control probability (TCP) with inhomogeneous dose escalated distributions in NSCLC. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Iyer V, McKusick M, Friese J, Bjarnason H, Stockland A, Fleming C, Andrews J. Outcomes of IVC stenting with Gianturco-Z stents in non-thrombotic IVC stenosis: a 11-year experience. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.367] [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] Open
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Godkin O, Fleming C, Burke T, Hogan P, Mealy K. The logistic and economic impact of special stage rallying on a general surgery department during a motor rally weekend event. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Godkin O, Fleming C, Kearney D, Moriarty P, Redmond P, Andrews E. Analysis of the impact of a 24-hour emergency theatre on time to appendicectomy. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.540] [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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