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Picha KJ, Welch Bacon CE, Bay C, Lewis JH, Snyder Valier AR. Athletic Trainers' Familiarity, Comfort, Knowledge, and Recognition of Social Determinants of Health. J Athl Train 2024; 59:403-409. [PMID: 36827608 PMCID: PMC11064108 DOI: 10.4085/1062-6050-0337.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
CONTEXT Social determinants of health (SDOH)-education, transportation, housing, employment, health systems and services, economic status, and physical and social environments-influence patient outcomes; therefore, athletic trainers (ATs) need to understand and address these factors. However, little is known about how ATs perceive SDOH or how knowledgeable they are about social factors that contribute to patient health and well-being. OBJECTIVE To evaluate ATs' familiarity and comfort with SDOH and their perceived knowledge and recognition of SDOH. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS Our survey was distributed to 17 000 ATs; 1829 accessed it (access rate = 10.8%), and 1694 completed it (completion rate = 92.6%, AT experience = 15.2 ± 10.6 years, age = 36.6 ± 10.8 years). MAIN OUTCOME MEASURE(S) The survey included multipart questions that evaluated ATs' perceptions of their familiarity, comfort, and knowledge about SDOH. Data were summarized using descriptive statistics. RESULTS Few respondents (4.1%, 70/1691) reported being extremely familiar with SDOH. Most indicated being moderately familiar (45.0%, 761/1691), minimally familiar (34.7%, 587/1691), or not familiar at all (16.1%, 273/1691). For questions about comfort, few described being extremely comfortable (3.5%, 59/1691) with SDOH, and most reported being moderately comfortable (35.4%, 598/1691), minimally comfortable (41.1%, 695/1691), or not comfortable at all (18.6%, 314/1691). For questions about knowledge, few indicated being extremely knowledgeable (2.7%, 46/1686) about SDOH, and the majority described being moderately (36.8%, 622/1686), minimally (41.8%, 704/1686), or not knowledgeable at all (18.6%, 314/1686). Over half of ATs accurately categorized 8 of the 9 SDOH listed in the survey, and 22% endorsed more correct than incorrect items. CONCLUSIONS A majority of ATs perceived their familiarity, comfort, and knowledge about SDOH to be moderate to low, which may reflect the relatively recent emphasis on SDOH in athletic health care. Because SDOH can have a major effect on patient health and well-being, strategies should be developed for educating ATs about SDOH. Developing strategies to increase comfort with SDOH in patient care is critical to ensure that those factors that can be addressed at the patient level are identified and managed.
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Affiliation(s)
- Kelsey J Picha
- Departments of Interdisciplinary Health Sciences, A.T. Still University, Mesa
- Departments of Athletic Training, A.T. Still University, A.T. Still University, Mesa
| | - Cailee E Welch Bacon
- Departments of Athletic Training, A.T. Still University, A.T. Still University, Mesa
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
| | - Curt Bay
- Departments of Interdisciplinary Health Sciences, A.T. Still University, Mesa
| | - Joy H Lewis
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
| | - Alison R Snyder Valier
- Departments of Athletic Training, A.T. Still University, A.T. Still University, Mesa
- Departments of Research Support, A.T. Still University, Mesa
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
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Sindu D, Razia D, Bay C, Padiyar J, Grief K, Buddhdev B, Arjuna A, Abdelrazek H, Mohamed H, McAnally K, Omar A, Walia R, Schaheen L, Tokman S. Evolving impact of the COVID-19 pandemic on lung transplant recipients: A single-center experience. J Heart Lung Transplant 2024; 43:442-452. [PMID: 37852512 DOI: 10.1016/j.healun.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Lung transplant recipients (LTRs) are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19); however, the disease course has changed as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants have mutated. We compared COVID-19-related clinical outcomes in LTRs at different stages of the pandemic. We also identified risk factors for developing severe COVID-19 independent of the dominant SARS-CoV-2 variant. METHODS This single-center, retrospective cohort study of LTRs with COVID-19 used Cox regression analyses and bootstrapping to identify factors affecting COVID-19 severity. RESULTS Between March 2020 and August 2022, 195 LTRs were diagnosed with COVID-19, almost half (89 [45.6%]) during the Omicron period. A total of 113 (58.5%) LTRs were hospitalized and 47 (24.1%) died. Age >65 years increased the risk of hospitalization and death. Although infection with the Omicron variant was associated with a lower risk of hospitalization, the median length of hospital stay (10 days, [interquartile range, 5-19]) was similar between the variants. Intensive care unit (ICU) admission and death were more common with the Delta variant but comparable between the original, Alpha, and Omicron variants. Remdesivir and molnupiravir reduced the risk of hospitalization, and monoclonal antibody therapy reduced the risk of ICU admission, intubation, and death. Vaccination and pre-exposure prophylaxis (PrEP) with tixagevimab-cilgavimab did not significantly reduce COVID-19-related ICU admission, intubation, or mortality among LTRs. CONCLUSIONS LTRs with COVID-19 continue to have high hospitalization rates and prolonged hospital stays, despite the reduced virulence of the Omicron variant. More effective PrEP and therapeutic interventions for COVID-19 among vulnerable patient groups are needed.
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Affiliation(s)
- Devika Sindu
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Deepika Razia
- Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Curt Bay
- Department of Interdisciplinary Health Sciences, A. T. Still University, Phoenix, Arizona
| | - Josna Padiyar
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Katherine Grief
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Bhuvin Buddhdev
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Ashwini Arjuna
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Hesham Abdelrazek
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Hesham Mohamed
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Kendra McAnally
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Ashraf Omar
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Lara Schaheen
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Surgery, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Sofya Tokman
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona.
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Tassabehji NM, Leach ER, Duffy RL, Bay C, Hill BJ, Shaw HK, Stephens NS, Howe BJ, Kowolik JE. Exploring dental faculty perceptions of current strategies and barriers to retention. J Dent Educ 2023; 87:1654-1660. [PMID: 37759373 DOI: 10.1002/jdd.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The aims of the study were to identify perceived strategies for and barriers to faculty retention and examine differences regarding age, gender, and race. METHODS Cross-sectional data was captured from the eight author-affiliated dental schools. A Qualtrics survey was emailed to all faculty members at these institutions (1467 possible participants) between November 2021 and February 2022. The survey was formulated from best practices listed in the American Dental Education Association Faculty Diversity Toolkit. It consisted of 18 questions, including demographic information and faculty perceptions of their respective workplaces. These responses were then evaluated with descriptive statistics, Chi-squared analysis, Pearson Correlation, and Fleiss' kappa. RESULTS The survey's response rate was 19.2%. There was no significant difference in perceived retention strategies across race, age, gender, practice tenure, practice type, or clinical versus tenure track. The top four barriers identified were inadequate financial compensation, workload, poor work environment, and burnout. There was a significant difference between racial groups and their perceived barrier of support for promotion (p = 0.048). This was more prevalent among clinical faculty (47.7%) than tenure track faculty (16.2%). The work environment was listed as a leading factor for both promoting retention and encouraging the exodus of faculty members. CONCLUSION Strategies aimed at improving financial compensation, career recognition, and transparency of the promotion process, along with those aimed at improving the work environment were shown to be vital to retaining faculty. Though the low response rate is a study limitation, these findings provide valuable information and a framework for future studies regarding dental faculty recruitment and retention.
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Affiliation(s)
- Nadine M Tassabehji
- Department of Comprehensive Care, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Elena Riccio Leach
- Department of Comprehensive Dentistry, UT Health San Antonio School of Dentistry, San Antonio, Texas, USA
| | - Rachel L Duffy
- Comprehensive Care Unit, AT Still University, Arizona School of Dentistry and Oral Health, Mesa, Arizona, USA
| | - Curt Bay
- Department of Interdisciplinary Health Sciences, AT Still University, Arizona School of Dentistry and Oral Health, Mesa, Arizona, USA
| | - Brittaney J Hill
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois, Chicago, Illinois, USA
| | - Holly K Shaw
- Department of Operative Dentistry, Columbia University College of Dental Medicine, New York, New York, USA
| | - Nadejda Stefanova Stephens
- Eastman Institute for Oral Health, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Brian J Howe
- Department of Family Dentistry, University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
| | - Joan E Kowolik
- Department of Pediatric Dentistry, Indiana University School of Dentistry, Indianapolis, Indiana, USA
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Shah DA, Sharer R, Sall D, Bay C, Turner A, Bisk D, Peng W, Gifford B, Rosas J, Radhakrishnan P. Racial, Ethnic, and Socioeconomic Differences in Primary Care No-Show Risk with Telemedicine During the COVID-19 Pandemic. J Gen Intern Med 2023; 38:2734-2741. [PMID: 37308779 PMCID: PMC10506986 DOI: 10.1007/s11606-023-08236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/09/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) pandemic resulted in rapid implementation of telemedicine. Little is known about the impact of telemedicine on both no-show rates and healthcare disparities on the general primary care population during the pandemic. OBJECTIVE To compare no-show rates between telemedicine and office visits in the primary care setting, while controlling for the burden of COVID-19 cases, with focus on underserved populations. DESIGN Retrospective cohort study. SETTING Multi-center urban network of primary care clinics between April 2021 and December 2021. PARTICIPANTS A total of 311,517 completed primary care physician visits across 164,647 patients. MAIN MEASURES The primary outcome was risk ratio of no-show incidences (i.e., no-show rates) between telemedicine and office visits across demographic sub-groups including age, ethnicity, race, and payor type. RESULTS Compared to in-office visits, the overall risk of no-showing favored telemedicine, adjusted risk ratio of 0.68 (95% CI 0.65 to 0.71), absolute risk reduction (ARR) 4.0%. This favorability was most profound in several cohorts with racial/ethnic and socioeconomic differences with risk ratios in Black/African American 0.47 (95% CI 0.41 to 0.53), ARR 9.0%; Hispanic/Latino 0.63 (95% CI 0.58 to 0.68), ARR 4.6%; Medicaid 0.58 (95% CI 0.54 to 0.62) ARR 7.3%; Self-Pay 0.64 (95% CI 0.58 to 0.70) ARR 11.3%. LIMITATION The analysis was limited to physician-only visits in a single setting and did not examine the reasons for visits. CONCLUSION As compared to office visits, patients using telemedicine have a lower risk of no-showing to primary care appointments. This is one step towards improved access to care.
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Affiliation(s)
- Dania A Shah
- HonorHealth Internal Medicine, Phoenix, AZ, USA.
| | - Rustan Sharer
- HonorHealth Internal Medicine, Phoenix, AZ, USA
- HonorHealth Clinical Informatics, Phoenix, AZ, USA
- College of Medicine, University of Arizona-Phoenix, Phoenix, AZ, USA
| | - Dana Sall
- HonorHealth Internal Medicine, Phoenix, AZ, USA
- College of Medicine, University of Arizona-Phoenix, Phoenix, AZ, USA
| | - Curt Bay
- Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA
| | | | - Dmitry Bisk
- HonorHealth Family Medicine, Phoenix, AZ, USA
| | - Wesley Peng
- HonorHealth Academic Affairs, Phoenix, AZ, USA
| | - Benjamin Gifford
- HonorHealth Internal Medicine, Phoenix, AZ, USA
- HonorHealth Clinical Informatics, Phoenix, AZ, USA
| | - Jennifer Rosas
- Neighborhood Outreach Access to Health (NOAH) Clinic, Phoenix, AZ, USA
| | - Priya Radhakrishnan
- HonorHealth Internal Medicine, Phoenix, AZ, USA
- HonorHealth Clinical Informatics, Phoenix, AZ, USA
- College of Medicine, University of Arizona-Phoenix, Phoenix, AZ, USA
- HonorHealth Academic Affairs, Phoenix, AZ, USA
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Hahn A, Travis B, Hunter D, Colorafi A, Regan C, Bay C, Koo P, Dragovich T, Choti MA, Kundranda MN, Chang J. Association of CA19-9 and tumor size in treatment monitoring for patients with metastatic pancreatic ductal adenocarcinoma (PDAC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.693] [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: 01/25/2023] Open
Abstract
693 Background: Although modern cancer treatment has significantly prolonged patient’s life, it comes with a high financial cost. Based on an NIH report on Financial Burden of Cancer Care, treating PDAC costs $108K, $18K, and $125K for initial treatment, during follow up, and in last year of life, respectively. Of these, CA19-9 and CT studies are obtained concurrently to evaluate tumor burden whose cost can be reduced by decreasing imaging frequency when CA19-9 remains stable. As a pilot study, we evaluated whether changes in CA19-9, an inexpensive laboratory study commonly used for monitoring treatment response, correlates with tumor size change on imaging studies. A positive correlation may lead us to design future studies to evaluate whether stable CA19-9 can serve as an indicator for stable disease on CT scan such that imaging frequency (and cost) may be reduced. Methods: We retrospectively identified PDAC patients from our tumor registry from 2016 to 2019. Subjects were included if they met the following criteria: 1) diagnosed with PDAC 2) had at least 2+ CA19-9 and CT/MR follow up assessments with the laboratory and imaging studies within one month of each other, and 3) had measurable lesions as defined by RECIST 1.1 criteria. Due to limited resources, we limited the maximum number of lesions to 4 instead of the usual 5 for RECIST 1.1. Two-dimensional orthogonal tumor sizes were measured on axial images with the largest cross-section. Changes in the values were obtained serially (from the immediately prior study). Nonparametric correlations (Spearman’s rho) were used to evaluate monotonicity. The significance level was set at p < 0.05. Results: We screened 300 subjects from the tumor registry and identified 23 subjects suitable for our study. 13 subjects were female and 10 were male with ages ranging from 35 to 84. We identified 55 target lesions and 128 assessments (with both CA19-9 and imaging) from the 23 subjects. We analyzed the log absolute and log relative change in CA19-9 with change in tumor area. When absolute CA19-9 value, absolute change in CA19-9, and relative change in CA19-9 were tested against the absolute change in tumor size, the correlation was significant for the absolute value and absolute change of CA19-9 (p < 0.01), but not for relative change of CA19-9 (p < 0.11). When tested against relative change in tumor size, all three values were highly significant (p < 0.001). Conclusions: Our finding of direct correlations between changes of CA19-9 and relative change of tumor size on imaging suggests that CA19-9 can serve as a surrogate measure of relative change of tumor burden for patients undergoing treatment. This provides motivation for future studies evaluating the possibility that stable CA19-9 can represent stable tumor burden such that expensive imaging studies may be obtained at longer time intervals to reduce financial cost to patients.
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Affiliation(s)
- Andrew Hahn
- A.T. Still University of Health Sciences, Kirksville, MO
| | - Bethnay Travis
- A.T. Still University of Health Sciences, Kirksville, MO
| | - David Hunter
- A.T. Still University of Health Sciences, Kirksville, MO
| | | | | | - Curt Bay
- A.T. Still University of Health Sciences, Kirksville, MO
| | - Phillip Koo
- Banner MD Anderson Cancer Center, Gilbert, AZ
| | | | | | | | - John Chang
- Banner MD Anderson Cancer Center, Gilbert, AZ
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Ikonne U, Brodie A, Bay C, Campbell A. Frequency of Student Resource Use and Academic Performance in Preclerkship Education: A Survey Study. Med Sci Educ 2022; 32:1465-1479. [PMID: 36407815 PMCID: PMC9648453 DOI: 10.1007/s40670-022-01674-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Medical students have unprecedented access to a large variety of learning resources, but patterns of resource use, differences in use across education cohorts, and the relationship between resource use and academic performance are unclear. Therefore, the purpose of the current study was to evaluate student resource use and its relationship to academic performance during preclerkship years. First-year and second-year medical students completed a 10-question electronic survey that assessed likelihood of using outside resources recommended by others, reasons for using outside resources, frequency of use of resources, and use of outside resources for specific disciplines. Outcomes were compared between the 2 cohorts of students. First-year students were more likely to use instructor-produced resources and self-generated study resources, and second-year students were more likely to use board review resources. Although differences were found between cohorts for frequency of use of certain resources, correlations between resource use and academic performance were modest. Overall, our results indicated that student use of study resources changed between the first and second years of medical school. These results suggest opportunities for medical educators to guide students in the selection and effective use of outside resources as they mature as self-regulated learners. Further, since students seem to extensively use external resources for learning, institutions should consider calibrating their curriculum and teaching methods to this learning style and providing high-quality, accessible resource materials for all students to reduce the potential impact of socioeconomic factors on student performance.
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Affiliation(s)
- Uzoma Ikonne
- Department of Physiological Sciences, Eastern Virginia Medical School, 700 W. Olney Rd, Norfolk, VA USA
- Fine Family Academy of Medical Educators, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA USA
| | - Adrienne Brodie
- A.T. Still Memorial Library, A.T. Still University, 5850 E. Still Circle, Mesa, AZ USA
| | - Curt Bay
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ USA
| | - Anna Campbell
- Department of Anatomy, School of Osteopathic Medicine in Arizona, A.T. Still University, 5850 E. Still Circle, Mesa, AZ USA
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Jancaitis G, Snyder Valier AR, Bay C. A descriptive and comparative analysis of injuries reported in USA Cycling-sanctioned competitive road cycling events. Inj Epidemiol 2022; 9:22. [PMID: 35836302 PMCID: PMC9284847 DOI: 10.1186/s40621-022-00385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Competition in road cycling events is common, yet little is known about the nature and disposition of injuries sustained in these events. The purpose of this study is to describe injured body regions and the disposition of injuries sustained by cyclists during competitive road cycling events. Methods Data regarding body region injured and injury disposition were retrospectively analyzed from a convenience sample of 1053 injury reports (male: n = 650 [61.7%], age = 33.4 ± 13.6 years; female: n = 116 [11.0%], age = 33.3 ± 13.9 years; missing: n = 284 [27.0%]) completed during the 2016 competitive season. Results A total of 1808 injuries were reported. Injured body regions included upper extremity (46.5%, n = 841), lower extremity (32.2%, n = 583), head/neck (10.4%, n = 189), torso/back (5.2%, n = 95), face (4%, n = 87), and internal/other (0.7%, n = 13). There were 1.37 ± 0.81 injuries recorded per report. Dispositions following injury were medical attention (34.1%, n = 316), ambulance/EMS (19.3%, n = 179), report only (15% n = 139), referred (13.0% n = 121), released to parent/personal vehicle (12.1% n = 112), refused care (4.1% n = 38), and continued riding (2.5% n = 23). Males (34.0%, n = 212) received medical attention more frequently than females (23.3%), p < 0.05. Females received EMS transport (29.1%, n = 30) more frequently than males (16.8%, n = 105), p < 0.05. Conclusions Upper extremity is the most injured body region in this data set. Following injury, racers often receive medical attention and a substantial percentage require transport by EMS. Clinical relevance Anticipating the nature of injuries sustained by cyclists may promote positive health outcomes by ensuring medical teams are prepared for the immediate medical needs of cyclists.
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Affiliation(s)
| | | | - Curt Bay
- A.T. Still University, 5850 E. Still Circle, Mesa, AZ, 85206, USA
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Modica C, Bay C, Lewis JH, Silva C. Applying the Value Transformation Framework in Federally Qualified Health Centers to Increase Clinical Measures Performance. J Healthc Qual 2022; 44:185-193. [PMID: 35289770 PMCID: PMC9236304 DOI: 10.1097/jhq.0000000000000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The transition in health care from a volume-based to value-based model of care, combined with pressures brought about by the COVID-19 pandemic, makes the need for efficiency and coordination of the health center system imperative. The Value Transformation Framework (VTF), developed with health centers in mind, provides an organizing framework to support transformation of infrastructure, care delivery, and people systems. METHODS NACHC applied the VTF within a cohort of health centers across the country to drive systems change and improve performance on measures of clinical care. RESULTS A comparison of health centers "participating" in application of the VTF relative to "nonparticipating" health centers nationally showed improvement during 3 years of program implementation. Significant differences ( p < .05) favoring health centers who participated were noted for screening of colorectal cancer ( p < .001), depression ( p < .001), hypertension ( p < .001), obesity ( p = .001), and cervical cancer ( p = .011). Performance for diabetes control also favored participating programs, although the difference did not quite reach significance ( p = .45). CONCLUSIONS Applying a systems approach, organized by the VTF, with evidence-based interventions and deployed in a learning community, can result in improved performance across multiple measures of clinical care.
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Darnall AR, Sall D, Bay C. Types and Prevalence of Adverse Skin Reactions Associated With Prolonged N95 and Simple Mask Usage during the COVID-19 Pandemic. J Eur Acad Dermatol Venereol 2022; 36:1805-1810. [PMID: 35748134 PMCID: PMC9349824 DOI: 10.1111/jdv.18365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/02/2022] [Indexed: 12/01/2022]
Abstract
Background As the coronavirus 2019 (COVID‐19) pandemic persists on a global level, the chronic daily use of face masks within the healthcare system remains an important component of disease prevention and transmission. Increased use of personal protective equipment (PPE) may result in increased rates of occupational dermatoses and adverse skin reactions. Objectives The purpose of this study is to explore how chronic, prolonged use of N95 masks or simple surgical masks affects the prevalence of adverse skin reactions in Healthcare Workers (HCWs). Methods An optional, quantitative, web‐based survey was administered to patient‐facing HCWs across six network hospitals in a large metropolitan city. Data were analysed to assess the types and sites of adverse skin reactions, and to evaluate correlations between single mask use duration and adverse skin reactions. Results A total of 230 HCWs responded with 192 endorsing occupational dermatoses. Among the healthcare responders, (n = 192, 83.5%) experienced at least one adverse skin reaction. The most common occupational adverse skin reactions were acne (n = 133, 57.8%), dryness (n = 108, 47.0%) and redness (n = 105, 45.7%). Anatomical areas most commonly affected included the nasal bridge (n = 92, 40.0%), cheeks (n = 92, 40.0%) and chin (n = 91, 39.6%). Acne (P = 0.002), dryness/scaling (P = 0.002), increased pore size (0.003), itch (P = 0.003), nasal bridge scarring (P < 0.001), redness (P < 0.001), frictional erosions (P = 0.001) and ulcerations (P = 0.002) showed a positive correlation to duration of mask use. Conclusions Prolonged, daily usage of PPE is associated with numerous adverse skin reactions among HCWs with acne being the most commonly seen adverse reaction. Many adverse reactions are associated with prolonged use of single mask.
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Affiliation(s)
- Ariel R Darnall
- Department of Dermatology, Honorhealth, Scottsdale, Arizona, USA.,HonorHealth Internal Medicine Residency, Honorhealth, Scottsdale, Arizona, USA
| | - Dana Sall
- HonorHealth Internal Medicine Residency, Honorhealth, Scottsdale, Arizona, USA.,Department of Internal Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | - Curt Bay
- Biostatistics, A.T. Still University, Mesa, Arizona, USA
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Salinel B, Grudza M, Zeien S, Murphy M, Adkins J, Jensen C, Bay C, Kodibagkar V, Koo P, Dragovich T, Choti MA, Kundranda MN, Wang H, Syeda-Mahmood T, Chang J. Ensemble voting decreases false positives in AI second-observer reads for detecting colorectal cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
141 Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths, and survival can be improved if early, suspect imaging features on CT of the abdomen and pelvis (CTAP) can be routinely identified. At present, up to 40% of these features are undiagnosed on routine CTAP, but this can be improved with a second observer. In this study, we developed a deep ensemble learning method for detecting CRC on CTAP to determine if increasing agreement between ensemble models can decrease the false positives detected by artificial intelligence (AI) second-observer. Methods: 2D U-Net convolutional neural network (CNN) containing 31 million trainable parameters was trained with 58 CRC CT images from Banner MD Anderson (AZ) and MD Anderson Cancer Center (TX) (51 used for training and 7 for validation) and 59 normal CT scans from Banner MD Anderson Cancer Center. 20 of the 25 CRC cases from public domain data (The Cancer Genome Atlas) were used to evaluate the performance of the models. The CRC was segmented using ITK-SNAP open-source software (v. 3.8). To apply the deep ensemble approach, five CNN models were trained independently with random initialization using the same U-Net architect and the same training data. Given a testing CT scan, each of the five trained CNN models was applied to produce tumor segmentation for the testing CT scan. The tumor segmentation results produced by the trained CNN models were then fused using a simple majority voting rule to produce consensus tumor segmentation results. The segmentation was analyzed by the percentage of correct detection, the number of false positives per case, and the Dice similarity coefficient (DSC). If parts of the CRC were flagged by AI, then it was considered correct. A detection was considered false positive if the marked lesion did not overlap with any CRC; contiguous false positives across different slices of CT image were considered a single false positive. DSC measures the quality of the segmentation by measuring the overlap between the ground-truth and AI detected lesion. Results: Our results showed that increasing the agreement between the 5 models dramatically decreases the number of false positives per CT at the expense of slight decrease in accuracy and DSC. This is described in the table. Conclusions: Our results show that AI-based second observer can potentially detect CRC on routine CTAP. Although the initial result yields high false positives per case, ensemble voting is an effective method for decreasing the false positives with a slight decrease in accuracy. This technique can be further improved for eventual clinical application.[Table: see text]
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Affiliation(s)
| | | | - Sarah Zeien
- A.T. Still University of Health Sciences, Kirksville, MO
| | - Matthew Murphy
- A.T. Still University of Health Sciences, Kirksville, MO
| | | | | | - Curt Bay
- A.T. Still University of Health Sciences, Kirksville, MO
| | | | - Phillip Koo
- Banner MD Anderson Cancer Center, Gilbert, AZ
| | | | | | | | | | | | - John Chang
- Banner MD Anderson Cancer Center, Gilbert, AZ
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11
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Salinel B, Grudza M, Zeien S, Murphy M, Adkins J, Jensen C, Bay C, Kodibagkar V, Koo P, Dragovich T, Choti MA, Kundranda MN, Wang H, Syeda-Mahmood T, Chang J. Comparison of segmentation methods to improve throughput in annotating AI-observer for detecting colorectal cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
142 Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths, and its outcome can be improved with better detection of incidental early CRC on routine CT of the abdomen and pelvis (CTAP). AI-second observer (AI) has the potential as shown in our companion abstract. The bottleneck in training AI is the time required for radiologists to segment the CRC. We compared two techniques for accelerating the segmentation process: 1) Sparse annotation (annotating some of the CT slice containing CRC instead of every slice); 2) Allowing AI to perform initial segmentation followed by human adjustment. Methods: 2D U-Net convolutional neural network (CNN) containing 31 million trainable parameters was trained with 58 CRC CT images from Banner MD Anderson (AZ) and MD Anderson Cancer Center (TX) (51 used for training and 7 for validation) and 59 normal CT scans from Banner MD Anderson Cancer Center. Twenty of the 25 CRC cases from public domain data (The Cancer Genome Atlas) were used to evaluate the performance of the models. The CRC was segmented using ITK-SNAP open-source software (v. 3.8). For the first objective, 3 separate models were trained (fully annotated CRC, every other slice, and every third slice). The AI-annotation on the TCGA dataset was analyzed by the percentage of correct detection of CRC, the number of false positives, and the Dice similarity coefficient (DSC). If parts of the CRC were flagged by AI, then it was considered correct. A detection was considered false positive if the marked lesion did not overlap with CRC; contiguous false positives across different slices of CT image were considered a single false positive. DSC measures the quality of the segmentation by measuring the overlap between the ground-truth and AI detected lesion. For the second objective, the time required to adjust the AI-produced annotation was compared to the time required for annotating the entire CRC without AI assistance. The AI-models were trained using ensemble learning (see our companion abstract for details of the techniques). Results: Our results showed that skipping slices of tumor in training did not alter the accuracy, false positives, or DSC classification of the model. When adjusting the AI-observer segmentation, there was a trend toward decreasing the time required to adjust the annotation compared to full manual segmentation, but the difference was not statistically significant (Table; p=0.121). Conclusions: Our results show that both skipping slices of tumor as well as starting with AI-produced annotation can potentially decrease the effort required to produce high-quality ground truth without compromising the performance of AI. These techniques can help improve the throughput to obtain a large volume of cases to train AI for detecting CRC.[Table: see text]
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Affiliation(s)
| | | | - Sarah Zeien
- A.T. Still University of Health Sciences, Kirksville, MO
| | - Matthew Murphy
- A.T. Still University of Health Sciences, Kirksville, MO
| | | | | | - Curt Bay
- A.T. Still University of Health Sciences, Kirksville, MO
| | | | - Phillip Koo
- Banner MD Anderson Cancer Center, Gilbert, AZ
| | | | | | | | | | | | - John Chang
- Banner MD Anderson Cancer Center, Gilbert, AZ
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12
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Lentner J, Adams T, Knutson V, Zeien S, Abbas H, Moosavi R, Manuel C, Wallace T, Harmon A, Waters R, Ledford S, Vijayakrishnan R, Jagan N, Falluji N, DelCore M, Bay C, Jhamnani S. C-reactive protein levels associated with COVID-19 outcomes in the United States. J Osteopath Med 2021; 121:869-873. [PMID: 34592071 DOI: 10.1515/jom-2021-0103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/05/2021] [Accepted: 08/20/2021] [Indexed: 01/08/2023]
Abstract
CONTEXT COVID-19 caused a worldwide pandemic, and there are still many uncertainties about the disease. C-reactive protein (CRP) levels could be utilized as a prognosticator for disease severity in COVID-19 patients. OBJECTIVES This study aims to determine whether CRP levels are correlated with COVID-19 patient outcomes and length of stay (LoS). METHODS A retrospective cohort study was conducted utilizing data obtained between March and May 2020. Data were collected by abstracting past medical records through electronic medical records at 10 hospitals within CommonSpirit Health. Patients were included if they had a positive COVID-19 test from a nasopharyngeal swab sample, and if they were admitted and then discharged alive or had in-hospital mortality and were ≥18 years. A total of 541 patients had CRP levels measured and were included in this report. Patient outcome and LoS were the endpoints measured. RESULTS The 541 patients had their CRP levels measured, as well as the demographic and clinical data required for analysis. While controlling for body mass index (BMI), number of comorbidities, and age, the first CRP was significantly predictive of mortality (p<0.001). The odds ratio for first CRP indicates that for each one-unit increase in CRP, the odds of death increased by 0.007. For LoS, the first CRP was a significant predictor (p<0.001), along with age (p=0.002). The number of comorbidities also predicted LoS (p=0.007), but BMI did not. The coefficient for the first CRP indicates that, for each one-unit increase in CRP, LoS increased 0.003 days. CONCLUSIONS The results indicate that there is a positive correlation between the CRP levels of COVID-19 patients and their respective outcomes with regard to death and LoS.
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Affiliation(s)
- Jacob Lentner
- A.T. Still University - Kirksville College of Medicine, Kirksville, MO, USA
| | - Taylor Adams
- A.T. Still University - Kirksville College of Medicine, Kirksville, MO, USA
| | - Valene Knutson
- A.T. Still University - Kirksville College of Medicine, Kirksville, MO, USA
| | - Sarah Zeien
- A.T. Still University - Kirksville College of Medicine, Kirksville, MO, USA
| | | | | | | | - Thomas Wallace
- Department of Cardiovascular Medicine, CHI St. Vincent Infirmary, Chicago, IL, USA
| | - Adam Harmon
- Department of Cardiovascular Medicine, Sequoia Hospital, Redwood City, CA, USA
| | - Richard Waters
- Department of Cardiovascular Medicine, St. Joseph Medical Center, Stockton, CA, USA
| | - Samuel Ledford
- Department of Cardiovascular Medicine, CHI Memorial Hospital, Chattanooga, TN, USA
| | | | - Nikhil Jagan
- Department of Pulmonary and Critical Care Medicine, CHI Health St. Francis, Grand Island, NE, USA
| | - Nezar Falluji
- Department of Cardiovascular Medicine, CHI St. Joseph Hospital, Lexington, KY, USA
| | - Michael DelCore
- Department of Cardiovascular Medicine, CHI Health Creighton University Medical Center - Bergan Mercy, Omaha, NE, USA
| | - Curt Bay
- A.T. Still University, Mesa, AZ, USA
| | - Sunny Jhamnani
- Department of Cardiology, Chandler Regional Medical Center, Chandler, AZ, USA
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13
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Thomson P, Núñez P, Quera R, Bay C. Gastrointestinal microbiome, what is behind faecal microbiota transplantation? New Microbes New Infect 2021; 42:100898. [PMID: 34168881 PMCID: PMC8207221 DOI: 10.1016/j.nmni.2021.100898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/19/2022] Open
Abstract
The intestinal microbiota is made up of billions of microorganisms that coexist in an organised ecosystem, where strict and facultative anaerobic bacteria predominate. The alteration or imbalance of these microorganisms, known as dysbiosis, can be associated with both gastrointestinal and extraintestinal diseases. Based on a review of the literature, the intestinal microbiota is described in its state of health, the changes associated with some gastrointestinal diseases and the potential role that faecal microbiota transplantation has in the reestablishment of an altered ecosystem. Undoubtedly, the information revealed makes us reflect on the indication of faecal microbiota transplantation in various pathologies of intestinal origin. However, to ensure the efficacy and safety of this therapy, more studies are needed to obtain more evidence.
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Affiliation(s)
- P. Thomson
- Veterinarian School of Medicine, Faculty of Life Science, Andrés Bello University, Avenida República 440, Santiago, Chile
| | - P. Núñez
- Department of Gastroenterology, Hospital San Juan De Dios – University of Chile, Huérfanos 3255, Santiago, Chile
- Gastroenterology Department, Clínica Universidad de los Andes, Avda. Plaza 2501, Chile
| | - R. Quera
- Gastroenterology Department, Clínica Universidad de los Andes, Avda. Plaza 2501, Chile
| | - C. Bay
- Department of Pediatrics, Medicine School, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
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14
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Brubaker RB, Bay C, Chacon DW, Carson M, Cahill JA, Foster KN. 93 Virtual Burn Camp 2020 vs. In-Person Burn Camp - Did It Hit the Mark. J Burn Care Res 2021. [PMCID: PMC8083710 DOI: 10.1093/jbcr/irab032.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Burn camps have served burn-injured youth in the U.S. for over 35 years. Camp is a rehabilitation program that has been recognized as an important part of young survivors’ recovery. The 2020 global pandemic made an in-person camp impossible, so volunteers rallied to provide a virtual experience. Registered campers received a “Camp in a Box” filled with activities, art supplies, a camp tee-shirt, and snacks to enjoy at Virtual Burn Camp (VBC). Participants connected with campers and counselors online. This study sought to determine how youth viewed VBC compared to in-person camp, how the pandemic was affecting their emotional status and whether VBC helped them.
Methods
The study asked participants to rate survey items regarding levels of comfort, connection, and support at VBC vs. in-person camp on a 4-point scale from 1. NO! 2. no 3. yes 4. YES! Multiple choice questions such as My favorite thing about virtual camp, and “Things I missed most about regular burn camp” - choose 2. General stress & anxiety levels related to Covid-19 were assessed, as well as if VBC helped to reduce their anxiety/stress levels.
Results
Pediatric burn survivors (n=77) participating in 2 virtual camps, demographic’s included mean age 13.8 years, male (n=39%), female (n=61%), visible scars (74%) vs. (10%) hidden scars with the majority representing racial/ethnic minorities (65%) vs. white (35%). Campers reported feeling more connected at in-person camp (84%) vs. VBC (38%). Feeling supported was higher at regular burn camp (84%), but the majority (76%) also claimed feeling supported at VBC. Camper’s favorite things about VBC were Camp in a Box (66%), Being Part of the Burn Community (51%), and Seeing Counselors (47%). Things missed most about regular burn camp were seeing Friends (83%) and Counselors (61%). Respondents reported high Covid-19 related stress/anxiety levels (66%) and (88%) said that VBC reduced their anxiety/stress. Top benefits included feeling Happy (48%) and Thankful (32%).
Conclusions
Pediatric burn survivors place a high value on their burn community involvement. Though not the preferred camp method, the VBC earned high marks for camper’s improved emotional status and for reducing their Covid-19 stress and anxiety levels. The program succeeded in helping Virtual Campers feel supported and provided an important venue for connecting them with their burn-injured peers and camp counselors.
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Affiliation(s)
- Ruth B Brubaker
- Arizona Burn Center Valleywise, Phoenix, Arizona; A. T. Still University, Tempe, Arizona; Alisa Ann Ruch Burn Foundation, El Cerrito, California; Burns Recovered, Saint Louis, Missouri; Arizona Burn Center, Auburn, California; The Arizona Burn Center Valleywise Health, Phoenix, Arizona
| | - Curt Bay
- Arizona Burn Center Valleywise, Phoenix, Arizona; A. T. Still University, Tempe, Arizona; Alisa Ann Ruch Burn Foundation, El Cerrito, California; Burns Recovered, Saint Louis, Missouri; Arizona Burn Center, Auburn, California; The Arizona Burn Center Valleywise Health, Phoenix, Arizona
| | - Daniel W Chacon
- Arizona Burn Center Valleywise, Phoenix, Arizona; A. T. Still University, Tempe, Arizona; Alisa Ann Ruch Burn Foundation, El Cerrito, California; Burns Recovered, Saint Louis, Missouri; Arizona Burn Center, Auburn, California; The Arizona Burn Center Valleywise Health, Phoenix, Arizona
| | - Madeleine Carson
- Arizona Burn Center Valleywise, Phoenix, Arizona; A. T. Still University, Tempe, Arizona; Alisa Ann Ruch Burn Foundation, El Cerrito, California; Burns Recovered, Saint Louis, Missouri; Arizona Burn Center, Auburn, California; The Arizona Burn Center Valleywise Health, Phoenix, Arizona
| | - Jade A Cahill
- Arizona Burn Center Valleywise, Phoenix, Arizona; A. T. Still University, Tempe, Arizona; Alisa Ann Ruch Burn Foundation, El Cerrito, California; Burns Recovered, Saint Louis, Missouri; Arizona Burn Center, Auburn, California; The Arizona Burn Center Valleywise Health, Phoenix, Arizona
| | - Kevin N Foster
- Arizona Burn Center Valleywise, Phoenix, Arizona; A. T. Still University, Tempe, Arizona; Alisa Ann Ruch Burn Foundation, El Cerrito, California; Burns Recovered, Saint Louis, Missouri; Arizona Burn Center, Auburn, California; The Arizona Burn Center Valleywise Health, Phoenix, Arizona
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15
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Bayome M, Park JH, Bay C, Kook Y. Distalization of maxillary molars using temporary skeletal anchorage devices: A systematic review and meta‐analysis. Orthod Craniofac Res 2021; 24:103-112. [DOI: 10.1111/ocr.12470] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/09/2021] [Indexed: 08/30/2023]
Affiliation(s)
- Mohamed Bayome
- Department of Preventive Dental Sciences, College of Dentistry King Faisal University Al Hofuf Saudi Arabia
- Department of Postgraduate Studies Universidad Autónoma del Paraguay Asunción Paraguay
| | - Jae Hyun Park
- Postgraduate Orthodontic Program Arizona School of Dentistry & Oral Health, A.T. Still University Mesa AZ USA
- Graduate School of Dentistry Kyung Hee University Seoul Korea
| | - Curt Bay
- Department of Interdisciplinary Health Sciences Arizona School of Health Sciences, A.T. Still University Mesa AZ USA
| | - Yoon‐Ah Kook
- Department of Orthodontics Seoul St. Mary’s Hospital The Catholic University of Korea Seoul Korea
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16
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Nauffal V, Bay C, Shah P, Sobieszczyk P, Kaneko T, O'Gara P, Nohria A. Outcomes of transcatheter vs. isolated surgical aortic valve replacement in mediastinal radiation-associated severe aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2592] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Mediastinal radiation can lead to long-term cardiac sequelae, including aortic valve disease. Surgical aortic valve replacement (SAVR) is associated with poor outcomes in this population. Transcatheter aortic valve replacement (TAVR) now provides an alternative treatment strategy that may improve outcomes.
Purpose
To compare 30-day outcomes after TAVR vs. isolated SAVR for radiation-associated severe symptomatic aortic stenosis using the Society of Thoracic Surgery (STS) National Adult Cardiac Surgery Database.
Methods
We evaluated 1,668 TAVR and 2,611 isolated SAVR patients enrolled in the STS national database from July 2011 through December 2018. A propensity score for TAVR vs. SAVR was derived using a non-parsimonious logistic regression model that included 29 pre-operative variables and was used to generate a 1:1 matched cohort (NTotal=1,560). 30-day outcomes in TAVR vs. SAVR patients were compared in the matched cohort using conditional logistic regression. We also tested for temporal trends in 30-day mortality separately for TAVR and SAVR in the matched cohort, adjusted for potential confounders, to see if outcomes varied across the study period.
Results
In the propensity-matched cohort, baseline demographics, comorbidities and preoperative characteristics were balanced between the TAVR and SAVR groups. The mean age was 73.3 years and 75% were females in each group. In the propensity-matched cohort, TAVR was associated with significantly reduced 30-day all-cause [OR=0.50 (0.30–0.84), p=0.01] and cardiovascular mortality as compared to SAVR [OR=0.33 (0.14–0.78), p=0.01]. Similarly, post-operative complications occurred less in the TAVR group except for stroke/transient ischemic attack (TIA) [OR=3.17 (1.27–7.93), p=0.01] and pacemaker implantation [OR=1.71 (1.21–2.44), p=0.003] which were significantly higher with TAVR (Figure 1A). While, 30-day mortality associated with both procedures improved over the course of the study, the trend was only statistically significant in the TAVR group following adjustment for potential confounders. TAVR was consistently associated with better survival than SAVR in the matched cohort across the study period (Figure 1B).
Conclusion
Our findings suggest that TAVR is a safe alternative to SAVR for radiation-associated severe symptomatic aortic stenosis and is associated with lower 30-day mortality and post-operative complications. The risk of stroke/TIA and pacemaker implantation is higher with TAVR and should be considered when choosing therapy. Additional prospective studies to validate our findings and evaluate long-term outcomes are needed to further guide clinical decision making in this population.
Figure 1
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Funding to support acquisition of the data from the Society of Thoracic Surgery was obtained from discretionary funds available to Dr. Anju Nohria from the Cardiovascular Medicine Division.
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Affiliation(s)
- V Nauffal
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - C Bay
- Harvard T. H. Chan School of Public Health, Biostatistics, Boston, United States of America
| | - P Shah
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - P Sobieszczyk
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - T Kaneko
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - P O'Gara
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - A Nohria
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
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17
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Halgas B, Bay C, Neagoe A, Richey K, Hofmann L, Foster K. Associationbetween hyperoxia and mortality in severely burned patients. Burns 2020; 46:1297-1301. [PMID: 32600936 DOI: 10.1016/j.burns.2019.12.002] [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: 06/29/2019] [Revised: 11/30/2019] [Accepted: 12/06/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The use of oxygen is a key component of acute burn resuscitation, particularly when there is concern for carbon monoxide toxicity or inhalation injury. Prior studies of critically-ill patients have shown an association between early hyperoxia and increased mortality. There are no studies to date evaluating outcomes related to excessive oxygen administration in burn patients. METHODS We conducted a retrospective analysis of 219 severely burned patients to quantify the average amount of oxygen given during initial resuscitation, the level of carbon monoxide exposure, and to determine if early exposure to supratherapeutic oxygen was associated with increased hospital mortality or ventilator-associated pneumonia (VAP). The models were adjusted for inhalation injury and total body surface area (TBSA) burned. RESULTS Early hyperoxia in severely burn patients is common and possibly associated with increased overall mortality, although the results were inconclusive and after adjusting for burn-specific scoring systems, we found a negative correlation between hyperoxia and mortality. Confirmed carbon monoxide poisoning was relatively uncommon, but also associated with increased mortality. Patients with elevated carboxyhemoglobin did not receive more oxygen compared to others within the cohort. CONCLUSIONS Burn patients are exposed to higher concentrations of pure oxygen compared to other critically-ill patients, presumably for empiric treatment of carbon monoxide poisoning. Our data showed a liberal use of oxygen therapy across all patients. Considering the potentially negative effects of hyperoxia, this study exposes either a gap in clinical research or need for clearer indications.
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Affiliation(s)
- B Halgas
- William Beaumont Army Medical Center, 5005 N Piedras St, El Paso, TX, 79920, United States.
| | - C Bay
- A.T. Still University, 5850 E Still Cir, Mesa, AZ 85206, United States
| | - A Neagoe
- Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ 85008, United States
| | - K Richey
- Arizona Burn Center, 2601 E Roosevelt St, Phoenix, AZ 85008, United States
| | - L Hofmann
- San Antonio Military Medical Center 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - K Foster
- Arizona Burn Center 2601 E Roosevelt St, Phoenix, AZ 85008, United States
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18
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Sood S, Ramos G, Van Der Veer N, Bay C, Kaur BR, Nasef A, Ayutyanot N. Risk factors for rehospitalization for patients following release from court-ordered evaluation: A retrospective study. Psychiatr Psychol Law 2020; 27:637-646. [PMID: 33679202 PMCID: PMC7901682 DOI: 10.1080/13218719.2020.1742236] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We have noticed an increase in the number of patients who go through the court-ordered evaluation (COE) process but are not placed on a court-ordered treatment, and who then return to the hospital on another COE petition within one year from their initial discharge. The aim of this study is to examine what factors might be involved in rehospitalization in this population of psychiatric patients. The records of 146 readmitted patients and 146 randomized patients not readmitted were compared for various risk factors. Data were analyzed using univariate and mutivariate procedures. All patients who had diagnoses of substance-induced mood or psychotic disorders were readmitted within one year. Other risk factors included younger age, seriously mentally ill (SMI) status, longer length of stay and having a psychotic or schizophrenia spectrum disorder. Substance-induced mood or psychotic disorder may play significant roles for patients who are rehospitalized within a year of initial COE.
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Affiliation(s)
- Shabnam Sood
- Maricopa Integrated Health Systems, Phoenix, AZ, USA
- District Medical Group, Phoenix, AZ, USA
- School of Medicine–Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Gilbert Ramos
- Maricopa Integrated Health Systems, Phoenix, AZ, USA
| | - Nancy Van Der Veer
- Maricopa Integrated Health Systems, Phoenix, AZ, USA
- District Medical Group, Phoenix, AZ, USA
| | - Curt Bay
- Maricopa Integrated Health Systems, Phoenix, AZ, USA
- A T Still University of Osteopathic Medicine, Mesa, AZ, USA
| | - B. Rose Kaur
- Maricopa Integrated Health Systems, Phoenix, AZ, USA
| | - Amr Nasef
- Maricopa Integrated Health Systems, Phoenix, AZ, USA
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19
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Ikonne US, Brodie A, Bay C, Campbell A. Student Use of Outside Study Resources. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.06447] [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: 11/11/2022]
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20
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Han W, Qin L, Bay C, Chen X, Yu KH, Miskin N, Li A, Xu X, Young G. Deep Transfer Learning and Radiomics Feature Prediction of Survival of Patients with High-Grade Gliomas. AJNR Am J Neuroradiol 2020; 41:40-48. [PMID: 31857325 PMCID: PMC6975328 DOI: 10.3174/ajnr.a6365] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 07/13/2019] [Accepted: 10/25/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Patient survival in high-grade glioma remains poor, despite the recent developments in cancer treatment. As new chemo-, targeted molecular, and immune therapies emerge and show promising results in clinical trials, image-based methods for early prediction of treatment response are needed. Deep learning models that incorporate radiomics features promise to extract information from brain MR imaging that correlates with response and prognosis. We report initial production of a combined deep learning and radiomics model to predict overall survival in a clinically heterogeneous cohort of patients with high-grade gliomas. MATERIALS AND METHODS Fifty patients with high-grade gliomas from our hospital and 128 patients with high-grade glioma from The Cancer Genome Atlas were included. For each patient, we calculated 348 hand-crafted radiomics features and 8192 deep features generated by a pretrained convolutional neural network. We then applied feature selection and Elastic Net-Cox modeling to differentiate patients into long- and short-term survivors. RESULTS In the 50 patients with high-grade gliomas from our institution, the combined feature analysis framework classified the patients into long- and short-term survivor groups with a log-rank test P value < .001. In the 128 patients from The Cancer Genome Atlas, the framework classified patients into long- and short-term survivors with a log-rank test P value of .014. For the mixed cohort of 50 patients from our institution and 58 patients from The Cancer Genome Atlas, it yielded a log-rank test P value of .035. CONCLUSIONS A deep learning model combining deep and radiomics features can dichotomize patients with high-grade gliomas into long- and short-term survivors.
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Affiliation(s)
- W Han
- From the Department of Radiology (W.H., C.B., X.C., N.M., A.L., X.X., G.Y.), Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School (W.H., L.Q., C.B., K.-H.Y., N.M., X.X., G.Y.), Boston, Massachusetts
| | - L Qin
- Department of Imaging (L.Q., G.Y.), Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School (W.H., L.Q., C.B., K.-H.Y., N.M., X.X., G.Y.), Boston, Massachusetts
| | - C Bay
- From the Department of Radiology (W.H., C.B., X.C., N.M., A.L., X.X., G.Y.), Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School (W.H., L.Q., C.B., K.-H.Y., N.M., X.X., G.Y.), Boston, Massachusetts
| | - X Chen
- From the Department of Radiology (W.H., C.B., X.C., N.M., A.L., X.X., G.Y.), Brigham and Women's Hospital, Boston, Massachusetts
- Department of Radiology (X.C.), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - K-H Yu
- Harvard Medical School (W.H., L.Q., C.B., K.-H.Y., N.M., X.X., G.Y.), Boston, Massachusetts
| | - N Miskin
- From the Department of Radiology (W.H., C.B., X.C., N.M., A.L., X.X., G.Y.), Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School (W.H., L.Q., C.B., K.-H.Y., N.M., X.X., G.Y.), Boston, Massachusetts
| | - A Li
- From the Department of Radiology (W.H., C.B., X.C., N.M., A.L., X.X., G.Y.), Brigham and Women's Hospital, Boston, Massachusetts
| | - X Xu
- From the Department of Radiology (W.H., C.B., X.C., N.M., A.L., X.X., G.Y.), Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School (W.H., L.Q., C.B., K.-H.Y., N.M., X.X., G.Y.), Boston, Massachusetts
| | - G Young
- From the Department of Radiology (W.H., C.B., X.C., N.M., A.L., X.X., G.Y.), Brigham and Women's Hospital, Boston, Massachusetts
- Department of Imaging (L.Q., G.Y.), Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School (W.H., L.Q., C.B., K.-H.Y., N.M., X.X., G.Y.), Boston, Massachusetts
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21
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Heick JD, Bay C. Determining Near Point of Convergence: An Exploration of One Component of the Vestibular/Ocular Motor Screen Compared to Varied Target Sizes. Neurology 2019. [DOI: 10.1212/01.wnl.0000581008.36432.1b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveSport-related concussions are considered a public health issue due to the number of athletes who sustain concussions.BackgroundThe Vestibular Ocular Motor Screening (VOMS) Assessment appears to be useful in evaluating concussion. Investigators have reported that abnormal near point of convergence (NPC), a component of the VOMS, is associated with prolonged concussion recovery. The purpose of this study was to compare four commonly used approaches to estimating NPC.Design/MethodsFour methods of measuring NPC were evaluated (tip of a pen, 12-point font, 14-point font, and the Bernell Vergel™ 9-point font). A generalized estimating equations approach was used to compare NPC measurements with the four methods, employing one practice trial, followed by three test trials. A sequential Bonferroni adjustment was used for pairwise comparisons. NPC estimate was modestly correlated with age of the subject, so age was included as a covariate. Significance was set at p = 0.05, a priori.ResultsSeventy-five healthy adults (16 males, 59 females; mean age, 21 ± 6.12 years, range, 18-58 years) were tested. The mean (standard error) for NPC was 7.13 ± 0.36 (95% CI, 6.45, 7.88). The smaller targets (Bernell Vergell™ and pen) yielded significantly larger estimates of NPC than both the 12- and 14-point font targets, p < 0.001). The Bernell Vergell™ and pen NPC did not differ (p = 0.134), and the 12- and 14-point font NPC’s did not differ (p = 0.794).ConclusionsEvaluation of NPC in the clinical environment uses non-standardized items of convenience that vary in size. The results of this study suggest that size is an important consideration when measuring NPC. Multiple disciplines are investigating NPC because of its relationship with concussion. Using evidence-based assessment tools such as the VOMS requires a systematic approach. Precision is required in clinical assessment, so it is suggested that clinicians use one standard approach to estimate NPC.
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Modica C, Lewis JH, Bay C. Colorectal Cancer: Applying the Value Transformation Framework to increase the percent of patients receiving screening in Federally Qualified Health Centers. Prev Med Rep 2019; 15:100894. [PMID: 31198660 PMCID: PMC6556543 DOI: 10.1016/j.pmedr.2019.100894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/30/2018] [Revised: 05/07/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022] Open
Abstract
Background Colorectal cancer is the second leading cause of cancer death in the U.S. and third-most common cancer in both men and women. Colorectal cancer screening (CRCS) rates remain low, particularly among vulnerable patients receiving care at federally qualified health centers. Through its Value Transformation Framework, the National Association of Community Health Centers provides a systematic approach to improving CRCS by transforming health center infrastructure, care delivery, and people systems—to improve health outcomes, patient and staff experiences, and lower costs (Quadruple Aim). Methods We combined the Value Transformation Framework, evidence-based CRCS interventions, and the Learning Community Model to drive system improvements and implement evidence-based practices. Multi-disciplinary teams at 8 health centers in Georgia and Iowa participated for 1-year with Primary Care Association support. Results Pre−/post- 1-year-intervention data showed, within health centers, raw percentage of eligible patients screened for CRC increased from 33.2% (13.5%–61.7%) in January 2017 to 46.5% (14.2%–81.5%) in December 2017, with an overall 13.3 percentage point average increase. This translates into an average increase of 3.3 (95% CI: 1.7, 5.0) eligible patients screened per month per health center over the year or 317 additional patients meeting CRCS guidelines. Specific interventions associated with higher CRCS rates included standing orders, sharing performance data, and electronic health record alerts. Conclusion Findings support a three-pronged approach for improving CRCS: The Value Transformation Framework's evidence-based recommendations, with actionable CRC interventions, offered in a learning community. These results guide methodological approaches to improving CRCS in health centers through a multi-level, multi-modality quality improvement and transformation approach.
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Affiliation(s)
- Cheryl Modica
- National Association of Community Health Centers, 7501 Wisconsin Avenue, Suite 1100W, Bethesda, MD 20814, United States of America
| | - Joy H Lewis
- A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ 85206, United States of America
| | - Curt Bay
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206, Mesa, AZ 85206, United States of America
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Rimmer RB, Bay C, Dillard D, Chacon D, Wise D, Milem M, Foster KN. 262 Young Adult Burn Survivors Burned as Children Self-Report on Wellbeing - How are they Faring? J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- R B Rimmer
- Arizona Burn Center, Phoenix, AZ; A.T. Still University, Mesa, AZ; Georgia Firefighters Burn Foundation, Atlanta, GA; Alisa Ann Ruch Burn Foundation, El Cerrito, CA; Preferred Pediatric Home Health Care, Tulsa, OK; Arizona Burn Foundation, Phoenix, AZ
| | - C Bay
- Arizona Burn Center, Phoenix, AZ; A.T. Still University, Mesa, AZ; Georgia Firefighters Burn Foundation, Atlanta, GA; Alisa Ann Ruch Burn Foundation, El Cerrito, CA; Preferred Pediatric Home Health Care, Tulsa, OK; Arizona Burn Foundation, Phoenix, AZ
| | - D Dillard
- Arizona Burn Center, Phoenix, AZ; A.T. Still University, Mesa, AZ; Georgia Firefighters Burn Foundation, Atlanta, GA; Alisa Ann Ruch Burn Foundation, El Cerrito, CA; Preferred Pediatric Home Health Care, Tulsa, OK; Arizona Burn Foundation, Phoenix, AZ
| | - D Chacon
- Arizona Burn Center, Phoenix, AZ; A.T. Still University, Mesa, AZ; Georgia Firefighters Burn Foundation, Atlanta, GA; Alisa Ann Ruch Burn Foundation, El Cerrito, CA; Preferred Pediatric Home Health Care, Tulsa, OK; Arizona Burn Foundation, Phoenix, AZ
| | - D Wise
- Arizona Burn Center, Phoenix, AZ; A.T. Still University, Mesa, AZ; Georgia Firefighters Burn Foundation, Atlanta, GA; Alisa Ann Ruch Burn Foundation, El Cerrito, CA; Preferred Pediatric Home Health Care, Tulsa, OK; Arizona Burn Foundation, Phoenix, AZ
| | - M Milem
- Arizona Burn Center, Phoenix, AZ; A.T. Still University, Mesa, AZ; Georgia Firefighters Burn Foundation, Atlanta, GA; Alisa Ann Ruch Burn Foundation, El Cerrito, CA; Preferred Pediatric Home Health Care, Tulsa, OK; Arizona Burn Foundation, Phoenix, AZ
| | - K N Foster
- Arizona Burn Center, Phoenix, AZ; A.T. Still University, Mesa, AZ; Georgia Firefighters Burn Foundation, Atlanta, GA; Alisa Ann Ruch Burn Foundation, El Cerrito, CA; Preferred Pediatric Home Health Care, Tulsa, OK; Arizona Burn Foundation, Phoenix, AZ
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24
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Sharifi M, Awdisho A, Schroeder B, Jiménez J, Iyer P, Bay C. Retrospective comparison of ultrasound facilitated catheter-directed thrombolysis and systemically administered half-dose thrombolysis in treatment of pulmonary embolism. Vasc Med 2019; 24:103-109. [DOI: 10.1177/1358863x18824159] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study retrospectively compared the outcomes of patients who received ultrasound facilitated catheter-directed thrombolysis (UFCDT) versus systemically administered ‘half-dose’ thrombolysis (HDT) in 97 patients with PE. The outcomes assessed included changes in baseline pulmonary artery systolic pressure (PASP), right ventricle/left ventricle ratio (RV/LV), cost and duration of hospitalization, death, bleeding, and recurrent venous thromboembolism in the short and intermediate term follow-up. Analyses were performed using a covariance adjustment propensity score approach to address baseline differences between groups in variables associated with PASP and RV/LV, covarying baseline scores. The baseline mean ± SE PASP dropped from 49.3 ± 1.1 to 32.5 ± 0.3 mmHg at 36 hours in the HDT group, and from 50.6 ± 1.2 to 35.1 ± 0.4 mmHg in the UFCDT group; group × time interaction p-value = 0.007. Corresponding drops in the RV/LV were from a baseline of 1.26 ± 0.05 to 1.07 ± 0.01 in the HDT group and from 1.30 ± 0.05 to 1.14 ± 0.01 in the UFCDT group at 36 hours; group × time interaction p-value = 0.269. Statistically significant decreases were noted in PASP and RV/LV for both the HDT and UFCDT at 36 hours and follow-up. PASP through follow-up was significantly lower in the HDT than the UFCDT group. Likewise, RV/LV was lower in the HDT group. The duration and cost of hospitalization were lower in the HDT group (6.2 ± 1.4 days vs 1.9 ± 0.3 days, p < 0.001; US$12,000 ± $3000 vs $74,000 ± $6000, p < 0.001). We conclude that both UFCDT and HDT lead to rapid reduction of PASP and RV/LV, whereas HDT leads to a lower duration and cost of hospitalization.
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Affiliation(s)
- Mohsen Sharifi
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA
- A.T. Still University, Mesa, AZ, USA
- Banner Health System, Mesa, AZ, USA
| | - Alan Awdisho
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA
| | | | - José Jiménez
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA
- Banner Health System, Mesa, AZ, USA
| | | | - Curt Bay
- A.T. Still University, Mesa, AZ, USA
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25
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Swann JA, Matthews MR, Bay C, Foster KN. Burn injury outcome differences in Native Americans. Burns 2019; 45:494-501. [DOI: 10.1016/j.burns.2018.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 08/19/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
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Chang J, Egert D, Padniewski J, Johnson B, Bay C, Dragovich T, Kundranda MN, Koo P. Circulating tumor DNA may correlate with tumor size changes following therapy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
233 Background: Pancreatic cancer has significant mortality at five years, even in resectable disease. Recent effort has been dedicated to identify a more specific tumor marker for screening and assessing tumor response, in part because 10% of the population does not produce CA19-9. Detection and quantification of circulating tumor DNA (ctDNA) in the bloodstream is a novel concept for screening and treatment response assessment. This study examined possible correlations between ctDNA levels and various aspects of pancreatic cancer in a total of 17 patients receiving treatment at Banner MD Anderson Cancer Center. Methods: Present study is approved by our local IRB. Research was conducted according HIPPA regulation. Subjects on the present study were obtained from the list of patients participating in our ctDNA trial. A total of 17 subjects were identified from the list. Their ctDNA index levels were obtained from the sponsor (Chronyx) at baseline and following each cycle of the treatment. For each CT scan and each ctDNA study, they are considered the same time if they are obtained within 4 weeks of each other. The sizes of the primary tumor and the largest metastatic lesion were on a transverse image at the largest extent of the lesion. Data was analyzed with Spearman's correlation. Results: Baseline ctDNA levels did not correlate with patient demographic data (N = 17; gender, p = 0.63; age, p = 0.82), baseline size of primary mass on CT scan (N = 16; p = 0.85), baseline vessel involvement on CT Scan (N = 17; p = 0.58), presence of metastasis on CT scan (N = 17; p = 0.78), size of largest metastasis on CT scan (N = 17; p = 0.85), presence of peripancreatic lymph nodes on CT scan (N = 17; p = 0.45), or overall survival (N = 8; p = 0.6). However, there is a trend toward correlating the change in ctDNA and change in size on CT scan following treatment (N = 7; p = 0.12). Conclusions: ctDNA at baseline appears to be secreted independent of the primary tumor size, location, or presence of metastasis. However, changes in ctDNA does seem to correlate with changes in tumor size following treatment. Although our data was not statistically significant, this may be related to the low sample size. With larger sample size, it is expected that changes in ctDNA may prove to correlate with changes in tumor size.
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Affiliation(s)
- John Chang
- Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Daniel Egert
- A.T. Still University of Health Sciences, Kirksville, MO
| | | | | | - Curt Bay
- A.T. Still University of Health Sciences, Kirksville, MO
| | | | | | - Phillip Koo
- Banner MD Anderson Cancer Center, Gilbert, AZ
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27
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Wenande E, Phothong W, Bay C, Karmisholt K, Haedersdal M, Togsverd‐Bo K. Efficacy and safety of daylight photodynamic therapy after tailored pretreatment with ablative fractional laser or microdermabrasion: a randomized, side‐by‐side, single‐blind trial in patients with actinic keratosis and large‐area field cancerization. Br J Dermatol 2018; 180:756-764. [DOI: 10.1111/bjd.17096] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 01/02/2023]
Affiliation(s)
- E. Wenande
- Department of Dermatology Bispebjerg University Hospital University of Copenhagen Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - W. Phothong
- Department of Dermatology Bispebjerg University Hospital University of Copenhagen Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
- Department of Dermatology Siriraj Hospital Mahidol University Bangkok Thailand
| | - C. Bay
- Department of Dermatology Bispebjerg University Hospital University of Copenhagen Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - K.E. Karmisholt
- Department of Dermatology Bispebjerg University Hospital University of Copenhagen Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - M. Haedersdal
- Department of Dermatology Bispebjerg University Hospital University of Copenhagen Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - K. Togsverd‐Bo
- Department of Dermatology Bispebjerg University Hospital University of Copenhagen Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
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28
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Heick JD, Bay C, Valovich McLeod TC. EVALUATION OF VERTICAL AND HORIZONTAL SACCADES USING THE DEVELOPMENTAL EYE MOVEMENT TEST COMPARED TO THE KING-DEVICK TEST. Int J Sports Phys Ther 2018; 13:808-818. [PMID: 30276013 PMCID: PMC6159500] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Oculomotor function is impaired when an individual has a concussion and as such, it is important to identify tests that are able to assess oculomotor impairment. The King-Devick (K-D) test assesses horizontal saccadic eye movement and attention. The Developmental Eye Movement (DEM) test is designed to identify oculomotor dysfunction in children. It measures both horizontal and vertical saccades. The K-D test shows promise as a concussion-screening tool and part of a multifactorial assessment. The DEM has not been tested as a concussion assessment tool, but the neuroanatomical control of horizontal and vertical saccades originates from different areas of the brain, so one might expect to see differences in performance on the K-D and DEM tests when administered to concussed patients. First, it is important to determine if performance on the DEM and K-D tests, particularly with respect to the measurement of vertical and horizontal saccades, is similar in a healthy population.Hypothesis/Purpose: The primary purpose was to evaluate the relationship between horizontal and vertical saccade tests over repeated trials in normal, healthy subjects. A secondary purpose of this study was to determine the number of trials needed to reach a performance plateau for both the DEM and K-D tests.Study Design: This study used a prospective cohort research design. METHODS Forty-two healthy non-concussed participants (22 males, 20 females; mean age, 24.2 ± 2.92 years) completed six repeated trials of both the DEM, and then six trials of the K-D test in a single testing session. Trials within each test were performed in random order and participants were offered short rest breaks as needed between test administrations. RESULTS Results indicated strong correlations, r=.67, or greater, between measurements of horizontal and vertical saccades. Performance plateaued on the K-D at trial three and on the DEM at trial two for both horizontal and vertical saccades. CONCLUSION It appears that the DEM and K-D tests measure similar constructs in healthy individuals and that no additional information is provided by assessment of vertical saccades. Additional studies are required to investigate the usefulness of the DEM in concussed individuals. LEVEL OF EVIDENCE 3: Laboratory study with repeated measures.
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Affiliation(s)
- John D. Heick
- Northern Arizona University, Program in Physical Therapy, Flagstaff, AZ, USA
| | - Curt Bay
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ, USA
| | - Tamara C. Valovich McLeod
- Athletic Training Programs and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ, USA
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29
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Halgas B, Bay C, Foster K. A comparison of injury scoring systems in predicting burn mortality. Ann Burns Fire Disasters 2018; 31:89-93. [PMID: 30374258 PMCID: PMC6199008] [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] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/02/2018] [Indexed: 06/08/2023]
Abstract
The models most widely used to predict burn patient mortality are the revised Baux score, Ryan, Smith, McGwin, Abbreviated Burn Severity Index (ABSI), Belgian Outcome of Burn Injury (BOBI), and the Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex (FLAMES). Improvements in critical care have reduced mortality resulting from severe burns, which may affect the predictive strength of older models. We conducted a cross-validation study on all burn patients (n = 114) with TBSA greater than 20%, admitted to the Arizona Burn Center between 2014 and 2016. The study compared the accuracy of seven previously validated burn-specific models and one new model derived for our cohort. Data were collected on age, ethnicity, gender, total body surface area burned (TBSA), inhalational injury, associated trauma, and injury severity (ISS, APACHE II). The accuracy of each model was tested using logistic regression, preserving the published regression coefficients. Predictive performance of the models was assessed by Receiving Operator Curve (ROC) curve analyses and Hosmer-Lemeshow (H-L) goodness of fit tests. Age, TBSA and APACHE II score were found to be significant, independent risk factors for patient mortality. The FLAMES model performed best (AUC 0.96) and was comparable to our native model (AUC 0.96). The revised Baux score was both accurate and easy to calculate, making it clinically useful. The older models demonstrated adequate predictive performance compared with the newer models. Even without key burn parameters, the APACHE II score performed well in critically ill patients with moderate to severe burn injuries.
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Affiliation(s)
- B. Halgas
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - C. Bay
- Maricopa Integrated Health System, Phoenix, Arizona, USA
| | - K. Foster
- Arizona Burn Center, Maricopa Integrated Health System, Phoenix, Arizona, USA
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30
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Wallace TJ, Qian J, Avital I, Bay C, Man YG, Wellman LL, Moskaluk C, Troyer D, Ramnani D, Stojadinovic A. Technical Feasibility of Tissue Microarray (TMA) Analysis of Tumor-Associated Immune Response in Prostate Cancer. J Cancer 2018; 9:2191-2202. [PMID: 29937939 PMCID: PMC6010688 DOI: 10.7150/jca.22846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/28/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction: The androgen receptor (AR) regulates immune-related epithelial-to-mesenchymal transition (EMT), and prostate cancer (PCa) metastasis. Primary tumor-infiltrating lymphocytes (TILs) [CD3+, CD4+, and CD8+ TILs] are potential prognostic indicators in PCa, and variations may contribute to racial disparities in tumor biology and PCa outcomes. Aim: To assess the technical feasibility of tumor microarray (TMA)-based methods to perform multi-marker TIL profiling in primary resected PCa. Methods: Paraffin-embedded tissue cores of histopathologically-confirmed primary PCa (n = 40; 1 TMA tissue specimen loss) were arrayed in triplicate on TMAs. Expression profiles of AR, CD3+, CD4+, and CD8+ TILs in normal prostate, and the center and periphery of both the tumor-dominant nodule and highest Gleason grade were detected by IHC and associated with clinical and pathological data using standard statistical methodology. An independent pathologist, blinded to the clinical data, scored all samples (percent and intensity of positive cells). Results: TMAs were constructed from 21 (53.8%) Black and 18 (46.2%) White males with completely-resected, primarily pT2 stage PCa [pT2a (n = 3; 7.7%); pT2b (n = 2; 5.1%); pT2c (n = 27; 69.2%); pT3a (n = 5; 12.8%); mean pre-op PSA = 8.17 ng/ml]. The CD3, CD4, CD8, and CD8/CD3 cellular protein expression differed from normal in the periphery of the dominant nodule, the center of the highest Gleason grade, and the periphery of the highest Gleason grade (P < 0.05). Correlations between TIL expression in the center and periphery of the dominant nodule, with corresponding center and periphery of the highest Gleason grade, respectively, were robust, and the magnitude of these correlations differed markedly by race (P < 0.05). Conclusions: Multi-marker (AR, CD3, CD4, CD8) profiling with IHC analysis of TMAs consisting of primary, non-metastatic resected prostate cancer is technically feasible in this pilot study. Future studies will evaluate primary tumor immunoscore using semi-quantitative, IHC-based methodology to assess differences in the spectrum, quantity, and/or localization of TILs, and to gain insights into racial disparities in PCa tumor biology and clinical outcomes.
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Affiliation(s)
| | - Junqi Qian
- Virginia Urology, Richmond, Virginia, U.S.A
| | - Itzhak Avital
- Soroka University Center for Advanced Cancer Care, Ber Sheva, Israel
| | - Curt Bay
- A.T. Still University, Mesa, Arizona, U.S.A
| | - Yan-Gao Man
- National Medical Centre of Colorectal Disease, Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (TCM), Nanjing, China
| | | | - Chris Moskaluk
- University of Virginia, Charlottesville, Virginia, U.S.A
| | - Dean Troyer
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
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31
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Sartor-Glittenberg C, Bordenave E, Bay C, Bordenave L, Alexander JL. Effect of a Matter of Balance programme on avoidance behaviour due to fear of falling in older adults. Psychogeriatrics 2018; 18:224-230. [PMID: 29424113 DOI: 10.1111/psyg.12310] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/03/2017] [Accepted: 10/23/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fear of falling (FOF) is associated with restricted activities, increased risk of falling, and decreased quality of life. A Matter of Balance (AMOB) is an evidence-based programme designed to decrease FOF. The current study investigated the influence of the AMOB on activity avoidance caused by FOF in older adults using the Fear of Falling Avoidance Behavior Questionnaire (FFABQ), health-related quality of life, and a question regarding concerns about falling. METHODS Participants of this quasi-experimental, one-group, pretest-post-test study design were older adults from community sites in the Phoenix, Arizona, metropolitan area. Participants attended the AMOB programme, which consisted of one weekly 2-h session for 8 weeks. At the beginning and end of the programme, participants completed the standard AMOB assessments, the FFABQ, the Centers for Disease Control Core Healthy Days Measure (CDC HRQOL-4), and a question regarding concerns about falling. RESULTS Sixty-three participants completed the study; their mean ± SD age was 75.3 ± 7.1 years (range: 60.0-90.0 years), and 84.1% were women. The FFABQ scores decreased from baseline (24.4 ± 12.7 points) to post-AMOB (20.1 ± 11.9 points; t = 2.62, P = 0.01). No changes in any of the CDC HRQOL-4 questions were noted (CDC HRQOL-4 question (Q)1 (z = -1.41, P = 0.16), CDC HRQOL-4 Q2 and Q3 summary index (z = -1.60, P = 0.11), and CDC HRQOL-4 Q4 (z = -0.97, P = 0.33)). Concerns about falling decreased from baseline (3.4 ± 0.9 points) to post-AMOB (2.8 ± 0.8 points; z = -4.09, P < 0.001). CONCLUSION Avoidance behaviour caused by FOF, as measured by the FFABQ, and concerns about falling decreased in community-dwelling older adults who participated in the AMOB. Findings support the efficacy of the AMOB for reducing both avoidance behaviour caused by FOF and concerns about falling through an approach that combines education and exercise.
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Affiliation(s)
- Cecelia Sartor-Glittenberg
- Physical Therapy Department, Arizona School of Health Sciences, A.T. Still University, Mesa, Arizona, USA
| | - Elton Bordenave
- Audiology Department, Arizona School of Health Sciences, and A.T. Still University Center for Resilience in Aging, A.T. Still University, Mesa, Arizona, USA
| | - Curt Bay
- Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, Arizona, USA
| | - Lori Bordenave
- Physical Therapy Department, Arizona School of Health Sciences, A.T. Still University, Mesa, Arizona, USA
| | - Jeffrey L Alexander
- Doctor of Health Sciences Program, College of Graduate Health Studies and A.T. Still University Center for Resilience in Aging, A.T. Still University, Mesa, Arizona, USA
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Housler GJ, Cross S, Marcel V, Kennedy DO, Husband M, Register A, Roberts T, Grubbs S, Dudewicz D, Setka N, Bay C, Wendelken ME, Izadjoo MJ. A Prospective Randomized Controlled Two-Arm Clinical Study Evaluating the Efficacy of a Bioelectric Dressing System for Blister Management in US Army Ranger Recruits. J Spec Oper Med 2017; 17:49-58. [PMID: 28599034 DOI: 10.55460/bupv-pavd] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 11/09/2022]
Abstract
This study focused on a clinically relevant healthcare problem in the military: acute soft tissue wounds, or blisters. The trial was a prospective, controlled, randomized two-arm study evaluating the efficacy of a bioelectric dressing, Procellera®, applied topically two to three times per week for 2 weeks to blisters developed in Ranger trainees during training at Fort Benning, Georgia. A total of 80 US Army Ranger recruits with blister wounds below the knee were randomly assigned to one of two treatment groups (n = 40/group). The primary goal was to assess the clinical efficacy (rate of healing) of administered Procellera in conjunction with the standard-of-care (SOC) treatment, moleskin and Tegaderm ®, on the healing rate of blisters compared with the SOC treatment alone. The secondary end points for efficacy were the quantities of wound fluid biomarkers and bacterial bioburden. The tertiary end point was assessment of pain in the treatment group compared with that of the control group during the 2-week study. The results showed no statistical difference between the SOC and SOC+Procellera groups in wound healing and pain. Wound fluid was reported for 24 participants (64.9%) in the SOC group and 21 participants (56.8%) in SOC+Procellera group at the baseline measurement (ρ = .475); however, the wounds were devoid of fluid on follow-up visits. The mild nature of the wounds in this study was apparent by the low pain scores at the beginning of the study, which disappeared by the follow-up visits. The average wound sizes were 2.2cm2 and 1.5cm2 for the SOC and SOC+Procellera groups, respectively. This trial protocol should be conducted on open softtissue wounds in severe heat. To our knowledge, this is the first clinical study conducted within the US Army Rangers training doctrine.
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Heick JD, Bay C, Dompier TP, Valovich McLeod TC. RELATIONSHIPS AMONG COMMON VISION AND VESTIBULAR TESTS IN HEALTHY RECREATIONAL ATHLETES. Int J Sports Phys Ther 2017; 12:581-591. [PMID: 28900564 PMCID: PMC5534148] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Disruption of the visual and vestibular systems is commonly observed following concussion. Researchers have explored the utility of screening tools to identify deficits in these systems in concussed patients, but it is unclear if these tests are measuring similar or distinct phenomena. PURPOSE To determine the relationships between common vestibular tests including the King-Devick (K-D) test, Sensory Organization Test (SOT), Head Shake-Sensory Organization Test (HS-SOT), and Dynamic Visual Acuity (DVA) test, when administered contiguously, to healthy recreational athletes aged 14 to 24 years. STUDY DESIGN This study used a prospective design to evaluate relationships between the K-D, SOT, HS-SOT, and DVA tests in 60 healthy individuals. METHODS Sixty participants (30 males, 30 females; mean age, 19.9 ± 3.74 years) completed the four tests in a single testing session. RESULTS Results did not support a relationship between any pair of the K-D, SOT, HS-SOT, and DVA tests. Pearson correlations between tests were poor, ranging from 0.14 to 0.20. As expected the relationship between condition 2 of the SOT and HS-SOT fixed was strong (ICC=0.81) as well as condition 5 of the SOT with HS-SOT sway (ICC=0.78). The test-retest reliability of all 4 tests was evaluated to ensure the relationships of the 4 tests were consistent between test trials and reliability was excellent with intraclass correlations ranging from 0.79 to 0.97. CONCLUSIONS The lack of relationships in these tests is clinically important because it suggests that the tests evaluate different aspects of visual and vestibular function. Further, these results suggest that a comprehensive assessment of visual and vestibular deficits following concussion may require a multifaceted approach. LEVEL OF EVIDENCE 2b: Individual Cohort Study.
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Affiliation(s)
| | - Curt Bay
- A.T. Still University, Mesa, AZ, USA
| | - Thomas P. Dompier
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN, USA
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Kristensen PL, Tarnow L, Bay C, Nørgaard K, Jensen T, Parving HH, Perrild H, Beck-Nielsen H, Christiansen JS, Thorsteinsson B, Pedersen-Bjergaard U. Comparing effects of insulin analogues and human insulin on nocturnal glycaemia in hypoglycaemia-prone people with Type 1 diabetes. Diabet Med 2017; 34:625-631. [PMID: 28099755 DOI: 10.1111/dme.13317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 12/17/2022]
Abstract
AIMS To assess the difference between analogue and human insulin with regard to nocturnal glucose profiles and risk of hypoglycaemia in people with recurrent severe hypoglycaemia. METHODS A total of 72 people [46 men, mean ± sd age 54 ± 12 years, mean ± sd HbA1c 65 ± 12 mmol/mol (8.1 ± 1.1%), mean ± sd duration of diabetes 30 ± 14 years], who participated in a 2-year randomized, crossover trial of basal-bolus therapy with insulin detemir/insulin aspart or human NPH insulin/human regular insulin (the HypoAna trial) were studied for 2 nights during each treatment. Venous blood was drawn hourly during sleep. Primary endpoints were nocturnal glucose profiles and occurrence of hypoglycaemia (blood glucose ≤ 3.9 mmol/l). RESULTS During insulin analogue treatment, the mean nocturnal plasma glucose level was significantly higher than during treatment with human insulin (10.6 vs 8.1 mmol/l). The fasting plasma glucose level was similar between the treatments. Nocturnal hypoglycaemia was registered during 41/101 nights (41%) in the human insulin arm and 19/117 nights (16%) in the insulin analogue arm, corresponding to a hazard ratio of 0.26 (95% CI 0.14 to 0.45; P < 0.0001) with insulin analogue. CONCLUSIONS Treatment with insulin analogue reduces the occurrence of nocturnal hypoglycaemia assessed by nocturnal glucose profiles in people with Type 1 diabetes prone to severe hypoglycaemia. Nocturnal glucose profiles provide a more comprehensive assessment of clinical benefit of insulin regimens as compared to conventional recording of hypoglycaemia.
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Affiliation(s)
- P L Kristensen
- Nordsjaellands Hospital Hillerød, Department of Cardiology, Nephrology and Endocrinology, Hillerød, Denmark
| | - L Tarnow
- Steno Diabetes Centre, Department of Clinical Research, Gentofte, Denmark
- Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, Nordsjaellands Hospital Hillerød, Hillerød, Denmark
| | - C Bay
- Nordsjaellands Hospital Hillerød, Department of Cardiology, Nephrology and Endocrinology, Hillerød, Denmark
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - K Nørgaard
- Department of Endocrinology, Hvidovre University Hospital, Hvidovre, Denmark
| | - T Jensen
- Department of Endocrinology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - H-H Parving
- Health, Aarhus University, Aarhus, Denmark
- Department of Endocrinology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - H Perrild
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - H Beck-Nielsen
- Department of Endocrinology M, Odense University Hospital, Odense, Denmark
| | - J S Christiansen
- Health, Aarhus University, Aarhus, Denmark
- Department of Endocrinology M, Aarhus University Hospital, Aarhus, Denmark
| | - B Thorsteinsson
- Nordsjaellands Hospital Hillerød, Department of Cardiology, Nephrology and Endocrinology, Hillerød, Denmark
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - U Pedersen-Bjergaard
- Nordsjaellands Hospital Hillerød, Department of Cardiology, Nephrology and Endocrinology, Hillerød, Denmark
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark
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Sharifi M, Berger J, Beeston P, Bay C, Vajo Z, Javadpoor S. Pulseless electrical activity in pulmonary embolism treated with thrombolysis (from the "PEAPETT" study). Am J Emerg Med 2016; 34:1963-1967. [PMID: 27422214 DOI: 10.1016/j.ajem.2016.06.094] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/07/2016] [Accepted: 06/29/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Pulseless electrical activity (PEA) during cardiac arrest portends a poor prognosis. There is a paucity of data in the use of thrombolytic therapy in PEA and cardiopulmonary arrest due to confirmed pulmonary embolism (PE). We evaluated the outcome of low-dose systemic thrombolysis with tissue plasminogen activator (tPA) in patients presenting with PEA due to PE. METHODS During a 34-month period, we treated 23 patients with PEA and cardiopulmonary arrest due to confirmed massive PE. All patients received 50 mg of tPA as intravenous push in 1 minute while cardiopulmonary resuscitation was ongoing. The time from initiation of cardiopulmonary resuscitation to administration of tPA was 6.5 ± 2.1 minutes. RESULTS Return of spontaneous circulation occurred in 2 to 15 minutes after tPA administration in all but 1 patient. There was no minor or major bleeding despite chest compression. Of the 23 patients, 2 died in the hospital, and at 22 ± 3 months of follow-up, 20 patients (87%) were still alive. The right ventricular/left ventricular ratio and pulmonary artery systolic pressure dropped from 1.79 ± 0.27 and 58.10 ± 7.99 mm Hg on admission to 1.16 ± 0.13 and 40.25 ± 4.33 mm Hg within 48 hours, respectively (P< .001 for both comparisons). There was no recurrent venous thromboembolism or bleeding during hospitalization or at follow-up. CONCLUSION Rapid administration of 50 mg of tPA is safe and effective in restoration of spontaneous circulation in PEA due to massive PE leading to enhanced survival and significant reduction in pulmonary artery pressures.
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Affiliation(s)
- Mohsen Sharifi
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ; A.T. Still University, Mesa, AZ.
| | | | | | | | - Zoltan Vajo
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ
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Sharifi M, Freeman W, Bay C, Sharifi M, Schwartz F. Low incidence of post-thrombotic syndrome in patients treated with new oral anticoagulants and percutaneous endovenous intervention for lower extremity deep venous thrombosis. Vasc Med 2016; 20:112-6. [PMID: 25832599 DOI: 10.1177/1358863x14553882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-thrombotic syndrome (PTS) is a common complication of deep venous thrombosis (DVT) of the iliofemoral venous system leading to significant morbidity and high health care costs. It has been recently shown that percutaneous endovenous intervention (PEVI) can effectively reduce the incidence of PTS. The role of new oral anticoagulants (NOACs) in combination with PEVI in the reduction of PTS has not been previously studied. This report sought to evaluate the role of PEVI plus NOACs in the reduction of PTS in acute symptomatic femoropopliteal and iliac DVT. We studied 127 patients with acute lower extremity DVT who had undergone PEVI plus administration of NOACs. All had received a minimum of 3 months of anticoagulation with a NOAC following PEVI. The mean follow-up was 22±5 months. The patients were evaluated for development of PTS, bleeding, recurrent venous thromboembolism (VTE), duration of hospitalization and mortality. There was no in-hospital bleeding. The mean duration of hospitalization was 46±9 hours. DVT occurred in two patients who had been later switched to warfarin. There were four non-VTE-related deaths. PTS developed in five patients (3%), two of whom were those who had been switched to warfarin. Their mean Villalta score was 6.2±0.9. We conclude that the combination of PEVI plus NOAC and low dose aspirin is associated with a very low rate of PTS with the severity being only mild. This approach leads to very low rates of bleeding and recurrent VTE and promotes early discharge.
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Affiliation(s)
- Mohsen Sharifi
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA A.T. Still University, Mesa, AZ, USA
| | | | - Curt Bay
- A.T. Still University, Mesa, AZ, USA
| | - Mirali Sharifi
- Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA
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McCoy L, Pettit RK, Lewis JH, Allgood JA, Bay C, Schwartz FN. Evaluating medical student engagement during virtual patient simulations: a sequential, mixed methods study. BMC Med Educ 2016; 16:20. [PMID: 26774892 PMCID: PMC4715308 DOI: 10.1186/s12909-016-0530-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 01/06/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND Student engagement is an important domain for medical education, however, it is difficult to quantify. The goal of this study was to investigate the utility of virtual patient simulations (VPS) for increasing medical student engagement. Our aims were specifically to investigate how and to what extent the VPS foster student engagement. This study took place at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA), in the USA. METHODS First year medical students (n = 108) worked in teams to complete a series of four in-class virtual patient case studies. Student engagement was measured, defined as flow, interest, and relevance. These dimensions were measured using four data collection instruments: researcher observations, classroom photographs, tutor feedback, and an electronic exit survey. Qualitative data were analyzed using a grounded theory approach. RESULTS Triangulation of findings between the four data sources indicate that VPS foster engagement in three facets: 1) Flow. In general, students enjoyed the activities, and were absorbed in the task at hand. 2) Interest. Students demonstrated interest in the activities, as evidenced by enjoyment, active discussion, and humor. Students remarked upon elements that caused cognitive dissonance: excessive text and classroom noise generated by multi-media and peer conversations. 3) Relevance. VPS were relevant, in terms of situational clinical practice, exam preparation, and obtaining concrete feedback on clinical decisions. CONCLUSIONS Researchers successfully introduced a new learning platform into the medical school curriculum. The data collected during this study were also used to improve new learning modules and techniques associated with implementing them in the classroom. Results of this study assert that virtual patient simulations foster engagement in terms of flow, relevance, and interest.
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Affiliation(s)
- Lise McCoy
- A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ, 85206, USA.
| | - Robin K Pettit
- A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ, 85206, USA
| | - Joy H Lewis
- A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ, 85206, USA
| | - J Aaron Allgood
- A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ, 85206, USA
| | - Curt Bay
- A.T. Still University, Arizona School of Health Sciences, 5850 East Still Circle, Mesa, 85206, Arizona, USA
| | - Frederic N Schwartz
- A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ, 85206, USA
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Sharifi M, Freeman W, Bay C, Sharifi M, Chatham J, Schwartz F. PERCUTANEOUS ENDOVENOUS INTERVENTION PLUS NEW ORAL ANTICOAGULANTS IN CANCER PATIENTS WITH LOWER EXTREMITY DEEP VENOUS THROMBOSIS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)62130-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kristensen PL, Diemar SS, Bay C, Pedersen-Bjergaard U, Beck-Nielsen H, Christiansen JS, Nørgaard K, Perrild H, Tonny J, Parving HH, Thorsteinsson B, Tarnow L. ACTH stimulation test in patients with type 1 diabetes and recurrent severe hypoglycaemia. Clin Endocrinol (Oxf) 2015; 82:155-6. [PMID: 25041498 DOI: 10.1111/cen.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P L Kristensen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands University Hospital, Hillerød, Denmark; Steno Diabetes Center, Gentofte, Denmark.
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Bay C, Cyr PL, Jensen I. Estimating The Value Of Cangrelor From Eliminating Preloading In Coronary Artery Bypass Graft (Cabg) Patients. Value Health 2014; 17:A480. [PMID: 27201397 DOI: 10.1016/j.jval.2014.08.1389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- C Bay
- ICON plc, Cambridge, MA, USA
| | - P L Cyr
- ICON plc, Cambridge, MA, USA
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Hamstra-Wright KL, Bliven KCH, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med 2014; 49:362-9. [DOI: 10.1136/bjsports-2014-093462] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Sharifi M, Freeman WK, Camiliere TM, Vajo Z, Bay C, Sharifi M, Schwartz F. TCT-478 New Oral Anticoagulants in Cancer Patients Undergoing Percutaneous Endovenous Intervention for Lower Extremity Deep Venous Thrombosis. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.532] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sharifi M, Freeman W, Bay C, Sharifi M, Schwartz F, Skrocki L. PARADIGM SHIFT IN THE TREATMENT OF PULMONARY EMBOLISM: SAFE DOSE THROMBOLYSIS PLUS RIVAROXABAN. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61476-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sharifi M, Bay C, Schwartz F, Skrocki L. Safe-dose thrombolysis plus rivaroxaban for moderate and severe pulmonary embolism: drip, drug, and discharge. Clin Cardiol 2013; 37:78-82. [PMID: 24122947 DOI: 10.1002/clc.22216] [Citation(s) in RCA: 28] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 08/31/2013] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Thrombolysis, though very effective, has not been embraced as routine therapy for symptomatic pulmonary embolism (PE) except in very severe cases. Rivaroxaban recently has been approved for the treatment of venous thromboembolism (VTE). There are no data on the combined use of thrombolysis and rivaroxaban in PE. HYPOTHESIS "Safe dose" thrombolysis (SDT) plus new oral anticoagulants are expected to become an appealing, safe and effective approach in the treatment of moderate and severe PE in the near future, thereby drastically reducing hospitalization time. METHODS Over a 12-month period, 98 consecutive patients with symptomatic PE were treated by a combination of SDT and rivaroxaban. The SDT was started in parallel with unfractionated heparin and given in 2 hours. Heparin was given for a total of 24 hours and rivaroxaban started at 15 or 20 mg daily 2 hours after termination of heparin infusion. RESULTS There was no bleeding due to SDT. Recurrent VTE occurred in 3 patients who had been switched to warfarin. No patient on rivaroxaban developed VTE. Two patients died of cancer at a mean follow-up of 12 ± 2 months. The pulmonary artery systolic pressure dropped from 52.8 ± 3.9 mm Hg before to 32 ± 4.4 mm Hg within 36 hours of SDT (P < 0.001). The duration of hospitalization for patients presenting primarily for PE was 1.9 ± 0.2 days. CONCLUSIONS "Safe dose" thrombolysis plus rivaroxaban is highly safe and effective in the treatment of moderate and severe PE, leading to favorable early and intermediate-term outcomes and early discharge.
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Affiliation(s)
- Mohsen Sharifi
- Arizona Cardiovascular Consultants and Vein Clinic, Mesa, Arizona
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Sharifi M, Freeman WK, Chatham J, Emami T, Bay C, Schwartz F. TCT-516 Argatroban and t-PA During Catheter-Directed thrombolysis for Extensive lower Extremity Deep Venous Thrombosis. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1262] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sharifi M, Bay C, Nowroozi S, Bentz S, Valeros G, Memari S. Catheter-directed thrombolysis with argatroban and tPA for massive iliac and femoropopliteal vein thrombosis. Cardiovasc Intervent Radiol 2013; 36:1586-1590. [PMID: 23377239 DOI: 10.1007/s00270-013-0569-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Catheter-directed thrombolysis (CDT) is a highly effective approach in the treatment of deep venous thrombosis (DVT). There are no data on the primary use of CDT with argatroban and tissue plasminogen activator (tPA) in patients without heparin-induced thrombocytopenia (HIT). The aim of this study was to evaluate the efficacy and safety of the combined administration of argatroban and tPA during CDT for massive DVT in patients without HIT. METHODS Thirty-three patients with massive symptomatic iliac and femoropopliteal DVT underwent CDT with tPA and argatroban within 28 ± 6 h of presentation. The dose of tPA was 0.75-1 mg/h through the infusion port and that of argatroban at 0.3-1 μg/kg/min through the side port of the sheath. The patients were evaluated for the efficacy and safety of CDT and recurrent symptomatic venous thromboembolism (VTE) at a mean follow-up of 22 months. RESULTS There was no bleeding or iatrogenic pulmonary embolism with the CDT regimen we used. Grade III lysis (complete resolution of thrombus on venography) was achieved in 30 patients (91 %). In 3 patients with additional inferior vena cava filter thrombosis, further thrombectomy of the filter was required. No patient developed recurrent VTE. CONCLUSION Concomitant administration of argatroban and tPA is a highly safe and effective regimen for CDT for massive DVT.
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Affiliation(s)
- Mohsen Sharifi
- Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA. .,A. T. Still University, 5850 East Still Circle, Mesa, AZ, 85206, USA.
| | - Curt Bay
- A. T. Still University, 5850 East Still Circle, Mesa, AZ, 85206, USA
| | - Sasan Nowroozi
- Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA
| | - Suzanne Bentz
- Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA
| | - Gayle Valeros
- Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA
| | - Sara Memari
- Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA
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Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M. Moderate pulmonary embolism treated with thrombolysis (from the "MOPETT" Trial). Am J Cardiol 2013; 111:273-7. [PMID: 23102885 DOI: 10.1016/j.amjcard.2012.09.027] [Citation(s) in RCA: 356] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 09/18/2012] [Accepted: 09/18/2012] [Indexed: 12/26/2022]
Abstract
The role of low-dose thrombolysis in the reduction of pulmonary artery pressure in moderate pulmonary embolism (PE) has not been investigated. Because the lungs are very sensitive to thrombolysis, we postulated that effective and safe thrombolysis might be achieved by a lower dose of tissue plasminogen activator. The purpose of the present study was to evaluate the role of this "safe dose" thrombolysis in the reduction of pulmonary artery pressure in moderate PE. During a 22-month period, 121 patients with moderate PE were randomized to receive a "safe dose" of tissue plasminogen activator plus anticoagulation (thrombolysis group [TG], n = 61 patients) or anticoagulation alone (control group [CG], n = 60). The primary end points consisted of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. Pulmonary hypertension and the composite end point developed in 9 of 58 patients (16%) in the TG and 32 of 56 patients (57%) in the CG (p <0.001) and 9 of 58 patients (16%) in the TG and 35 of 56 patients (63%) in the CG (p <0.001), respectively. The secondary end points were total mortality, the duration of hospital stay, bleeding at the index hospitalization, recurrent PE, and the combination of mortality and recurrent PE. The duration of hospitalization was 2.2 ± 0.5 days in the TG and 4.9 ± 0.8 days in the CG (p <0.001). The combination of death plus recurrent PE was 1 (1.6%) in TG and 6 (10%) in the CG (p = 0.0489). No bleeding occurred in any group, and despite a positive trend in favor of a "safe dose" thrombolysis, no significant difference was noted in the rate of individual outcomes of death and recurrent PE when assessed independently. In conclusion, the results from the present prospective randomized trial suggests that "safe dose" thrombolysis is safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was maintained at 28 months.
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Zivkovic AM, Yang J, Georgi K, Hegedus C, Nording ML, O’Sullivan A, German JB, Hogg RJ, Weiss RH, Bay C, Hammock BD. Serum oxylipin profiles in IgA nephropathy patients reflect kidney functional alterations. Metabolomics 2012; 8:1102-1113. [PMID: 23833568 PMCID: PMC3700377 DOI: 10.1007/s11306-012-0417-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Immunoglobulin A nephropathy (IgAN) is a leading cause of chronic kidney disease, frequently associated with hypertension and renal inflammation. ω-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in fish oil (FO) improve kidney function in animal models, but have inconsistent metabolic effects in humans. Oxylipin profiles in serum from IgAN patients supplemented with either FO or corn oil (CO) placebo were analyzed by liquid chromatography coupled to tandem mass spectrometry. EPA cyclooxygenase and lipoxygenase metabolites, and EPA and DHA epoxides and diols were increased in response to FO supplementation, as were total epoxides and epoxide/diol ratios. Several of these metabolites were drivers of separation as assessed by multivariate analysis of FO patients pre- vs. post-supplementation, including 17,18-dihydroxyeicosatrienoic acid, prostaglandin D3, prostagalandin E3, Resolvin E1, 12-hydroxyeicosapentaenoic acid, and 10(11)-epoxydocosapentaenoic acid. In patients whose proteinuria improved, plasma total oxylipins as well as several hydroxyoctadecadienoic acids, hydroxyeicosatetraenoic acids, and leukotriene B4 metabolites were among the metabolites that were significantly lower than in patients whose proteinuria either did not improve or worsened. These data support the involvement of oxylipins in the inflammatory component of IgAN as well as the potential use of oxylipin profiles as biomarkers and for assessing responsiveness to ω-3 fatty acid supplementation in IgAN patients.
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Affiliation(s)
- Angela M. Zivkovic
- Foods for Health Institute, Department of Entomology, Department of Food Science and Technology, University of California, Davis, CA, phone: 530-752-9211; Fax: 530-752-4759
| | - Jun Yang
- Department of Entomology, University of California, Davis, CA
| | - Katrin Georgi
- Department of Entomology, University of California, Davis, CA
| | | | | | | | - J. Bruce German
- Foods for Health Institute, Department of Food Science and Technology, University of California, Davis, CA
| | | | - Robert H. Weiss
- Nephrology Division, Department of Medicine, University of California at Davis, Davis, CA
| | - Curt Bay
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ
| | - Bruce D. Hammock
- Foods for Health Institute, Department of Entomology, University of California, Davis, CA
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Sharifi M, Bay C, Mehdipour M, Sharifi J. ThrombusObliteration byRapidPercutaneousEndovenous Intervention inDeep VenousOcclusion (TORPEDO) Trial:Midterm Results. J Endovasc Ther 2012; 19:273-80. [DOI: 10.1583/11-3674mr.1] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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