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Anderson RT, Eton DT, Camacho FT, Kennedy EM, Brenin CM, DeGuzman PB, Carter KF, Guterbock T, Ruddy KJ, Cohn WF. Impact of comorbidities and treatment burden on general well-being among women's cancer survivors. J Patient Rep Outcomes 2021; 5:2. [PMID: 33411204 PMCID: PMC7790943 DOI: 10.1186/s41687-020-00264-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/02/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Gains in cancer detection and treatment have meant that more patients are now living with both cancer and other chronic health conditions, which may become burdensome. We used the Patient Experience with Treatment and Self-Management (PETS) framework to study challenges in self-management and its impact on health among survivors of women's cancers who are caring for other chronic health conditions. METHODS Applicability of the PETS domains among survivors of women's cancers with comorbidities was assessed in focus groups to create the study survey. Women surviving primary breast, cervical, ovarian, or endometrial/uterine cancer treated between 6 months and 3 years prior at two large healthcare systems in Virginia were mailed study invitation letters to complete a telephone-based survey. The survey included questions on cancer treatment history, comorbid conditions prior to cancer, treatment and self-management experiences, health literacy, financial security, and items on self-management activities, self-management difficulties and self-management impact (i.e., role/social activity limitations and physical/mental exhaustion). Additionally, general health was assessed with items from the Patient-Reported Outcomes Measurement Information System (PROMIS). Hierarchical regression models and path analysis were used to examine correlates of self-management impact on general physical health (GPH) and mental health (GMH). RESULTS Of 1448 patients contacted by mail, 274 (26%) returned an interest form providing their consent to be contacted. Of these, 183 completed the survey. Reasons for non-completion included ineligibility (42), unable to be reached (33) and refusal (6). The majority were survivors of breast (58%) or endometrial/uterine cancer (28%), and 45% resided in non-urban locations. After adjusting for age, race, and cancer type, survivors with higher self-management difficulty reported higher self-management impact, which was associated with lower perceived general health. Reports of higher self-management impact was associated with being single or unmarried, white race, fulltime employed, higher financial insecurity, lower health literacy and more comorbidities. In path analysis, self-management impact was a significant mediator in the association of comorbidity and financial insecurity on GPH and GMH. CONCLUSIONS Among survivors of women's cancer, pre-diagnosis comorbidity, health literacy, and financial security are associated with psychosocial impact of self-management and general physical and mental health in the 6 month to 3-year period after cancer treatment has ended. The impact of self-management on psychosocial functioning is an important factor among cancer survivors caring for multiple chronic health conditions. This study provides evidence on the importance of assessing cancer survivors' self-management difficulties such as in future interventions to promote health and wellness.
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Affiliation(s)
- R T Anderson
- Department of Public Health Sciences, University of Virginia, PO Box 800717, Charlottesville, VA, 22908, USA.
| | - D T Eton
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - F T Camacho
- Department of Public Health Sciences, University of Virginia, PO Box 800717, Charlottesville, VA, 22908, USA
| | - E M Kennedy
- Department of Public Health Sciences, University of Virginia, PO Box 800717, Charlottesville, VA, 22908, USA
| | - C M Brenin
- Department of Hematology-Oncology, University of Virginia, Charlottesville, VA, USA
| | - P B DeGuzman
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | | | - T Guterbock
- Center for Survey Research, Department of Public Health Sciences and Department of Sociology, University of Virginia, Charlottesville, VA, USA
| | - K J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - W F Cohn
- Department of Public Health Sciences, University of Virginia, PO Box 800717, Charlottesville, VA, 22908, USA
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Benhelal E, Oliver TK, Farhang F, Hook JM, Rayson MS, Brent GF, Stockenhuber M, Kennedy EM. Structure of Silica Polymers and Reaction Mechanism for Formation of Silica-Rich Precipitated Phases in Direct Aqueous Carbon Mineralization. Ind Eng Chem Res 2019. [DOI: 10.1021/acs.iecr.9b04379] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. Benhelal
- Department of Chemical Engineering, The University of Newcastle, Callaghan, New South Wales 2308, Australia
| | - T. K. Oliver
- Department of Chemical Engineering, The University of Newcastle, Callaghan, New South Wales 2308, Australia
| | - F. Farhang
- Department of Chemical Engineering, The University of Newcastle, Callaghan, New South Wales 2308, Australia
| | - J. M. Hook
- NMR Facility, Mark Wainwright Analytical Centre, and School of Chemistry, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - M. S. Rayson
- Department of Chemical Engineering, The University of Newcastle, Callaghan, New South Wales 2308, Australia
- Orica Limited, Kurri Kurri, New South Wales 2327, Australia
| | - G. F. Brent
- Orica Limited, Kurri Kurri, New South Wales 2327, Australia
| | - M. Stockenhuber
- Department of Chemical Engineering, The University of Newcastle, Callaghan, New South Wales 2308, Australia
| | - E. M. Kennedy
- Department of Chemical Engineering, The University of Newcastle, Callaghan, New South Wales 2308, Australia
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Lynch HN, Zu K, Kennedy EM, Lam T, Liu X, Pizzurro DM, Loftus CT, Rhomberg LR. Corrigendum to "Quantitative assessment of lung and bladder cancer risk and oral exposure to inorganic arsenic: Meta-regression analyses of epidemiological data" Environmental International 106 :178-206. Environ Int 2017; 109:195-196. [PMID: 29078863 DOI: 10.1016/j.envint.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- H N Lynch
- Gradient, 20 University Road, Cambridge, MA02138, USA
| | - K Zu
- Gradient, 20 University Road, Cambridge, MA02138, USA
| | - E M Kennedy
- Gradient, 20 University Road, Cambridge, MA02138, USA
| | - T Lam
- Gradient, 20 University Road, Cambridge, MA02138, USA
| | - X Liu
- Gradient, 20 University Road, Cambridge, MA02138, USA
| | - D M Pizzurro
- Gradient, 20 University Road, Cambridge, MA02138, USA
| | - C T Loftus
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, 4225 Roosevelt Way NE, Suite 301, Seattle, WA 98105, USA
| | - L R Rhomberg
- Gradient, 20 University Road, Cambridge, MA02138, USA.
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Abstract
Not an ordinary day for Mario and Luigi; this work explores the decomposition pathways of RSNO+ species.
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Affiliation(s)
- J. B. Dorado
- Process Safety and Environment Protection Research Group
- School of Engineering
- The University of Newcastle
- Callaghan
- Australia
| | - B. Z. Dlugogorski
- School of Engineering and Information Technology
- Murdoch University
- Murdoch
- Australia
| | - E. M. Kennedy
- Process Safety and Environment Protection Research Group
- School of Engineering
- The University of Newcastle
- Callaghan
- Australia
| | - J. C. Mackie
- Process Safety and Environment Protection Research Group
- School of Engineering
- The University of Newcastle
- Callaghan
- Australia
| | - J. Gore
- Dyno Nobel Asia Pacific Pty. Ltd
- Mt. Thorley
- Australia
| | - M. Altarawneh
- School of Engineering and Information Technology
- Murdoch University
- Murdoch
- Australia
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Kennedy AE, O'Doherty EF, Byrne N, O'Mahony J, Kennedy EM, Sayers RG. A survey of management practices on Irish dairy farms with emphasis on risk factors for Johne's disease transmission. Ir Vet J 2014; 67:27. [PMID: 25610611 PMCID: PMC4300563 DOI: 10.1186/s13620-014-0027-9] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/11/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Johne's disease (JD) is a chronic granulomatous enteritis affecting ruminants. A number of farm management practices are associated with increased risk of JD transmission. The aim of the current study was to document JD-related management practices currently employed on Irish dairy farms. Survey questions focused on calving area (CA), calf and manure management. Independent variables (region, calving-season, enterprise type, herd size and biosecurity status) were used to examine influences on JD associated dependent variables (survey questions). Additionally general biosecurity practices were also examined. RESULTS Results showed management practices implemented by Irish dairy farmers pose a high risk of JD transmission. Of the farmers surveyed, 97% used the CA for more than one calving, 73.5% and 87.8% pooled colostrum and milk respectively, 33.7% never cleaned the CA between calving's, and 56.6% used the CA for isolating sick cows. Survey results also highlighted that larger herds were more likely to engage in high risk practices for JD transmission, such as pooling colostrum (OR 4.8) and overcrowding the CA (OR 7.8). Larger herds were also less likely than smaller herds to clean the CA (OR 0.28), a practice also considered of risk in the transmission of JD. CONCLUSION Many management practices associated with risk of JD transmission were commonly applied on Irish dairy farms. Larger herds were more likely to engage in high risk practices for JD transmission. Control programmes should incorporate educational tools outlining the pathogenesis and transmission of JD to highlight the risks associated with implementing certain management practices with regard to JD transmission.
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Affiliation(s)
- Aideen E Kennedy
- Animal & Bioscience Research Department, Animal & Grassland Research and Innovation Centre, Teagasc, Moorepark, Fermoy, Co. Cork, Ireland ; Department of Biological Sciences, Cork Institute of Technology, Bishopstown, Co. Cork, Ireland
| | - Eugene F O'Doherty
- Animal & Bioscience Research Department, Animal & Grassland Research and Innovation Centre, Teagasc, Moorepark, Fermoy, Co. Cork, Ireland
| | - Noel Byrne
- Animal & Bioscience Research Department, Animal & Grassland Research and Innovation Centre, Teagasc, Moorepark, Fermoy, Co. Cork, Ireland
| | - Jim O'Mahony
- Department of Biological Sciences, Cork Institute of Technology, Bishopstown, Co. Cork, Ireland
| | - E M Kennedy
- Animal & Bioscience Research Department, Animal & Grassland Research and Innovation Centre, Teagasc, Moorepark, Fermoy, Co. Cork, Ireland
| | - Riona G Sayers
- Animal & Bioscience Research Department, Animal & Grassland Research and Innovation Centre, Teagasc, Moorepark, Fermoy, Co. Cork, Ireland
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Reichgelt T, Jones WA, Jones DT, Conran JG, Bannister JM, Kennedy EM, Mildenhall DC, Lee DE. The flora of Double Hill (Dunedin Volcanic Complex, Middle–Late Miocene) Otago, New Zealand. J R Soc N Z 2014. [DOI: 10.1080/03036758.2014.923476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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McDowall RM, Kennedy EM, Lindqvist JK, Lee DE, Alloway BV, Gregory MR. ProbableGobiomorphusfossils from the Miocene and Pleistocene of New Zealand (Teleostei: Eleotridae). J R Soc N Z 2006. [DOI: 10.1080/03014223.2006.9517803] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- R West
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York City
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McDowall RM, Kennedy EM, Alloway BV. A fossil southern grayling, genusPrototroctes,from the Pleistocene of north‐eastern New Zealand (Teleostei: Retropinnidae). J R Soc N Z 2006. [DOI: 10.1080/03014223.2006.9517797] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tame NW, Dlugogorski BZ, Kennedy EM. Assessing influence of experimental parameters on formation of PCDD/F from ash derived from fires of CCA-treated wood. Environ Sci Technol 2003; 37:4148-4156. [PMID: 14524447 DOI: 10.1021/es0304143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Ash residues from fires of radiata pine timber, both untreated and treated with chromated copper arsenate (CCA), were analyzed for the presence of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/F). Fire conditions were simulated using a cone calorimeter. The sensitivity of the magnitude and profile of PCDD/F in the ash under controlled experimental conditions were examined to gain an insight into the formation of PCDD/F in a system containing CCA. The total amount of PCDD/F increased from 2.0 ng/kg of ash (0.05 ng of TE/kg of ash, using WHO-TEF) for untreated radiata pine to a maximum of 2700 ng/kg of ash (78 ng of TE/kg of ash) for 0.94% CCA. Ash containing CCA showed a distinct preference for formation of PCDFs, particularly the tetrachloro homologue. It is concluded that PCDD/F formation predominantly occurred via de novo synthesis during smoldering of the char rather than during the initial flaming and pyrolysis. Furthermore, the composition of the CCA constituents present in the timber was controlled to assess whether the physical presence of Cu, a known catalyst in PCDD/F production, was sufficient to account for the formation of PCDD/F in fires of timber impregnated with CCA.
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Affiliation(s)
- N W Tame
- Process Safety and Environment Protection Group, School of Engineering, The University of Newcastle, Callaghan, New South Wales 2308, Australia
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11
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Kennedy EM. Restoring public trust in gene therapy. J Biolaw Bus 2003; 4:3-4. [PMID: 12962103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Abstract
Bottom ash that was the result of the combustion of chromated copper arsenate (CCA) treated wood under controlled fire conditions showed an increase of several orders of magnitude in the levels of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), compared to that of untreated timber. Wood that has been pressure treated with CCA contains copper (II), which is known to catalyse the so-called de novo formation of PCDD/Fs. Comparable levels of PCDD/Fs would be expected in residual ash from burning CCA-treated wood in backyard fires, stoves and wood heaters, as a consequence of similar combustion conditions.
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Affiliation(s)
- N W Tame
- Process Safety and Environment Protection Group, School of Engineering, The University of Newcastle, Callaghan, NSW 2308, Australia
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13
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Cant NW, Kennedy EM, Nelson PF. Magnitude and origin of the deuterium kinetic isotope effect during methane coupling and related reactions over lithium/magnesium oxide catalysts. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100109a032] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Kennedy EM, Heard SR. Making mistakes in practice. Developing a consensus statement. Aust Fam Physician 2001; 30:295-9. [PMID: 11301774] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To develop a reference statement for the appropriate management of mistakes in the general practice training environment. METHOD The setting was a series of focus groups held during workshops with The Royal Australian College of General Practitioners Training Program in the Northern Territory (NT). The participants included NT supervisors and registrars, and representatives of the Consumer Reference Group, Top End Division of General Practice. RESULTS A reference statement and mutually agreed list of duties for registrars, their supervisors and patients. CONCLUSION Mistakes are a part of the practice of medicine and can impact on everyone. An appropriate response and the opportunity to reflect and learn from the experience are important elements in minimising the adverse impact. We recommend that the issue of mistakes be considered a priority in the teaching of medicine.
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Affiliation(s)
- E M Kennedy
- Royal Australian College of General Practitioners Training Program, Darwin Northern Territory.
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15
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Kennedy EM. National leadership in confronting bioterrorism: 2. Public Health Rep 2001; 116 Suppl 2:116-8. [PMID: 11880684 PMCID: PMC1497282 DOI: 10.1093/phr/116.s2.116] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Affiliation(s)
- E M Kennedy
- United States Senate, Washington, DC 20510, USA
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16
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Kennedy EM. The JIM interview. Edward M. Kennedy, United States Senator. J Investig Med 2000; 48:157-60. [PMID: 10822894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Senator Edward M. Kennedy has represented Massachusetts in the United States Senate for thirty-six years. He was first elected in 1962 to finish the term of his brother, President John F. Kennedy. Since then, he has been elected to six full terms, and he is now the third most senior member of the senate. The efforts to bring quality health care to every American is a battle that Kennedy has been waging ever since he arrived in the Senate. Recent achievements include the Health Insurance Portability and Accountability Act of 1996, which makes it easier for those who change their job or lose their job to keep their health insurance, and the Children's Health Insurance Act of 1997, which makes health insurance more widely available to children through age 18 in all 50 states. A strong supporter of clinical research, Senator Kennedy cosponsored the Clinical Research Enhancement Act and has been a vocal advocate of stem cell research. He is currently the senior Democrat on the Labor and Human Resources committee in the Senate.
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Kennedy EM. Partners or protagonists: Congress and the academic medical centers. 1974. Yale J Biol Med 2000; 73:403-9. [PMID: 11765963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Kennedy EM. Home care and the ADA: do limitations on coverage violate the law? Caring 1999; 18:6-8, 10-1. [PMID: 10538893] [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] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
To avoid liability, home care agencies must have a firm grasp of the basic requirements of the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973 ("Section 504"). Agency leaders must understand the legal issues that arise whenever care is limited or denied to persons with disabilities.
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Affiliation(s)
- E M Kennedy
- Wiggin & Dana, Health Care Department, New Haven, CT, USA
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Abstract
The surgical treatment of transsphenoidal cephaloceles in children is controversial. Reduction and repair via a transcranial approach are associated with high postoperative rates of morbidity, mortality, and hypothalamic dysfunction. In this study, four patients, aged 3 to 35 months at surgery, underwent successful transpalatal repair of two encephaloceles and two meningoceles. Two patients presented with nasal obstruction in infancy, one presented with unexplained meningitis, and in one patient the lesion was found incidentally during evaluation for seizures. Two children had median cleft face syndrome, another had an associated Arnold-Chiari type I malformation, and the fourth had no other cranial abnormalities. All patients underwent preoperative evaluation including magnetic resonance (MR) imaging. Auditory, ophthalmological, genetic, endocrinological, or other evaluation was undertaken as indicated. Lesions were approached through the median raphe of the hard and soft palates. All cephaloceles were easily visualized and dissected after division of the nasal palatal mucosa. The dural sac and its contents were reduced by surface coagulation after division and dissection of the overlying mucosa. Once reduced, the bone defect was obliterated in three of four patients. The dura was not opened and anomalous neural elements were not resected. At follow-up evaluation, all patients demonstrated resolution of preoperative symptoms without evidence of infection or lasting morbidity. Follow-up MR imaging showed reduction in all cases. The authors conclude that this transpalatal approach is safe and reliable for the treatment of transsphenoidal cephaloceles in young children.
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Affiliation(s)
- E M Kennedy
- Department of Plastic Surgery, University of Cincinnati, Children's Hospital Medical Center, and the Mayfield Clinic, Ohio, USA
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Kennedy EM. Health care reform: workers beware. Public Health Rep 1996; 111:11. [PMID: 8610186 PMCID: PMC1381734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Kennedy EM, Harms BA, Starling JR. Absence of maladaptive neuronal plasticity after genitofemoral-ilioinguinal neurectomy. Surgery 1994; 116:665-70; discussion 670-1. [PMID: 7940164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Pain (neuralgia) and paresthesia in the inguinal region after lower abdominal surgery is rare. Historically, treatment consisted of neurolysis, local injections, and administration of various medications. The management of chronic pain syndromes is often coordinated by anesthesiologists. Neurolytic therapy is seldom recommended, on the basis of the theory of maladaptive neuronal plasticity. METHODS Twenty-three patients underwent genitofemoral neurectomy at our institution between 1981 and 1990. Records were reviewed to determine preoperative symptoms, evaluation, and treatment. Patients were contacted and questioned about current symptoms and disability. RESULTS All records were reviewed. Sixteen (70%) of the patients were located for long-term follow-up. Patients were symptomatic for an average of 3.3 years and underwent 3.1 operations before referral. Inguinal herniorrhaphy was the most common initial surgery (14 of 16 patients). All patients underwent multidisciplinary evaluation. Fifteen underwent L1-2 paraspinous nerve block, and 13 had total pain relief. Postoperative follow-up ranged from 36 to 144 months. Ten patients reported significant pain relief, and three patients reported slight improvement. Three of the six patients who had persistent neuralgia had significant orchialgia. None of the patients who had significant relief had preoperative testicular pain. CONCLUSIONS Genitofemoral neurectomy provided long-term relief in 62.5% of patients with genitofemoral neuralgia. Severe testicular pain indicated a less favorable outcome. These data do not support the maladaptive neuronal plasticity theory but do support early referral of some patients for neurectomy.
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Affiliation(s)
- E M Kennedy
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison
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Udvarhelyi IS, Relman AS, Binder GM, Spence RK, Kennedy EM, Grossman JH, Termeer HA, Raines LJ, Marincola E, Pyle TO. Finding a lasting cure for U.S. health care. Harv Bus Rev 1994; 72:45-7, 50, 52 passim. [PMID: 10137002] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In "Making Competition in Health Care Work" (July-August 1994), Elizabeth Olmsted Teisberg, Michael E. Porter, and Gregory B. Brown ask a question that has been absent from the national debate on health care reform: How can the United States achieve sustained cost reductions while at the same time maintaining quality of care? The authors argue that innovation driven by rigorous competition is the key to successful reform. A lasting cure for health care in the United States should include four basic elements: corrected incentives to spur productive competition, universal insurance to secure economic efficiency, relevant information to ensure meaningful choice, and innovation to guarantee dynamic improvement. In this issue's Perspectives section, eleven experts examine the current state of the health care system and offer their views on the shape that reform should take. Some excerpts: "On the road to innovation, let us not forget to develop the tools that allow physicians, payers, and patients to make better decisions." I. Steven Udvarhelyi; "Health care is not a product or service that can be standardized, packaged, marketed, or adequately judged by consumers according to quality and price." Arnold S. Relman; "Just as antitrust laws are the wise restraints that make competition free in other sectors of the economy, so the right kind of managed competition can work well in health care." Edward M. Kennedy "Biomedical research should be considered primarily an investment in the national economic well-being with additional humanitarian benefits." Elizabeth Marincola.
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Affiliation(s)
- I S Udvarhelyi
- Prudential Insurance Company of America, Philadelphia, PA
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Kennedy EM. Comprehensive health reform and negotiated fees. Internist 1992; 33:8-9, 16. [PMID: 10121370] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Kennedy EM. Symposium: compliance and quality in residential life. Foreward. Ment Retard 1992; 30:v-vi. [PMID: 1386394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Kennedy EM, Wood RP, Shaw BW. Primary nonfunction. Is there a contribution from the back table bath? Transplantation 1990; 49:739-43. [PMID: 2326869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A persistent problem in orthotopic liver transplantation (OLT) is primary nonfunction (PNF) of the hepatic allograft. In most instances the cause of the failure is unknown. In an attempt to minimize these graft failure, modifications in the procurement and operative procedure have been investigated. One change in the procedure at the University of Nebraska Medical Center has been the monitoring of the temperature of the fluid in the back table bath during preparation of the donor liver. Our initial procedure involved creating an ice slurry of lactated Ringer's solution and ice slush in which the donor liver was then prepared. The temperature of this ice slurry was retrospectively found to be from -3 degrees C to -1 degrees C (group I). In this group there was a higher-than-expected incidence of PNF. To investigate whether the temperature of the back table bath influenced the incidence of PNF, beginning with transplant No. 42 the preparation of the back table bath was modified. The bath was created by adding a small amount of PlasmaLyte slush to 2 L of PlasmaLyte (group II). The temperature of the bath was maintained at 2-4 degrees C. Data were collected on 100 consecutive liver transplants. All transplants were performed using standard techniques, the operation for the two groups differing only as described above. Transaminase levels were followed as an index of the allograft function and were expected to begin to normalize within 2-3 days after transplantation. While both groups display this trend, transaminase levels in group II were significantly lower postoperatively than group I levels (P less than 0.05). Preoperative values were similar. There were 7 PNFs in group I; 0 in group II (P less than 0.005). We feel that the change in the back table procedure has positively influenced the function of the hepatic allografts, and we conclude that transplant centers need to monitor the temperature at which all allografts are stored and prepared, and the cognizant that this may influence the postoperative function of the transplanted liver.
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Affiliation(s)
- E M Kennedy
- Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280
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Kennedy EM. Kennedy proposes health care for all. Am Nurse 1990; 22:2. [PMID: 2181897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Stratta RJ, Shaefer MS, Markin RS, Wood RP, Kennedy EM, Langnas AN, Reed EC, Woods GL, Donovan JP, Pillen TJ. Clinical patterns of cytomegalovirus disease after liver transplantation. Arch Surg 1989; 124:1443-9; discussion 1449-50. [PMID: 2556090 DOI: 10.1001/archsurg.1989.01410120093018] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
During a 43-month period, we performed 248 liver transplantations in 211 patients (127 adults and 84 children). Cytomegalovirus (CMV) disease was documented in 73 recipients (34.6%). Risk factors for CMV disease included donor CMV seropositivity, antilymphocyte therapy, and retransplantation. The mean time of occurrence of CMV disease was 38.3 days after transplantation, and the most frequent site of disease was the hepatic allograft. A total of 69 patients were treated with intravenous ganciclovir, with a prompt and lasting response documented in 51 (73.9%). The remaining 18 (26.1%) developed recurrent CMV disease, which was more common after primary CMV exposure. Cytomegalovirus disease was ultimately controlled by ganciclovir in 94.2% of cases. This disease occurs early after transplantation and can be related to well-defined risk factors. Although ganciclovir therapy is effective, preliminary experience with prophylaxis shows promise in reducing the incidence of CMV disease.
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Affiliation(s)
- R J Stratta
- Department of Surgery, University of Nebraska Medical Center, Omaha 68105
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Newland MC, Leuschen P, Sarafian LB, Hurlbert BJ, Fleming WF, Chapin JW, Becker GL, Kennedy EM, Bolam DD, Newland JR. Fentanyl intermittent bolus technique for anesthesia in infants and children undergoing cardiac surgery. J Cardiothorac Anesth 1989; 3:407-10. [PMID: 2520913 DOI: 10.1016/s0888-6296(89)97315-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The use of fentanyl by an incremental intravenous (IV) bolus technique was evaluated in eight pediatric patients (ages 4 months to 5 years, ASA III-IV) undergoing corrective surgery for congenital heart defects. Anesthesia was induced with 5 to 10 micrograms/kg of fentanyl. Additional boluses of comparable size were given intermittently thereafter, in order that a total dose of 100 micrograms/kg was achieved just before instituting cardiopulmonary bypass (CPB). Heart rate, systolic blood pressure, various measures of anesthetic depth, and plasma fentanyl levels measured by radioimmunoassay were compared at various points during anesthesia, surgery, and recovery. Decreases in heart rate were observed at the time of sternal incision and at 30 minutes thereafter, when doses of fentanyl were near-maximal. No changes from baseline in systolic blood pressure or in anesthetic depth occurred at any of the intervals studied. The plasma concentration of fentanyl was 30 +/- 8 ng/mL just after completion of the fentanyl administration, immediately before CPB. With onset of CPB, the fentanyl level fell to 13 +/- 9 ng/mL, a statistically significant difference from the baseline value. No further change occurred over the additional 231 +/- 74 minutes in the operating room. The fentanyl concentration was 10 +/- 4 ng/mL upon entry into the recovery room. It is concluded that administration of fentanyl in small, intermittent IV boluses, with dosing completed before the onset of CPB, produces satisfactory plasma levels, anesthesia, and hemodynamic stability in children undergoing corrective surgery for congenital cardiac defects.
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Affiliation(s)
- M C Newland
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha 68105
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Kennedy EM. Bill mandates health insurance for employees. Health Prog 1988; 69:24-6. [PMID: 10287454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Kennedy EM. An interview with Senator Edward M. Kennedy. Interview by Janet I. Pisaneschi, Leopold G. Selker, Susan E. Siska, Arthur A. Savage and David C. Broski. J Allied Health 1988; 17:3-13. [PMID: 3350762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Kennedy EM. On Capitol Hill with Edward H. Kennedy. Interview by Hurdis Griffith. Nurs Econ 1987; 5:207-12. [PMID: 3657992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Chapin JW, Wood RP, Hurlbert BJ, Shaw BW, Kennedy EM, Cuka DJ, Markin RS, Peters KR, Newland MC. Sources of increased serum potassium following reperfusion of liver allografts. Transplant Proc 1987; 19:51-3. [PMID: 3303533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Kennedy EM. Balanced health care spending policy needed so hospitals won't be victimized for deficit. Rev Fed Am Health Syst 1987; 20:34-6. [PMID: 10301422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Ensuring access to essential health care. Hospitals 1987; 61:120. [PMID: 3793057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fleming WH, Sarafian LB, Leuschen MP, Newland MC, Kennedy EM, Kugler JD, Chapin JW, Hurlbert BJ, Bolam DL, Nelson RM. Serum concentrations of prostacyclin and thromboxane in children before, during, and after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1986; 92:73-8. [PMID: 3755198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty-six consecutive pediatric patients undergoing reparative procedures necessitating cardiopulmonary bypass were prospectively studied to determine changes in serum levels of 6-keto-prostaglandin F1 alpha and thromboxane B2. Cardiac lesions included acyanotic lesions (five patients), obstructive lesions (10 patients), and right-to-left shunts (11 patients). There was a significant (p less than 0.05) increase in 6-keto-prostaglandin F1 alpha from preoperative levels measured at the time of arterial and venous cannula insertion. This concentration was maintained throughout cardiopulmonary bypass and remained significantly elevated (p less than 0.001) in the recovery room, but returned to preoperative levels by the morning after the operation. Preoperative levels of thromboxane B2 varied widely and were not significantly different from intraoperative levels. The postoperative levels of thromboxane B2, however, were significantly different (p less than 0.05) from the intraoperative levels. In the pediatric age group undergoing cardiopulmonary bypass, 6-keto-prostaglandin F1 alpha and thromboxane B2 change during bypass but do not significantly differ when preoperative levels are compared to postoperative values.
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Kennedy EM. Views on doctors' income and legislation. An interview with Senator Kennedy. Interview by Penny Tselikis. Physicians Manage 1984; 24:90-2, 95. [PMID: 10268114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Health cost inflation affects profitability of American business as a whole. Bus Health 1984; 1:56. [PMID: 10310516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM, Snowden N, Westenfelder G, Phair JP. The effects of subinhibitory concentrations of various antibiotics on phagocytosis of Streptococcus faecalis. J Antimicrob Chemother 1983; 12 Suppl C:69-74. [PMID: 6417102 DOI: 10.1093/jac/12.suppl_c.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This study reports the effects of subinhibitory concentrations of the antibiotics, clindamycin, gentamicin, moxalactam, and penicillin G, against 6 blood isolates of Streptococcus faecalis to determine possible enhancement of phagocytosis. In addition, combinations of penicillin G plus streptomycin, penicillin G and gentamicin, and clindamycin plus gentamicin were studied to determine synergistic growth inhibition. Results suggest no observable effect in phagocytosis from subinhibitory concentrations of the studied antibiotics singly or in combination. The number of viable intracellular Str. faecalis were also not affected by pre-treatment with antibiotics.
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Kennedy EM. Federal EMS legislation. Emerg Med Serv 1982; 11:11-2. [PMID: 10253753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Current prospects for biomedical research. Clin Res 1979; 27:245-7. [PMID: 10243444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Legislating health care. J Assoc Care Child Hosp 1979; 7:3-7. [PMID: 10237005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Ted Kennedy: an old enemy takes a new look at doctors. Med Econ 1978; 55:35-6, 40, 42-4. [PMID: 10239445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. A positive health strategy: the time is now. Am Lung Assoc Bull 1978; 64:2-4. [PMID: 10238959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Califano and Kennedy take sides on national health plan. Health Care Week 1978; 2:8. [PMID: 10323948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Health manpower, DNA and National Health Insurance. Md State Med J 1978; 27:35-7. [PMID: 633954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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