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Abstract
Immune checkpoint inhibitor (ICI) therapy is now in widespread clinical use for the treatment of lung cancer. Although patients with autoimmune disease and other comorbidities were excluded from initial clinical trials, emerging real-world experience suggests that these promising treatments may be administered safely to individuals with inactive low-risk autoimmune disease such as rheumatoid arthritis or psoriasis, mild to moderate renal and hepatic dysfunction, and certain chronic viral infections. Considerations for ICI in autoimmune disease populations include exacerbations of the underlying autoimmune disease, increased risk of ICI-induced immune-related adverse events, and potential for compromised efficacy if patients are receiving chronic immunosuppression. Immune checkpoint inhibitor use in higher-risk autoimmune conditions, such as myasthenia gravis or multiple sclerosis, requires careful evaluation on a case-by-case basis. Immune checkpoint inhibitor use in individuals with solid organ transplant carries a substantial risk of organ rejection. Ongoing research into the prediction of ICI efficacy and toxicity may help in patient selection, treatment, and monitoring.
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Affiliation(s)
- Mitchell S. von Itzstein
- Department of Medicine, Division of Hematology and
Oncology, University of Texas, Southwestern Medical Center, Texas, 75390, USA
- Hamon Center for Therapeutic Oncology Research and the
Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Texas, 75390,
USA
| | | | - Helen G. Mayo
- UT Southwestern Health Sciences Digital Library and
Learning Center, Dallas, Texas, 75390, USA
| | - John. D. Minna
- Department of Medicine, Division of Hematology and
Oncology, University of Texas, Southwestern Medical Center, Texas, 75390, USA
- Hamon Center for Therapeutic Oncology Research and the
Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Texas, 75390,
USA
| | - David E. Gerber
- Department of Medicine, Division of Hematology and
Oncology, University of Texas, Southwestern Medical Center, Texas, 75390, USA
- Hamon Center for Therapeutic Oncology Research and the
Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Texas, 75390,
USA
- Department of Population and Data Sciences, UT Southwestern
Medical Center, Texas, 75390, USA
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Balachandra S, Kusin SB, Lee R, Blackwell JM, Tiro JA, Cowell LG, Chiang CM, Wu SY, Varma S, Rivera EL, Mayo HG, Ding L, Sumer BD, Lea JS, Bagrodia A, Farkas LM, Wang R, Fakhry C, Dahlstrom KR, Sturgis EM, Day AT. Blood-based biomarkers of human papillomavirus-associated cancers: A systematic review and meta-analysis. Cancer 2021; 127:850-864. [PMID: 33270909 PMCID: PMC8135101 DOI: 10.1002/cncr.33221] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/06/2020] [Accepted: 06/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite the significant societal burden of human papillomavirus (HPV)-associated cancers, clinical screening interventions for HPV-associated noncervical cancers are not available. Blood-based biomarkers may help close this gap in care. METHODS Five databases were searched, 5687 articles were identified, and 3631 unique candidate titles and abstracts were independently reviewed by 2 authors; 702 articles underwent a full-text review. Eligibility criteria included the assessment of a blood-based biomarker within a cohort or case-control study. RESULTS One hundred thirty-seven studies were included. Among all biomarkers assessed, HPV-16 E seropositivity and circulating HPV DNA were most significantly correlated with HPV-associated cancers in comparison with cancer-free controls. In most scenarios, HPV-16 E6 seropositivity varied nonsignificantly according to tumor type, specimen collection timing, and anatomic site (crude odds ratio [cOR] for p16+ or HPV+ oropharyngeal cancer [OPC], 133.10; 95% confidence interval [CI], 59.40-298.21; cOR for HPV-unspecified OPC, 25.41; 95% CI, 8.71-74.06; cOR for prediagnostic HPV-unspecified OPC, 59.00; 95% CI, 15.39-226.25; cOR for HPV-unspecified cervical cancer, 12.05; 95% CI, 3.23-44.97; cOR for HPV-unspecified anal cancer, 73.60; 95% CI, 19.68-275.33; cOR for HPV-unspecified penile cancer, 16.25; 95% CI, 2.83-93.48). Circulating HPV-16 DNA was a valid biomarker for cervical cancer (cOR, 15.72; 95% CI, 3.41-72.57). In 3 cervical cancer case-control studies, cases exhibited unique microRNA expression profiles in comparison with controls. Other assessed biomarker candidates were not valid. CONCLUSIONS HPV-16 E6 antibodies and circulating HPV-16 DNA are the most robustly analyzed and most promising blood-based biomarkers for HPV-associated cancers to date. Comparative validity analyses are warranted. Variations in tumor type-specific, high-risk HPV DNA prevalence according to anatomic site and world region highlight the need for biomarkers targeting more high-risk HPV types. Further investigation of blood-based microRNA expression profiling appears indicated.
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Affiliation(s)
| | | | - Rebecca Lee
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas
| | | | - Jasmin A. Tiro
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Lindsay G. Cowell
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas
- Department of Immunology, UT Southwestern Medical Center, Dallas, Texas
| | - Cheng-Ming Chiang
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
- Department of Biochemistry, UT Southwestern Medical Center, Dallas, Texas
- Department of Pharmacology, UT Southwestern Medical Center, Dallas, Texas
| | - Shwu-Yuan Wu
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
- Department of Biochemistry, UT Southwestern Medical Center, Dallas, Texas
| | - Sanskriti Varma
- Department of Internal Medicine, NewYork-Presbyterian Hospital–Columbia Campus, New York, New York
| | - Erika L. Rivera
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Helen G. Mayo
- Digital Library and Learning Center, UT Southwestern Medical Center, Dallas, Texas
| | - Lianghao Ding
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Baran D. Sumer
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Jayanthi S. Lea
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
| | - Aditya Bagrodia
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Linda M. Farkas
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Richard Wang
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Carole Fakhry
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristina R. Dahlstrom
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M. Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew T. Day
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
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Gupta A, Majumder K, Arora N, Mayo HG, Singh PP, Beg MS, Hughes R, Singh S, Johnson DH. Premorbid body mass index and mortality in patients with lung cancer: A systematic review and meta-analysis. Lung Cancer 2016; 102:49-59. [DOI: 10.1016/j.lungcan.2016.10.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/19/2016] [Accepted: 10/30/2016] [Indexed: 01/07/2023]
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Gupta A, Majumder K, Arora N, Mayo HG, Singh PP, Singh S, Halm E, Johnson DH. Effect of premorbid body mass index on mortality in patients with lung cancer: A systematic review and meta-analysis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.8523] [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: 11/20/2022] Open
Affiliation(s)
- Arjun Gupta
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Helen G Mayo
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Ethan Halm
- The University of Texas Southwestern Medical Center, Dallas, TX
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Huerta S, Varshney A, Patel PM, Mayo HG, Livingston EH. Biological Mesh Implants for Abdominal Hernia Repair: US Food and Drug Administration Approval Process and Systematic Review of Its Efficacy. JAMA Surg 2016; 151:374-81. [PMID: 26819222 DOI: 10.1001/jamasurg.2015.5234] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Expensive biological mesh materials are increasingly used to reinforce abdominal wall hernia repairs. The clinical and cost benefit of these materials are unknown. OBJECTIVES To review the published evidence on the use of biological mesh materials and to examine the US Food and Drug Administration (FDA) approval history for these devices. EVIDENCE ACQUISITION Search of multiple electronic databases (Ovid, MEDLINE, EMBASE, Cochrane Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Cochrane National Health Service Economic Evaluation Database) to identify articles published between 1948 and June 30, 2015, on the use of biological mesh materials used to reinforce abdominal wall hernia repair. Keywords searched included surgical mesh, abdominal hernia, recurrence, infection, fistula, bioprosthesis, biocompatible materials, absorbable implants, dermis, and collagen. The FDA online database for 510(k) clearances was reviewed for all commercially available biological mesh materials. The median national price for mesh materials was established by a benchmarking query through several Integrated Delivery Network and Group Purchasing Organization tools. EVIDENCE SYNTHESIS Of 274 screened articles, 20 met the search criteria. Most were case series that reported results of convenience samples of patients at single institutions with a variety of clinical problems. Only 3 of the 20 were comparative studies. There were no randomized clinical trials. In total, outcomes for 1033 patients were described. Studies varied widely in follow-up time, operative technique, meshes used, and patient selection criteria. Reported outcomes and clinical outcomes, such as fistula formation and infection, were inconsistently reported across studies. Conflicts of interest were not reported in 16 of the 20 studies. Recurrence rates ranged from 0% to 80%. All biological mesh devices were approved by the FDA based on substantial equivalence to a group of nonbiological predicate devices that, on average, were one-third less costly. CONCLUSIONS AND RELEVANCE There is insufficient evidence to determine the extra costs associated with or the clinical efficacy of biological mesh materials for the repair of abdominal wall hernia.
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Affiliation(s)
- Sergio Huerta
- School of Medicine, University of Texas Southwestern, Dallas2Department of Surgery, North Texas Veterans Affairs Health Care System, Dallas
| | - Anubodh Varshney
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Prachi M Patel
- School of Medicine, University of Texas Southwestern, Dallas
| | - Helen G Mayo
- Biomedical Library, University of Texas Southwestern, Dallas
| | - Edward H Livingston
- School of Medicine, University of Texas Southwestern, Dallas2Department of Surgery, North Texas Veterans Affairs Health Care System, Dallas5Department of Biomedical Engineering, University of Texas, Arlington6Deputy Editor, JAMA
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Pandey A, Garg S, Khunger M, Darden D, Ayers C, Kumbhani DJ, Mayo HG, de Lemos JA, Berry JD. Dose–Response Relationship Between Physical Activity and Risk of Heart Failure. Circulation 2015; 132:1786-94. [DOI: 10.1161/circulationaha.115.015853] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 08/03/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Ambarish Pandey
- From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.)
| | - Sushil Garg
- From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.)
| | - Monica Khunger
- From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.)
| | - Douglas Darden
- From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.)
| | - Colby Ayers
- From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.)
| | - Dharam J. Kumbhani
- From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.)
| | - Helen G. Mayo
- From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.)
| | - James A. de Lemos
- From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.)
| | - Jarett D. Berry
- From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.)
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Abstract
IMPORTANCE Bariatric surgery is an accepted treatment for obesity. Despite extensive literature, few studies report long-term follow-up in cohorts with adequate retention rates. OBJECTIVE To assess the quality of evidence and treatment effectiveness 2 years after bariatric procedures for weight loss, type 2 diabetes, hypertension, and hyperlipidemia in severely obese adults. EVIDENCE REVIEW MEDLINE and Cochrane databases were searched from 1946 through May 15, 2014. Search terms included bariatric surgery, individual bariatric procedures, and obesity. Studies were included if they described outcomes for gastric bypass, gastric band, or sleeve gastrectomy performed on patients with a body mass index of 35 or greater, had more than 2 years of outcome information, and had follow-up measures for at least 80% of the initial cohort. Two investigators reviewed each study and a third resolved study inclusion disagreements. FINDINGS Of 7371 clinical studies reviewed, 29 studies (0.4%, 7971 patients) met inclusion criteria. All gastric bypass studies (6 prospective cohorts, 5 retrospective cohorts) and sleeve gastrectomy studies (2 retrospective cohorts) had 95% confidence intervals for the reported mean, median, or both exceeding 50% excess weight loss. This amount of excess weight loss occurred in 31% of gastric band studies (9 prospective cohorts, 5 retrospective cohorts). The mean sample-size-weighted percentage of excess weight loss for gastric bypass was 65.7% (n = 3544) vs 45.0% (n = 4109) for gastric band. Nine studies measured comorbidity improvement. For type 2 diabetes (glycated hemoglobin <6.5% without medication), sample-size-weighted remission rates were 66.7% for gastric bypass (n = 428) and 28.6% for gastric band (n = 96). For hypertension (blood pressure <140/90 mm Hg without medication), remission rates were 38.2% for gastric bypass ( n = 808) and 17.4% for gastric band (n = 247). For hyperlipidemia (cholesterol <200 mg/dL, high-density lipoprotein >40 mg/dL, low-density lipoprotein <160 mg/dL, and triglycerides <200 mg/dL), remission rates were 60.4% for gastric bypass (n = 477) and 22.7% for gastric band (n = 97). CONCLUSIONS AND RELEVANCE Very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results. Gastric bypass has better outcomes than gastric band procedures for long-term weight loss, type 2 diabetes control and remission, hypertension, and hyperlipidemia. Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections.
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Affiliation(s)
- Nancy Puzziferri
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas2Department of Surgery, North Texas Veterans Administration Healthcare System, Dallas
| | - Thomas B Roshek
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Helen G Mayo
- University of Texas Southwestern Medical Center Library, Dallas
| | - Ryan Gallagher
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Steven H Belle
- Departments of Epidemiology and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward H Livingston
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas2Department of Surgery, North Texas Veterans Administration Healthcare System, Dallas5Department of Biomedical Engineering, University of Texas-Arlington, Arlington6Deputy Edito
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Khalili H, Patel VG, Mayo HG, de Lemos JA, Brilakis ES, Banerjee S, Bavry AA, Bhatt DL, Kumbhani DJ. Surrogate and clinical outcomes following ischemic postconditioning during primary percutaneous coronary intervention of ST--segment elevation myocardial infarction: a meta-analysis of 15 randomized trials. Catheter Cardiovasc Interv 2014; 84:978-86. [PMID: 24948465 DOI: 10.1002/ccd.25581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/05/2014] [Accepted: 06/14/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To conduct a meta-analysis on surrogate and clinical outcomes with myocardial ischemic postconditioning (IPoC) following revascularization with primary percutaneous intervention (PPCI) for ST-segment myocardial infarction (STEMI) compared with PPCI alone. BACKGROUND Reperfusion injury remains an important problem following PPCI for STEMI. Trials of IPoC have mainly focused on cardiac biomarkers; the impact on clinical outcomes is unknown. METHODS Clinical trials that randomized STEMI patients to IPoC as compared with conventional PPCI were included for analysis. RESULTS A total of 15 randomized trials with 1,545 patients met our selection criteria (785 underwent IPoC + PPCI, 760 PPCI alone). Mean follow-up for clinical outcomes was 4.7 months. The mean ischemic time was 225 min. ST-segment resolution (Relative Risk [RR] = 0.98; 95% Confidence Intervals [CI] 0.85-1.13; P = 0.75) and infarct size (Weighted mean difference [WMD] = -2.53%, 95% CI -6.10 to 1.05; P = 0.17) were similar between the IPoC + PPCI vs. PPCI arms. Left ventricular ejection fraction at follow-up was marginally higher in the IPoC (WMD = 4.15%, 95% CI 0.19-8.12%, P = 0.04). No differences were noted in any of the clinical outcomes studied, including mortality (RR = 1.52; 95% CI 0.77-2.99; P = 0.23), recurrent MI (RR = 3.04; 95% CI 0.74-12.54; P = 0.12); stent thrombosis (RR = 1.24, 95% CI 0.51-3.04; P = 0.83) or the composite MACE outcome (RR = 1.53; 95% CI 0.89-2.63; P = 0.13). CONCLUSIONS IPoC following PPCI is not associated with improvements in surrogate or clinical outcomes at 5 months as compared with PPCI alone. Our findings indicate no role for IPoC in the routine management of patients with STEMI.
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Affiliation(s)
- Houman Khalili
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
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Wang J, Liu GT, Mayo HG, Joshi GP. Pain Management for Elective Foot and Ankle Surgery: A Systematic Review of Randomized Controlled Trials. J Foot Ankle Surg 2014; 54:625-35. [PMID: 24954920 DOI: 10.1053/j.jfas.2014.05.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 04/29/2014] [Indexed: 02/03/2023]
Abstract
Pain after foot and ankle surgery can significantly affect the postoperative outcomes. We performed a systematic review of randomized controlled trials assessing postoperative pain after foot and ankle surgery, because the surgery will lead to moderate-to-severe postoperative pain, but the optimal pain therapy has been controversial. A systematic review of randomized controlled trials in English reporting on pain after foot and ankle surgery in adults published from January 1946 to February 2013 was performed. The primary outcome measure was the postoperative pain scores. The secondary outcome measures included supplemental analgesic requirements and other recovery outcomes. With 953 studies identified, 45 met the inclusion criteria. The approaches improving pain relief (reduced pain scores or opioid requirements) included peripheral nerve blocks, wound infiltration, intravenous dexamethasone, acetaminophen, nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 selective inhibitors, and opioids. Wound instillation, intra-articular injection, and intravenous regional analgesia had variable analgesia. The lack of homogeneous study design precluded quantitative analyses. Optimal pain management strategies included locoregional analgesic techniques plus acetaminophen and nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 selective inhibitors, with opioids used for "rescue," and 1 intraoperative dose of parenteral dexamethasone. Popliteal sciatic nerve blocks would be appropriate when expecting severe postoperative pain (extensive surgical procedure), and ankle blocks and surgical incision infiltration would be appropriate when expecting moderate postoperative pain (less extensive and minimally invasive surgical procedures). Additional studies are needed to assess multimodal analgesia techniques.
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Affiliation(s)
- Jia Wang
- Resident, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX
| | - George T Liu
- Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Helen G Mayo
- Research and Liaison Librarian, University of Texas Southwestern Health Sciences Digital Library and Learning Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Girish P Joshi
- Professor, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX.
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Abstract
IMPORTANCE Recent data from clinical trials have challenged traditional thinking about axillary surgery in patients with breast cancer. OBJECTIVES To summarize evidence regarding the role of axillary interventions (surgical and nonsurgical) in breast cancer treatment and to review the association of these axillary interventions with recurrence of axillary node metastases, mortality, and morbidity outcomes in patients with breast cancer. EVIDENCE REVIEW Ovid MEDLINE (1946-July 2013), Cochrane Database of Systematic Reviews (2005-July 2013), Cochrane Database of Abstracts of Reviews of Effects (1994-July 2013), and Cochrane Central Register of Controlled Trials (1989-July 2013) were searched for publications on axillary interventions in breast cancer. Clinical trials, observational studies, and meta-analyses with at least 2-year follow-up were included. A total of 1070 publications were reviewed, 17 of which met final inclusion criteria. FINDINGS Partial mastectomy followed by whole breast radiation is breast-conserving therapy. For women with no suspicious, palpable axillary nodes who undergo breast-conserving therapy, there is little evidence of benefit from surgical complete axillary node dissection compared with sentinel node biopsy alone. Complete axillary node dissection in patients with no palpable lymph nodes, compared with sentinel node biopsy, provides no survival benefit and is associated with a 1% to 3% reduction in recurrence of axillary lymph node metastases, but is associated with a 14% risk of lymphedema. Surgical axillary staging via sentinel node biopsy in patients with benign axillary nodes on radiological and clinical examination helps to inform decisions regarding adjuvant systemic and radiation therapy. Patients and physicians should tailor axillary lymph node interventions to maximize regional disease control and minimize morbidity. Complete axillary lymph node dissection is indicated in patients who present with palpable or needle biopsy-proven axillary metastases, patients with positive sentinel nodes undergoing mastectomy (who do not, as a standard, receive adjuvant radiation), patients with more than 3 positive sentinel nodes undergoing breast-conserving therapy, and patients not meeting eligibility criteria for recent trials establishing the safety of sentinel node biopsy alone in patients with breast cancer and metastases in their sentinel nodes. CONCLUSION AND RELEVANCE Available evidence suggests that axillary node dissection is associated with more harm than benefit in women undergoing breast-conserving therapy who do not have palpable, suspicious lymph nodes, who have tumors 3.0 cm or smaller, and who have 3 or fewer positive nodes on sentinel node biopsy.
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Affiliation(s)
- Roshni Rao
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9155, USA.
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Crossno JE, DeShay CH, Huslig MA, Mayo HG, Patridge EF. A case study: the evolution of a "facilitator model" liaison program in an academic medical library. J Med Libr Assoc 2012; 100:171-5. [PMID: 22879805 DOI: 10.3163/1536-5050.100.3.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
QUESTION What type of liaison program would best utilize both librarians and other library staff to effectively promote library services and resources to campus departments? SETTING The case is an academic medical center library serving a large, diverse campus. METHODS The library implemented a "facilitator model" program to provide personalized service to targeted clients that allowed for maximum staff participation with limited subject familiarity. To determine success, details of liaison-contact interactions and results of liaison and department surveys were reviewed. RESULTS Liaisons successfully recorded 595 interactions during the program's first 10 months of existence. A significant majority of departmental contact persons (82.5%) indicated they were aware of the liaison program, and 75% indicated they preferred email communication. CONCLUSION The "facilitator model" provides a well-defined structure for assigning liaisons to departments or groups; however, training is essential to ensure that liaisons are able to communicate effectively with their clients.
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Crossno JE, DeShay CH, Huslig MA, Mayo HG, Patridge EF. A case study: the evolution of a "facilitator model" liaison program in an academic medical library. J Med Libr Assoc 2012. [PMID: 22879805 DOI: 10.3163/1536-5050.100.3.006.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
QUESTION What type of liaison program would best utilize both librarians and other library staff to effectively promote library services and resources to campus departments? SETTING The case is an academic medical center library serving a large, diverse campus. METHODS The library implemented a "facilitator model" program to provide personalized service to targeted clients that allowed for maximum staff participation with limited subject familiarity. To determine success, details of liaison-contact interactions and results of liaison and department surveys were reviewed. RESULTS Liaisons successfully recorded 595 interactions during the program's first 10 months of existence. A significant majority of departmental contact persons (82.5%) indicated they were aware of the liaison program, and 75% indicated they preferred email communication. CONCLUSION The "facilitator model" provides a well-defined structure for assigning liaisons to departments or groups; however, training is essential to ensure that liaisons are able to communicate effectively with their clients.
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Shah ZH, Rao S, Mayo HG, Fashner J. Clinical inquiries. What are the most effective ways you can help patients stop smoking? J Fam Pract 2008; 57:478-479. [PMID: 18625173] [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: 05/26/2023]
Affiliation(s)
- Zille Huma Shah
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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King RV, Murphy-Cullen CL, Mayo HG, Marcee AK, Schneider GW. Use of computers and the Internet by residents in US family medicine programmes. ACTA ACUST UNITED AC 2007; 32:149-55. [PMID: 17541864 DOI: 10.1080/14639230701198601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Computers, personal digital assistants (PDA), and the Internet are widely used as resources in medical education and clinical care. Educators who intend to incorporate these resources effectively into residency education programmes can benefit from understanding how residents currently use these tools, their skills, and their preferences. The researchers sent questionnaires to 306 US family medicine residency programmes for all of their residents to complete. Respondents were 1177 residents from 125 (41%) programmes. Access to a computer was reported by 95% of respondents. Of these, 97% of desktop and 89% of laptop computers could access the Internet. Residents accessed various educational and clinical resources. Half felt they had 'intermediate' skills at Web searches, 23% had 'some skills,' and 27% were 'quite skilled.' Those under 30 years of age reported higher skill levels. Those who experienced a Web-based curriculum in medical school reported higher search skills and greater success in finding clinical information. Respondents preferred to use technology to supplement the didactic sessions offered in resident teaching conferences. Favourable conditions exist in family medicine residency programmes to implement a blend of traditional and technology-based learning experiences. These conditions include residents' experience, skills, and preferences.
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Affiliation(s)
- Richard V King
- Department of Health Care Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA.
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Rao S, Cherukuri M, Mayo HG, Sehgal M. Clinical inquiries. What is the best treatment for hypertension in African Americans? J Fam Pract 2007; 56:149-51. [PMID: 17270125] [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: 05/13/2023]
Affiliation(s)
- Shobha Rao
- University of Texas Southwestern, Dallas, USA
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Tubbs C, Niemi H, Mayo HG, Warren M. Clinical inquiries. What is the best treatment for pertussis? J Fam Pract 2005; 54:1096-8. [PMID: 16321352] [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: 05/05/2023]
Affiliation(s)
- Charles Tubbs
- Department of Family Practice and Community Medicine, University of Texas Southwestern, Dallas, USA
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Palacios LC, Jones WY, Mayo HG, Malaty W. Clinical inquiries. Do steroid injections help with osteoarthritis of the knee? J Fam Pract 2004; 53:921-922. [PMID: 15527732] [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: 05/24/2023]
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Tubbs CG, Safeek A, Mayo HG, Markova T. Clinical inquiries. Do routine eye exams reduce occurrence of blindness from type 2 diabetes? J Fam Pract 2004; 53:732-734. [PMID: 15353163] [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: 05/24/2023]
Affiliation(s)
- Charles G Tubbs
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Graves N, Krepcho M, Mayo HG, Hill J. Clinical inquiries. Does yoga speed healing for patients with low back pain? J Fam Pract 2004; 53:661-662. [PMID: 15298844] [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: 05/24/2023]
Affiliation(s)
- Nathan Graves
- University of Texas Southwestern Medical Center, Dallas, USA
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Abstract
PURPOSE To understand more about the nurse practitioner (NP) profession, a study was undertaken of the dissertation literature. DATA SOURCES A search of Dissertation Abstracts Online yielded 134 dissertations that included NPs in the title or abstract and were awarded between 1970 and 2000. CONCLUSIONS Most of the degrees are either PhD (61%) or EdD (27%). State-based universities produced the most degrees (70%) and six universities accounted for one-fourth of the degrees. The topics of NP-focused dissertations are wide ranging and include history, medical economics and managed care, NP education and professional role, and clinical and behavioral research. IMPLICATIONS FOR PRACTICE This dataset provides an important source of information for research on the NP profession.
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Affiliation(s)
- Roderick S Hooker
- University of Texas Southwestern Medical Center, Division of Health Services Research, Dallas, TX, USA.
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Higa-Moore ML, Bunnett B, Mayo HG, Olney CA. Use of focus groups in a library's strategic planning process. J Med Libr Assoc 2002; 90:86-92. [PMID: 11838465 PMCID: PMC64762] [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: 02/23/2023] Open
Abstract
The use of focus groups to determine patron satisfaction with library resources and services is extensive and well established. This article demonstrates how focus groups can also be used to help shape the future direction of a library as part of the strategic planning process. By responding to questions about their long-term library and information needs, focus group participants at the University of Texas Southwestern Medical Center at Dallas Library contributed an abundance of qualitative patron data that was previously lacking from this process. The selection and recruitment of these patrons is discussed along with the line of questioning used in the various focus group sessions. Of special interest is the way the authors utilized these sessions to mobilize and involve the staff in creating the library's strategic plan. This was accomplished not only by having staff members participate in one of the sessions but also by sharing the project's major findings with them and instructing them in how these findings related to the library's future. The authors' experience demonstrates that focus groups are an effective strategic planning tool for libraries and emphasizes the need to share information broadly, if active involvement of the staff is desired in both the development and implementation of the library's strategic plan.
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Affiliation(s)
- Mori Lou Higa-Moore
- Library The University of Texas Southwestern Medical Center at Dallas 5323 Harry Hines Boulevard Dallas, Texas 75390-9049
| | - Brian Bunnett
- Library The University of Texas Southwestern Medical Center at Dallas 5323 Harry Hines Boulevard Dallas, Texas 75390-9049
| | - Helen G. Mayo
- Library The University of Texas Southwestern Medical Center at Dallas 5323 Harry Hines Boulevard Dallas, Texas 75390-9049
| | - Cynthia A. Olney
- Educational Research and Development The University of Texas Health Sciences Center at San Antonio 7703 Floyd Curl Drive San Antonio, Texas 78229-7895
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