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Hamid A, Yimer W, Oshunbade A, Khan MS, Kamimura D, Kipchumba RK, Pandey A, Clark D, Mentz R, Fox ER, Berry J, Stacey B, Shah A, Correa A, Virani SS, Butler J, Hall ME. Trajectory of high sensitivity c-reactive protein and incident heart failure in black adults: the jackson heart study. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Butler J, Shalev Greene L. 1192 FALLS PREVENTION: COMMUNITY EXERCISE PROGRAMME; REDUCING RISK OF FALLS, DECONDITIONING AND LONELINESS IN FRAIL ELDERLY PATIENTS. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.095] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
Covid has had a devastating effect on the Elderly, resulting in deconditioning, increased falls and loneliness. Tailored exercises can reduce falls in people aged over 65 by 54% and participation in physical activity reduces the risk of hip fractures by 50%, currently costing the NHS £1.7 billion per year in England. This 8-week intervention delivered by trained volunteers in patient’s homes, aims to reduce deconditioning, loneliness and the risk, incidence and fear of falling (FOF) amongst frail patients post-discharge from hospital.
Method
A gap in service was identified in Frail patients discharged from hospital, at risk of falling and awaiting community physiotherapy. A steering group was set up including acute and community therapists, volunteers and carers to design a collaborative intervention to bridge the gap. At risk patients were identified and referred by ward therapists supported by the hospital volunteering team. Volunteers were trained to deliver an 8 weeks programme of progressive exercises in patients’ homes with additional signposting to appropriate statutory and voluntary services. Qualitative and quantitative outcome measures were taken at week 1 and week 8 of the intervention
Results
91.5% total health outcomes improved or maintained by average:
- FOF reduced by 22.5%
- 180 degree turn improved by 43%
- 60 sec Sit to Stand improved by 14.75%
- Timed Up And Go improved by 15.5%
- Confidence to cope at home improved by 15%
- Pain / discomfort (self-reported) improved by 18.75%
- Overall health (self-reported) improved by 8.5%
Conclusion(s)
Targeted exercise at home with skilled volunteers can improve functional fitness and health outcomes in a frail elderly population at risk of falls when discharged home from hospital. The programme increases patients’ connectivity to local voluntary and community sector services. Volunteers’ mental health improves by engaging in meaningful service.
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Affiliation(s)
- J Butler
- Kingston Hospital NHS Foundation Trust ; Department of Elderly Care
| | - L Shalev Greene
- Kingston Hospital NHS Foundation Trust ; Volunteering Department
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Cheng J, Buduhan G, Venkataraman S, Bashir B, Ahmed N, Tan L, Kidane B, Sasaki D, Rathod S, Sivananthan G, Koul R, Leylek A, Butler J, McCurdy B, Kim J. Endobronchial Implanted Real-Time Radiofrequency (RF) Transponder Beacon Guided, Respiratory-Gated, Stereotactic Body Radiotherapy for Moving Lung Tumors: Interim Analysis of a Prospective Phase I/II Cohort Study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Chau O, Islam A, Lock M, Yu E, Dinniwell R, Yaremko B, Brackstone M, Pavlosky W, Butler J, Biernaski H, Graf C, Wisenberg G, Prato F, Gaede S. Assessing Acute Cardiac Inflammation after Left-Sided Breast Cancer Radiotherapy with Hybrid PET/MRI (RICT-BREAST). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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5
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Nolte E, Morris M, Landon S, McKee M, Seguin M, Butler J, Lawler M. Exploring the link between cancer policies and cancer survival: a comparison of seven countries. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Disparity in cancer survival across countries has been linked to variation in cancer policy delivery but there is lack of empirical evidence for this association. We traced the evolution of cancer policies in 20 jurisdictions in Australia, Canada, Denmark, Ireland, Norway, New Zealand and the UK since 1995 and present the findings of an exploratory analysis linking cancer policy consistency to cancer survival.
Methods
We systematically searched and analysed national/regional cancer plans and strategies, mapping timelines of cancer policy evolution. For 10 jurisdictions, evidence was synthesised into five categories: oversight function; cancer plan; implementation plan; budget for plan implementation; and evaluation. We assigned scores evaluating whether a category was present or absent, and weighted scores for consistency. Summed scores were correlated with trends in survival from seven cancers between 1995-2014.
Results
All ten jurisdictions had implemented a high-level structure overseeing, steering or delivering cancer control policies (1995 - 2014); all had also published at least one major cancer plan. There was great variation in oversight mechanisms, ranging from institutionalising cancer control (New South Wales, Ontario) to cancer steering groups or taskforces (Denmark, Northern Ireland, Wales). Frequency and consistency of cancer plans also varied, from a succession of plans that build on each other (Denmark, New South Wales, Ontario) to the publication of isolated plans (New Zealand, Northern Ireland). We found a positive, albeit weak, correlation of cancer policy consistency and improvements in survival over time for six of the seven cancers.
Conclusions
Jurisdictions that have implemented consistent cancer control policies over time tended to be more successful in improving survival for a wide range of cancers. Our findings can help guide policymakers seeking approaches and frameworks to improve cancer services and, ultimately, cancer outcomes.
Key messages
• Sustained and consistent strategic cancer planning and investment are crucial for ensuring better patient outcomes, and this requires strong and sustained commitment at all levels.
• The findings can help guide policymakers seeking approaches and frameworks to improve cancer services and, ultimately, cancer outcomes.
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Affiliation(s)
- E Nolte
- Department of Health Services Research and Policy, LSHTM , London, UK
| | - M Morris
- Department of Health Services Research and Policy, LSHTM , London, UK
| | - S Landon
- Department of Health Services Research and Policy, LSHTM , London, UK
| | - M McKee
- Department of Health Services Research and Policy, LSHTM , London, UK
| | - M Seguin
- Department of Health Services Research and Policy, LSHTM , London, UK
| | - J Butler
- The Royal Marsden Hospital , London, UK
- Cancer Research UK , London, UK
| | - M Lawler
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast , Belfast, UK
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Defilippi C, Shah SJ, Alemayehu W, Lam CSP, Butler J, Reimann S, O'Connor CM, Shah P, Westerhout CM, Armstrong PW. Targeted discovery proteomics to identify clinical phenotypes in heart failure with preserved ejection fraction: a proteomics substudy of VITALITY-HFpEF. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.781] [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: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure with preserved ejection fraction (HFpEF) is a heterogenous syndrome that may emerge from overlapping systemic processes associated with several medical co-morbidities, often within an inflammatory milieu. Identification of unique proteins associated with distinct phenotypes may yield insight into novel therapeutics.
Purpose
Determine if unique clusters of circulating proteins are associated with specific clinical characteristics in patients with HFpEF.
Methods
A targeted discovery proteomics approach with 358 unique proteins associated with cardiovascular disease and inflammation (Olink) was used at baseline in VITALITY-HFpEF among 789 participants with documented left ventricular EF ≥45% and recent decompensation (<6 mos). Proteins were clustered applying the weighted correlation network analysis (WCNA). The associations of the clinical characteristics and frailty and clusters were estimated with linear regression adjusted for age and eGFR. Frailty was characterized as normal, pre-frail, and frail using the Fried criteria. KCCQ was the primary and 6-minute walk distance (6MWD) the secondary endpoint of VITALITY-HFpEF.
Results
Four unique clusters were identified containing 24, 66, 197, and 81 proteins, respectively. Figure 1 shows the adjusted association of the 4 protein clusters, shown with their hub proteins, with the clinical characteristics. The color (red: positive, green: negative relationship) and intensity indicate the magnitude of the standardized difference (relative to the variation [i.e., T-value]); p-value shown in boxes. Cluster 3, with tumor necrosis factor receptor 1 as a hub protein that mediates apoptosis and inflammation, was associated with greater frailty and physical limitation along with shorter 6MWD. In contrast, cluster 4, with protein C as a hub protein that regulates anticoagulation and exerts a protective function on endothelial cells, is associated with less frailty and younger age, and more frequently male sex. Cluster 2 was associated with only younger age and cluster 1 with no clinical characteristics.
Conclusions
Proteomics appear to identify specific clinical phenotypes associated with HFpEF. Further exploration of this approach may provide insight into the diverse pathophysiology characterizing this disorder and a more targeted approach to therapy.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): VITALITY-HFpEF was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and Bayer AG, Wuppertal, Germany.
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Affiliation(s)
- C Defilippi
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - S J Shah
- Northwestern University , Chicago , United States of America
| | - W Alemayehu
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - C S P Lam
- National University Heart Centre, Duke-NUS , Singapore , Singapore
| | - J Butler
- Baylor University Medical Center , Dallas , United States of America
| | | | - C M O'Connor
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - P Shah
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - C M Westerhout
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - P W Armstrong
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
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Boehm M, Anker SD, Mahfoud F, Filippatos G, Ferreira JP, Pocock SJ, Brueckmann M, Linetzky B, Schueler E, Wanner C, Zannad F, Packer M, Butler J. Association of heart rate with heart failure outcomes and the effects of empagliflozin in patients with preserved ejection fraction – EMPEROR-Preserved trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.983] [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: 11/14/2022] Open
Abstract
Abstract
Background and objective
High resting heart rate (HR) associates with cardiovascular death (CVD) and heart failure hospitalisation (HFH) in patients with reduced ejection fraction (HFrEF), but data are sparse in patients with preserved (HFpEF) or mildly reduced (HFmrEF) ejection fraction. Empagliflozin reduced the risk of CVD and HFH in HFpEF in the EMPEROR-Preserved trial. This study analyses the influence of HR on outcomes in patients with left ventricular ejection fraction (LVEF) >40% in EMPEROR-Preserved and evaluates the effects of empagliflozin across HR categories.
Methods
Patients (n=5988) with HFpEF (LVEF >40%) were categorised to HR <70 beats per minute (bpm), 70–75 bpm and >75 bpm. The composite of CVD or HFH (primary outcome), first HFH, CVD, recurrent HFH and all-cause mortality were studied in the HR groups and in patients separated by sinus rhythm (SR) or atrial fibrillation (AF) and true HFpEF (EF ≥50%) or HFmrEF (EF 40–49%).
Results
Empagliflozin did not influence HR over time. At HR >75 bpm, the primary outcome (hazard ratio: 1.31, 1.13–1.52, p=0.0003), time to first HFH (hazard ratio: 1.25, 1.04–1.49, p=0.02), recurrent HFH (hazard ratio: 1.29, 1.05–1.60, p=0.02), CVD (hazard ratio: 1.49, 1.21–1.84, p=0.0001) and all-cause mortality (hazard ratio: 1.49, 1.28–1.73, p<0.0001) were increased compared to HR of <70 bpm with HR 70–75 bpm showing intermediate results. The influence of HR on the primary outcome was only observed in SR (p trend=0.005), but not in AF (p trend=0.55). Patients with true HFpEF (≥50%) or HFmrEF (40–49%) showed similar effects. The treatment effects of empagliflozin to reduce the primary outcome, time to first HFH and recurrent HFH were not modified by HR.
Conclusions
HR in SR, but not in AF, predicts heart failure outcomes in HFpEF and HFmrEF, but the effects of empagliflozin were not modified by HR.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance
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Affiliation(s)
- M Boehm
- University Hospital of Saarland, Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine , Homburg/Saar , Germany
| | - S D Anker
- Department of Cardiology (CVK); Charité Universitätsmedizin Berlin , Berlin , Germany
| | - F Mahfoud
- University Hospital of Saarland, Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine , Homburg/Saar , Germany
| | - G Filippatos
- National & Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon , Athens , Greece
| | | | - S J Pocock
- London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - M Brueckmann
- Boehringer Ingelheim International GmbH , Ingelheim , Germany
| | - B Linetzky
- Eli Lilly Interamerica Inc. , Buenos Aires , Argentina
| | | | - C Wanner
- Wuerzburg University Clinic , Wuerzburg , Germany
| | - F Zannad
- Université de Lorraine , Nancy , France
| | - M Packer
- Baylor University Medical Center , Dallas , United States of America
| | - J Butler
- Baylor Scott & White Health , Dallas , United States of America
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Butler J. Efficacy of empagliflozin in patients with heart failure according to baseline KDIGO risk categories – findings from the EMPEROR-Pooled. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1064] [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: 11/12/2022] Open
Abstract
Abstract
Background and objective
Chronic kidney disease (CKD) is common in patients with heart failure (HF) and is associated with an incrementally higher risk for mortality and morbidity. EMPEROR-Pooled studied 9,718 HF patients across two trials and showed that empagliflozin reduces the risk for HF hospitalization or cardiovascular (CV) death, slows the progression of estimated glomerular filtration rate (eGFR) decline, and improves health status in patients with HF and reduced ejection fraction (HFrEF) as well as preserved ejection fraction (HFpEF).
Purpose
We explored the effect of empagliflozin on CV and kidney endpoints in patients across KDIGO (Kidney Disease Improving Global Outcomes) risk categories in EMPEROR-Pooled.
Methods
3,730 participants with left ventricular EF ≤40% (EMPEROR-Reduced) and 5,988 with left ventricular EF >40% (EMPEROR-Preserved) were categorized using baseline eGFR and UACR values into 4 categories according to KDIGO classification. The key outcomes were (1) a composite of CV death or hospitalization for HF, (2) first hospitalization for HF, (3) CV death and (4) eGFR slope change/year.
Results
The proportion of participants in low-, moderate-, high-, and very high-risk KDIGO categories was 31.4%, 29.6%, 22.0%, 16.9% for empagliflozin and 32.5%, 28.4%, 21.8%, 17.2% for placebo, respectively. Patients on placebo in higher baseline KDIGO risk categories had a higher risk of CV death or hospitalization for HF (6.78, 11.30, 15.15, and 20.70 events per 100 patient-years for low-, moderate-, high-, and very high-risk patients, respectively) (Figure 1). Similar trends were seen for first HF hospitalization (4.46, 7.68, 11.14, and 15.98 per 100 patients-years at risk) and CV death (2.98, 5.31, 5.69, and 7.60 per 100 patients-years at risk). eGFR slope decreased less in higher baseline KDIGO risk categories (−3.13 in low-, −2.81 in moderate-, −2.17 in high- and −1.61 ml/min/1.73 m2 per year in very high-risk category) (Figure 2).
Empagliflozin reduced the risk of CV death or hospitalizations for HF similarly across KDIGO risk categories (hazard ratio [HR] 0.81; 95% confidence interval [CI] 0.66, 1.01 for low-, HR 0.63; 95% CI 0.52, 0.76 for moderate-, HR 0.82; 95% CI 0.68, 0.98 for high- and HR 0.84; 95% CI 0.71, 1.01 for very high-risk group; P trend=0.299). Similarly, empagliflozin reduced the risk of first HF hospitalization (P trend=0.186), CV death (P trend=0.663) or eGFR slope change (P trend=0.069) across the four groups.
Conclusions
Treatment with empagliflozin reduced the risk for CV death or HF hospitalization and slowed the rate of kidney function decline similarly in all KDIGO CKD risk categories.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance
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Affiliation(s)
- J Butler
- Baylor Scott & White Health , Dallas , United States of America
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9
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Butler J. Effects of empagliflozin in patients with heart failure and preserved ejection fraction according to baseline diuretic use: results from the EMPEROR-Preserved trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.982] [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: 11/14/2022] Open
Abstract
Abstract
Background
In the EMPEROR-Preserved trial, empagliflozin reduced the risk of hospitalizations for heart failure (HHF) or cardiovascular (CV) death in patients with heart failure and preserved ejection fraction (HFpEF). Almost one in five patients in the trial were not on baseline diuretic therapy.
Purpose
To evaluate the efficacy and safety of empagliflozin according to baseline diuretic treatment, as well as change in diuretic therapy after initiation of empagliflozin.
Methods
Patients were categorized into subgroups as no diuretic and furosemide-equivalent diuretic dose of <40, 40 and >40mg and were compared for first HHF or CV death, HHF, CV death, total HHF, change in eGFR slope, and change in Kansas City Cardiomyopathy Questionnaire – Clinical Summary Scores (KCCQ-CSS) between patients on empagliflozin vs. placebo. Changes in diuretic therapy in the two treatment groups were also compared.
Results
Amongst 5815 patients with data on diuretic dose, 1179 (20%) were on no diuretic, 2039 (35%) were on <40mg, 1700 (29%) were on 40mg, and 897 (15%) were on >40mg at baseline. Patients on higher diuretic doses at baseline were more likely to be diabetic, had a higher body weight and NT-proBNP, and lower estimated glomerular filtration rate (eGFR) on average. Patients on higher diuretic doses also had worse health status based on NYHA class and KCCQ-CSS estimates. The reduction of the risk of CVD or HHF, total HHF, preservation of eGFR, and KCCQ-CSS improvement with empagliflozin were consistent across all doses of diuretics (Table 1). The findings for all outcomes were consistent in patients on diuretics (any dose) vs. not on diuretics. Treatment with empagliflozin was associated with decreased rates of initiation (HR: 0.73 [0.59,0.90; p=0.004) or intensification (HR: 0.74; [0.65, 0.84]; p<0.001) of diuretics, while there were increased rates in permanent discontinuation of diuretics (HR: 1.46 [1.17, 1.82]; p<0.001) or diuretic dose reduction (HR: 1.22 [1.06, 1.42]; p=0.007). The incidence of adverse events were similar between treatment arms, irrespective of baseline use of diuretics. Volume depletion events were more common with empagliflozin amongst patients treated with diuretics (7.4 vs 5.7 events per 100 patient-years for empagliflozin vs placebo).
Conclusion
Empagliflozin improved clinical outcomes and health status in patients with HFpEF irrespective of baseline use of diuretics. Additionally, empagliflozin was associated with increased de-escalation or discontinuation of diuretics and decreased chances of initiation or intensification.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance
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Affiliation(s)
- J Butler
- Baylor Scott & White Health , Dallas , United States of America
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10
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Logeay F, Butler J. Efficacité de l’empagliflozine chez les patients atteints d’insuffisance cardiaque en fonction des catégories de risque KDIGO initiales, résultats de l’étude EMPEROR-Pooled. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lynch C, Harrison S, Butler J, Baldwin D, Dawkins P, van der Horst J, Jakobsen E, McAleese J, McWilliams A, Redmond K, Swaminath A, Finley C. EP04.02-002 International Consensus on Actions to Improve Lung Cancer Survival: Delphi Method in the International Cancer Benchmarking Partnership. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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12
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Sudol A, Crispin M, Tews I, Butler J, Ivory D. Extensive substrate recognition by the streptococcal antibody-degrading enzymes IdeS and EndoS. Acta Cryst Sect A 2022. [DOI: 10.1107/s205327332209310x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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13
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Garner J, Butler J, Evans T, Ferguson H. 997 Audit Examining the Treatment of Patients Who Developed Post Operative Complications Following Appendicectomy. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim
To identify trends in management of patients with post operative complications following appendicectomy in a district general hospital.
Method
The coding department identified patients who were admitted with appendicitis in the previous year and those who developed post operative complications. Data was gathered retrospectively from these patients using their online records.
Results
Coding identified 270 patients that were admitted between 22/10/20–29/10/21 with appendicitis. 19 patients had post operative complications. 9 had intra-abdominal collections, 5 had wound infections/collections, 3 had an ileus.
15/19 patients with complications underwent imaging, 8 had CT scans and 7 had US scans. Patients waited a mean of 0.4 days between presentation and imaging. Patients waited a mean of 2.2 and median of 0 days between imaging and appendicectomy.
12 patients had complicated appendicitis, 6 had simple appendicitis and 1 had a normal appendix. 16 patients had antibiotics pre and post operatively, 3 did not. The mean length of stay was 5.6 days for patients with complications, compared to a mean length of stay of 3.9 days for all patients with appendicitis.
Conclusions
Early identification and management of appendicitis reduces morbidity, and our centre appears to have lower than average complication rates. The patients who did develop complications, were generally imaged and operated on efficiently
An area of improvement is ensuring all patients undergoing appendicectomies are given at least one preoperative dose of antibiotics and up to 3–5 days post operatively if complicated as per WSES guidelines. We aim to re-audit this after an education drive within our department.
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Affiliation(s)
- J Garner
- Warwick Hospital , Warwick , United Kingdom
| | - J Butler
- Warwick Hospital , Warwick , United Kingdom
| | - T Evans
- Warwick Hospital , Warwick , United Kingdom
| | - H Ferguson
- Warwick Hospital , Warwick , United Kingdom
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Butler J, Finger J, Wohlrab D. Die Zukunft der GBE ist … vernetzt! Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753934] [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: 12/12/2022]
Affiliation(s)
- J Butler
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institut
und Poliklinik für Arbeits- und Sozialmedizin (IPAS), Dresden,
Deutschland
| | - J Finger
- Senatsverwaltung für Wissenschaft, Gesundheit, Pflege und
Gleichstellung, Abteilung Gesundheit, I A 11, Berlin, Deutschland
| | - D Wohlrab
- Landeshauptstadt München, Gesundheitsreferat (GSR),
GSR-GVO-Stab-GBE, München, Deutschland
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15
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Girbig M, Butler J, Schefter C, Seidler A. Daten für Taten im Kita-Alter (KitaGesund): Studienkonzeption
und Vorgehensweise. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Butler J, Schmitz T, Lambio C, Manafa G, Savaskan N, Lakes T. Raum-zeitliche Exploration von COVID-19 Daten und lokalen
Risikofaktoren in Berlin: am Beispiel des Bezirks
Neukölln. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753723] [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: 12/12/2022]
Affiliation(s)
- J Butler
- Humboldt-Universität zu Berlin, Geographisches Institut,
Berlin, Deutschland
| | - T Schmitz
- Humboldt-Universität zu Berlin, Geographisches Institut,
Berlin, Deutschland
| | - C Lambio
- Humboldt-Universität zu Berlin, Geographisches Institut,
Berlin, Deutschland
| | - G Manafa
- Humboldt-Universität zu Berlin, Geographisches Institut,
Berlin, Deutschland
| | - N Savaskan
- Bezirksamt Neukölln von Berlin, Gesundheitsamt, Berlin,
Deutschland
| | - T Lakes
- Humboldt-Universität zu Berlin, Geographisches Institut,
Berlin, Deutschland
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Butler J, Finger J, Wohlrab D. Quo Vadis GBE? Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753933] [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: 12/12/2022]
Affiliation(s)
- J Butler
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin (IPAS), Dresden,
Deutschland
| | - J Finger
- Senatsverwaltung für Wissenschaft, Gesundheit, Pflege und
Gleichstellung, Gesundheitsberichterstattung, Berlin, Deutschland
| | - D Wohlrab
- Landeshauptstadt München, Gesundheitsreferat (GSR),
Gesundheitsberichterstattung, München, Deutschland
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Rossignol P, Silva-Cardoso J, Kosiborod MN, Brandenburg, Cleland JG, Hadimeri H, Hullin R, Makela S, Mörtl D, Paoletti E, Pollock C, Vogt L, Jadoul M, Butler J. Pragmatic Diagnostic and Therapeutic Algorithms to Optimize New Potassium Binder use in Cardiorenal Disease. Pharmacol Res 2022; 182:106277. [PMID: 35662631 DOI: 10.1016/j.phrs.2022.106277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pivotal randomized trials demonstrating efficacy, safety and good tolerance, of two new potassium binders (patiromer and sodium zirconium cyclosilicate) led to their recent approval. A major hurdle to the implementation of these potassium-binders is understanding how to integrate them safely and effectively into the long-term management of cardiovascular and kidney disease patients using renin angiotensin aldosterone system inhibitors (RAASi), the latter being prone to induce hyperkalaemia. METHODS a multidisciplinary academic panel including nephrologists and cardiologists was convened to develop consensus therapeutic algorithm(s) aimed at optimizing the use of the two novel potassium binders (patiromer and sodium zirconium cyclosilicate) in stable adults who require treatment with RAASi and experience(d) hyperkalaemia in a non-emergent setting. RESULTS Two dedicated pragmatic algorithms are proposed. The lowest intervention threshold (i.e. 5.1mmol/L or greater) was the one used in the patiromer and sodium zirconium cyclosilicate) pivotal trials, both drugs being indicated to treat hyperkalaemia in a non -emergent setting. Acknowledging the heterogeneity across specialty guidelines in hyperkalaemia definition and thresholds to intervene when facing hyperkalaemia, we have been mindful to use soft language i.e. "it is to consider", not necessarily "to do". CONCLUSIONS Providing the clinical community with pragmatic algorithms may help optimize the management of high-risk patients by avoiding the risks of both hyper and hypokalaemia and of suboptimal RAASi therapy.
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Affiliation(s)
- P Rossignol
- Université de Lorraine, INSERM CIC Plurithématique 1433, Nancy CHRU, Inserm U1116, FCRIN INI-CRCT, Nancy, France.
| | - J Silva-Cardoso
- Heart Failure and Transplant Clinic, Cardiology Service, São João University Hospital Centre, Faculty of Medicine, University of Porto, CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - M N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri; The George Institute for Global Health, and University of New South Wales, Sydney, New South Wales, Australia
| | - Brandenburg
- Department of Cardiology and Nephrology, Rhein-Maas Klinikum, Würselen, Germany
| | - J G Cleland
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow & National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - H Hadimeri
- Department of Nephrology, Skaraborgs sjukhus, Skövde, Sweden
| | - R Hullin
- Service de Cardiologie, Département Coeur-Vaisseaux, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Suisse
| | - S Makela
- Department of Internal Medicine, Kidney Unit, Tampere University Hospital, Tampere, Finland
| | - D Mörtl
- Department of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - E Paoletti
- Nephrology, Dialysis, and Transplantation, Policlinico San Martino, Genova, Italy
| | - C Pollock
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - L Vogt
- Department of Internal Medicine, section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - M Jadoul
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium;; Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - J Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
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19
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Smailovic H, Wilk B, Wisenberg G, Sykes J, Butler J, Hicks J, Thiessen JD, Prato FS. Simultaneous measurements of myocardial glucose metabolism and extracellular volumes with hybrid PET/MRI using concurrent injections of Gd-DTPA and [ 18F]FDG. J Nucl Cardiol 2022; 29:1304-1314. [PMID: 33502694 DOI: 10.1007/s12350-020-02486-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/28/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aims of this study were to investigate the application of a constant infusion (CI) to mitigate the issue of constantly changing Gd-DTPA contrast levels in a bolus injection for extracellular volume (ECV) measurements by (a) comparing a CI alone to a bolus alone and a bolus followed by CI in healthy myocardium, (b) evaluating the impact of glucose suppression using heparin on ECV. METHODS Five healthy canine subjects were imaged to compare three different protocols for injecting Gd-DTPA and FDG: bolus alone, CI alone, bolus followed by CI. Suppression of myocardial glucose uptake was induced using a continuous infusion of 20% lipid at a rate of 0.25 mL·min-1·kg-1 as well as 2000 units of intravenous heparin injected 20 minutes prior to FDG/Gd-DTPA injection. RESULTS There was no significant effect on ECV measurement when heparin was used for glucose suppression at equilibrium irrespective of infusion protocol). Measurements of ECV in myocardium, regardless of infusion protocol showed no significant difference at all time points (P = 0.21) prior to washout. CONCLUSIONS The suppression of myocardial uptake of [18F]FDG with heparin did not alter the determination of myocardial ECV though a larger sample size may show differences. Further, the infusion protocol (bolus or constant infusion) had no effect on the calculated ECV.
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Affiliation(s)
- H Smailovic
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
| | - B Wilk
- Department of Medical Imaging, Western University, London, Canada.
- Lawson Health Research Institute, London, Canada.
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada.
- Department of Medical Biophysics, Western University, London, Canada.
| | | | - J Sykes
- Lawson Health Research Institute, London, Canada
| | - J Butler
- Lawson Health Research Institute, London, Canada
| | - J Hicks
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
| | - J D Thiessen
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
| | - F S Prato
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
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20
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Wilk B, Smailovic H, Wisenberg G, Sykes J, Butler J, Kovacs M, Thiessen JD, Prato FS. Tracking the progress of inflammation with PET/MRI in a canine model of myocardial infarction. J Nucl Cardiol 2022; 29:1315-1325. [PMID: 33462785 DOI: 10.1007/s12350-020-02487-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Following myocardial infarction, tissue undergoes pathophysiological changes involving inflammation and scar tissue formation. However, little is known about the pathophysiology and prognostic significance of any corresponding changes in remote myocardium. The aim of this study was to investigate the potential application of a combined constant infusion of 18F-FDG and Gd-DTPA to quantitate inflammation and extracellular volume (ECV) from 3 to 40 days after myocardial infarction. METHODS Eight canine subjects were imaged at multiple time points following induction of an MI with a 60-minute concurrent constant infusion of Gd-DTPA and 18F-FDG using a hybrid PET/MRI scanner. RESULTS There was a significant increase in ECV in remote myocardium on day 14 post-MI (P = .034) and day 21 (P = .021) compared to the baseline. ECV was significantly elevated in the infarcted myocardium compared to remote myocardium at all time points post-MI (days 3, 7, 14, 21, and 40) (P < .001) while glucose uptake was also increased within the infarct on days 3, 7, 14, and 21 but not 40. CONCLUSIONS The significant increase in ECV in remote tissue may be due to an ongoing inflammatory process in the early weeks post-infarct.
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Affiliation(s)
- B Wilk
- Lawson Health Research Institute, London, Canada.
- Department of Medical Biophysics, Western University, London, Canada.
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada.
| | - H Smailovic
- Lawson Health Research Institute, London, Canada
- Department of Medical Imaging, Western University, London, Canada
| | - G Wisenberg
- Lawson Health Research Institute, London, Canada
- MyHealth Centre, Arva, Canada
| | - J Sykes
- Lawson Health Research Institute, London, Canada
| | - J Butler
- Lawson Health Research Institute, London, Canada
| | - M Kovacs
- Lawson Health Research Institute, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
- Department of Medical Imaging, Western University, London, Canada
| | - J D Thiessen
- Lawson Health Research Institute, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
- Department of Medical Imaging, Western University, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
| | - F S Prato
- Lawson Health Research Institute, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
- Department of Medical Imaging, Western University, London, Canada
- Collaborative Graduate Program in Molecular Imaging, Western University, London, Canada
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21
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Abrams D, Albataineh H, Aljawrneh BS, Alsalmi S, Androic D, Aniol K, Armstrong W, Arrington J, Atac H, Averett T, Gayoso CA, Bai X, Bane J, Barcus S, Beck A, Bellini V, Bhatt H, Bhetuwal D, Biswas D, Blyth D, Boeglin W, Bulumulla D, Butler J, Camsonne A, Carmignotto M, Castellanos J, Chen JP, Cohen EO, Covrig S, Craycraft K, Cruz-Torres R, Dongwi B, Duran B, Dutta D, Fuchey E, Gal C, Gautam TN, Gilad S, Gnanvo K, Gogami T, Gomez J, Gu C, Habarakada A, Hague T, Hansen JO, Hattawy M, Hauenstein F, Higinbotham DW, Holt RJ, Hughes EW, Hyde C, Ibrahim H, Jian S, Joosten S, Karki A, Karki B, Katramatou AT, Keith C, Keppel C, Khachatryan M, Khachatryan V, Khanal A, Kievsky A, King D, King PM, Korover I, Kulagin SA, Kumar KS, Kutz T, Lashley-Colthirst N, Li S, Li W, Liu H, Liuti S, Liyanage N, Markowitz P, McClellan RE, Meekins D, Beck SMT, Meziani ZE, Michaels R, Mihovilovic M, Nelyubin V, Nguyen D, Nycz M, Obrecht R, Olson M, Owen VF, Pace E, Pandey B, Pandey V, Paolone M, Papadopoulou A, Park S, Paul S, Petratos GG, Petti R, Piasetzky E, Pomatsalyuk R, Premathilake S, Puckett AJR, Punjabi V, Ransome RD, Rashad MNH, Reimer PE, Riordan S, Roche J, Salmè G, Santiesteban N, Sawatzky B, Scopetta S, Schmidt A, Schmookler B, Segal J, Segarra EP, Shahinyan A, Širca S, Sparveris N, Su T, Suleiman R, Szumila-Vance H, Tadepalli AS, Tang L, Tireman W, Tortorici F, Urciuoli GM, Wojtsekhowski B, Wood S, Ye ZH, Ye ZY, Zhang J. Measurement of the Nucleon F_{2}^{n}/F_{2}^{p} Structure Function Ratio by the Jefferson Lab MARATHON Tritium/Helium-3 Deep Inelastic Scattering Experiment. Phys Rev Lett 2022; 128:132003. [PMID: 35426713 DOI: 10.1103/physrevlett.128.132003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 01/23/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
The ratio of the nucleon F_{2} structure functions, F_{2}^{n}/F_{2}^{p}, is determined by the MARATHON experiment from measurements of deep inelastic scattering of electrons from ^{3}H and ^{3}He nuclei. The experiment was performed in the Hall A Facility of Jefferson Lab using two high-resolution spectrometers for electron detection, and a cryogenic target system which included a low-activity tritium cell. The data analysis used a novel technique exploiting the mirror symmetry of the two nuclei, which essentially eliminates many theoretical uncertainties in the extraction of the ratio. The results, which cover the Bjorken scaling variable range 0.19<x<0.83, represent a significant improvement compared to previous SLAC and Jefferson Lab measurements for the ratio. They are compared to recent theoretical calculations and empirical determinations of the F_{2}^{n}/F_{2}^{p} ratio.
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Affiliation(s)
- D Abrams
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - H Albataineh
- Texas A & M University, Kingsville, Texas 78363, USA
| | - B S Aljawrneh
- North Carolina A & T State University, Greensboro, North Carolina 27411, USA
| | - S Alsalmi
- Kent State University, Kent, Ohio 44240, USA
- King Saud University, Riyadh 11451, Kingdom of Saudi Arabia
| | - D Androic
- University of Zagreb, 10000 Zagreb, Croatia
| | - K Aniol
- California State University, Los Angeles, California 90032, USA
| | - W Armstrong
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - J Arrington
- Argonne National Laboratory, Lemont, Illinois 60439, USA
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - H Atac
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - T Averett
- William & Mary, Williamsburg, Virginia 23187, USA
| | | | - X Bai
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - J Bane
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - S Barcus
- William & Mary, Williamsburg, Virginia 23187, USA
| | - A Beck
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - V Bellini
- Istituto Nazionale di Fisica Nucleare, Sezione di Catania, 95123 Catania, Italy
| | - H Bhatt
- Mississippi State University, Mississipi State, Mississippi 39762, USA
| | - D Bhetuwal
- Mississippi State University, Mississipi State, Mississippi 39762, USA
| | - D Biswas
- Hampton University, Hampton, Virginia 23669, USA
| | - D Blyth
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - W Boeglin
- Florida International University, Miami, Florida 33199, USA
| | - D Bulumulla
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - J Butler
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - A Camsonne
- Jefferson Lab, Newport News, Virginia 23606, USA
| | | | - J Castellanos
- Florida International University, Miami, Florida 33199, USA
| | - J-P Chen
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - E O Cohen
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - S Covrig
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - K Craycraft
- William & Mary, Williamsburg, Virginia 23187, USA
| | - R Cruz-Torres
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Dongwi
- Istituto Nazionale di Fisica Nucleare, Sezione di Catania, 95123 Catania, Italy
| | - B Duran
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - D Dutta
- Mississippi State University, Mississipi State, Mississippi 39762, USA
| | - E Fuchey
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - C Gal
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - T N Gautam
- Hampton University, Hampton, Virginia 23669, USA
| | - S Gilad
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - K Gnanvo
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - T Gogami
- Tohoku University, Sendai 980-8576, Japan
| | - J Gomez
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - C Gu
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - A Habarakada
- Hampton University, Hampton, Virginia 23669, USA
| | - T Hague
- Kent State University, Kent, Ohio 44240, USA
| | - J-O Hansen
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - M Hattawy
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - F Hauenstein
- Old Dominion University, Norfolk, Virginia 23529, USA
| | | | - R J Holt
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - E W Hughes
- Columbia University, New York, New York 10027, USA
| | - C Hyde
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - H Ibrahim
- Cairo University, Cairo, Giza 12613 Egypt
| | - S Jian
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - S Joosten
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - A Karki
- Mississippi State University, Mississipi State, Mississippi 39762, USA
| | - B Karki
- Ohio University, Athens, Ohio 45701, USA
| | | | - C Keith
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - C Keppel
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - M Khachatryan
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - V Khachatryan
- Stony Brook, State University of New York, New York 11794, USA
| | - A Khanal
- Florida International University, Miami, Florida 33199, USA
| | - A Kievsky
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, 56127 Pisa, Italy
| | - D King
- Syracuse University, Syracuse, New York 13244, USA
| | - P M King
- Ohio University, Athens, Ohio 45701, USA
| | - I Korover
- Nuclear Research Center-Negev, Beer-Sheva 84190, Israel
| | - S A Kulagin
- Institute for Nuclear Research of the Russian Academy of Sciences, 117312 Moscow, Russia
| | - K S Kumar
- Stony Brook, State University of New York, New York 11794, USA
| | - T Kutz
- Stony Brook, State University of New York, New York 11794, USA
| | | | - S Li
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - W Li
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - H Liu
- Columbia University, New York, New York 10027, USA
| | - S Liuti
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - N Liyanage
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - P Markowitz
- Florida International University, Miami, Florida 33199, USA
| | | | - D Meekins
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - S Mey-Tal Beck
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Z-E Meziani
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - R Michaels
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - M Mihovilovic
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana 1000, Slovenia
- Jožef Stefan Institute, Ljubljana, Slovenia
- Institut für Kernphysik, Johannes Gutenberg-Universität, Mainz 55122, Germany
| | - V Nelyubin
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - D Nguyen
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - M Nycz
- Kent State University, Kent, Ohio 44240, USA
| | - R Obrecht
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - M Olson
- Saint Norbert College, De Pere, Wisconsin 54115, USA
| | - V F Owen
- William & Mary, Williamsburg, Virginia 23187, USA
| | - E Pace
- University of Rome Tor Vergata and INFN, Sezione di Roma Tor Vergata, 00133 Rome, Italy
| | - B Pandey
- Hampton University, Hampton, Virginia 23669, USA
| | - V Pandey
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - M Paolone
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - A Papadopoulou
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - S Park
- Stony Brook, State University of New York, New York 11794, USA
| | - S Paul
- William & Mary, Williamsburg, Virginia 23187, USA
| | | | - R Petti
- University of South Carolina, Columbia, South Carolina 29208, USA
| | - E Piasetzky
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - R Pomatsalyuk
- Institute of Physics and Technology, 61108 Kharkov, Ukraine
| | - S Premathilake
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - A J R Puckett
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - V Punjabi
- Norfolk State University, Norfolk, Virginia 23504, USA
| | - R D Ransome
- Rutgers, The State University of New Jersey, Piscataway, New Jersey 08855, USA
| | - M N H Rashad
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - P E Reimer
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - S Riordan
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - J Roche
- Ohio University, Athens, Ohio 45701, USA
| | - G Salmè
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, 00185 Rome, Italy
| | - N Santiesteban
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - B Sawatzky
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - S Scopetta
- University of Perugia and INFN, Sezione di Perugia, 06123 Perugia, Italy
| | - A Schmidt
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Schmookler
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J Segal
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - E P Segarra
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Shahinyan
- Yerevan Physics Institute, Yerevan 375036, Armenia
| | - S Širca
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana 1000, Slovenia
- Jožef Stefan Institute, Ljubljana, Slovenia
| | - N Sparveris
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - T Su
- Kent State University, Kent, Ohio 44240, USA
- Shandong Institute of Advanced Technology, Jinan, Shandong 250100, China
| | - R Suleiman
- Jefferson Lab, Newport News, Virginia 23606, USA
| | | | - A S Tadepalli
- Rutgers, The State University of New Jersey, Piscataway, New Jersey 08855, USA
| | - L Tang
- Hampton University, Hampton, Virginia 23669, USA
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - W Tireman
- Northern Michigan University, Marquette, Michigan 49855, USA
| | - F Tortorici
- Istituto Nazionale di Fisica Nucleare, Sezione di Catania, 95123 Catania, Italy
| | - G M Urciuoli
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, 00185 Rome, Italy
| | | | - S Wood
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - Z H Ye
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - Z Y Ye
- University of Illinois-Chicago, Chicago, Illinois 60607, USA
| | - J Zhang
- Stony Brook, State University of New York, New York 11794, USA
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22
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Chau O, Islam A, Yu E, Qu M, Butler J, Biernaski H, Sun A, Bissonnette JP, MacDonald A, Graf C, So A, Wisenberg G, Lee T, Prato FS, Gaede S. Multi-Modality Imaging Assessment of the Heart Before and After Stage III Non-Small Cell Lung Cancer Radiotherapy. Adv Radiat Oncol 2022; 7:100927. [PMID: 35434423 PMCID: PMC9006649 DOI: 10.1016/j.adro.2022.100927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/07/2022] [Indexed: 11/26/2022] Open
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Filippatos G, Ponikowski P, Farmakis D, Metra M, Ruschitzka F, Van Der Meer P, Kirwan BA, MacDougall IC, Fabien V, Waechter S, Butler J, Anker SD, Jankowska EA. Efficacy of intravenous ferric carboxymaltose in patients with acute heart failure and iron deficiency with and without anaemia: a subgroup analysis of AFFIRM-AHF. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1053] [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: 11/14/2022] Open
Abstract
Abstract
Background
Iron deficiency is associated with increased morbidity and mortality in patients with acute heart failure (HF), even in the absence of anaemia.
Purpose
This prespecified subanalysis of the AFFIRM-AHF trial investigated the effects of ferric carboxymaltose (FCM) on recurrent HF hospitalisations and cardiovascular (CV) mortality in patients with and without anaemia defined as baseline haemoglobin (Hb) <12 g/dL, ≥12 g/dL.
Methods
In total, 1108 patients (558 FCM, 550 placebo) were included in the modified intention-to-treat AFFIRM-AHF analysis. The primary outcome was a composite of total HF hospitalisations and CV death, evaluated up to 52 weeks post-randomisation.
Results
Of the 1108 patients, 228 and 329 in the FCM group and 236 and 314 in the placebo group had Hb <12 g/dL and ≥12 g/dL at baseline, respectively. For patients with a baseline Hb ≥12 g/dL, the total number of HF hospitalisations and CV death was 156 and 201 in the FCM and placebo groups, respectively, with a rate ratio (95% confidence interval) of 0.67 (0.48–0.93; p=0.016). For patients with Hb <12 g/dL, this was 136 and 171 in the FCM and placebo groups, respectively (0.97 [0.66–1.41; p=0.862]). This treatment effect was consistent for all secondary outcomes in patients in the FCM group vs placebo, for both Hb subgroups (Figure).
Conclusion
Iron deficiency treatment with FCM following acute HF reduced the risk of HF hospitalisations and CV death, irrespective of Hb level at baseline.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Vifor Pharma Ltd. Figure 1
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Affiliation(s)
- G Filippatos
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - P Ponikowski
- Wroclaw Medical University, Department of Heart Diseases, Wroclaw, Poland
| | - D Farmakis
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - M Metra
- University and Civil Hospital, Department of Cardiology, Brescia, Italy
| | - F Ruschitzka
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - P Van Der Meer
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands (The)
| | - B.-A Kirwan
- SOCAR Research, Department of Clinical Research, Nyon, Switzerland
| | - I C MacDougall
- King's College Hospital, Department of Renal Medicine, London, United Kingdom
| | - V Fabien
- Vifor Pharma, Glattbrugg, Switzerland
| | | | - J Butler
- The University of Mississippi Medical Center, Jackson, United States of America
| | - S D Anker
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - E A Jankowska
- Wroclaw Medical University, Department of Heart Diseases, Wroclaw, Poland
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Senni M, Alemayehu W, Sim D, Edelmann F, Butler J, Ezekowitz J, Hernandez A, Lam C, O'Connor C, Pieske B, Ponikowski P, Roessig L, Voors A, McMullan C, Armstrong P. Efficacy and safety of vericiguat in patients with HFrEF treated with sacubitril/valsartan: results from the VICTORIA trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0788] [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: 11/14/2022] Open
Abstract
Abstract
Background
In the VICTORIA trial (n=5050) the reduction in the primary composite endpoint of cardiovascular death (CVD) or heart failure hospitalization (HFH) was similar whether or not patients received sacubitril/valsartan. The distribution of those patients who received sacubitril/valsartan after randomization (drop-ins) and the relationship to the efficacy and safety of vericiguat is unknown.
Purpose
We assessed the efficacy and safety of vericiguat in patients who were or were not treated with sacubitril/valsartan at baseline in the VICTORIA trial and the implications of post- randomization use of sacubitril/valsartan.
Methods
A total of 5040 patients were analyzed according sacubitril/valsartan use at randomization or initiated after randomization. The efficacy of vericiguat on the primary composite endpoint and its components, time to first HF hospitalization or all-cause mortality, were assessed according to sacubitril/valsartan use. Safety outcomes included symptomatic hypotension, syncope, worsening renal function, and hyperkalemia.
Results
Overall, 731 patients (360 on vericiguat and 371 on placebo) received sacubitril/valsartan at randomization. Patients treated with sacubitril/valsartan were twice as likely to be from Western Europe or North America, to have a lower ejection fraction and systolic and diastolic blood pressures, were more often on triple therapy (65.9 vs 58.6%), and more likely to have received biventricular pacing (17.9 vs 14.1%) or ICDs (42.3 vs 25.3%). For patients on sacubitril/valsartan at baseline, the adjusted hazard ratios for vericiguat's treatment effect on the primary composite outcome, CVD, and HFH was 0.94 (95% CI 0.74–1.20), 0.81 (95% CI 0.55–1.20) and 0.99 (95% CI 0.76–1.30), respectively. For those patients not on sacubitril/valsartan (2161 vericiguat; 2148 on placebo), the corresponding adjusted hazard ratios for vericiguat's treatment effect on the primary composite outcome, CVD, and HFH were 0.89 (0.80–0.98), 0.95 (0.82–1.11), and 0,87 (0.78–0.98), respectively. There was no significant interaction on the treatment effect of vericiguat based on the use of sacubitril/valsartan. More placebo patients (n=238) received drop-in use of sacubitril/valsartan than vericiguat group (n=187; p=0.007) post-randomization during follow-up (Figure). Overall, adverse events in the 992 patients receiving sacubitril/valsartan (at either baseline or drop-in for at least 3 months) were not significantly different according to those on placebo vs vericiguat for symptomatic hypotension (21.0% vs 23.1), renal dysfunction (8.0 vs 9.0%), and hyperkalemia (10.3 vs 7.9%).
Conclusions
Sacubitril/valsartan use was initiated more frequently after randomization in patients on placebo than on vericiguat. Concomitant use of sacubitril/valsartan did not alter the efficacy of vericiguat and was similarly tolerated in both study arms.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Merck & Co., Inc. and Bayer
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Affiliation(s)
- M Senni
- ASST Papa Giovanni XXIII Bergamo, Bergamo, Italy
| | | | - D Sim
- National Heart Centre Singapore, Singapore, Singapore
| | - F Edelmann
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - J Butler
- The University of Mississippi Medical Center, Jackson, United States of America
| | | | - A.F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - C.S.P Lam
- National Heart Centre Singapore, Singapore, Singapore
| | - C.M O'Connor
- Inova Heart and Vascular Institute, Falls Church, United States of America
| | - B Pieske
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | | | | | - A.A Voors
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - C McMullan
- Merck & Co., Inc., Kenilworth, United States of America
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25
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Ezekowitz J, Zheng Y, Cohen-Solal A, Melenovsky V, Escobedo J, Butler J, Hernandez A, Lam C, O'Connor C, Pieske B, Ponikowski P, Voors A, McMullan C, Roessig L, Armstrong P. Hemoglobin, anemia, and clinical outcomes in vericiguat global study in subjects with heart failure with reduced ejection fraction (VICTORIA). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0787] [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: 11/14/2022] Open
Abstract
Abstract
Background
In the VICTORIA trial of patients with HFrEF after a worsening HF event, anemia occurred more often in patients treated with vericiguat (7.6%) compared with placebo (5.7%). We explored the association between vericiguat, baseline hemoglobin, and anemia and also whether hemoglobin was related to the benefit of vericiguat in HF.
Methods
Anemia was defined as a hemoglobin <13.0 g/dL in men and <12.0 g/dL in women (WHO anemia). Adverse events reported as new anemia were also evaluated (AE anemia). We evaluated the risk-adjusted relationship between baseline hemoglobin (as both quartiles and continuous variable), hematocrit, and hematinic indices with the primary outcome (composite of cardiovascular death or heart failure hospitalization). Time-updated hemoglobin relationship was also examined.
Results
Of 4812 patients with baseline hemoglobin data available, 1719 (35.7%) were WHO anemic; median hemoglobin was 13.4 g/dL (IQR 12.1 to 14.7 g/dL). In total, 1643 patients had WHO anemia at 16 weeks (of which 284 were new from baseline for vericiguat and 219 for placebo) and this occurred more often in the vericiguat group than the placebo group (P<.001). Subsequently, there was no further decline in hemoglobin over the 96 weeks of follow-up (Figure A). The ratio of hemoglobin/hematocrit remained constant and none of the hematinic indices including red cell density width, mean corpuscular volume, white blood cell or platelet counts changed over time. Overall, AE anemia occurred in 342 patients (7.1%) and was more frequent in those with a lower baseline hemoglobin (hemoglobin Q1: 184 [14.5%], Q2: 94 [7.9%], Q3: 40 [3.4%], Q4: 24 [2.1%]; p<.001). Whereas outcomes were associated, quartiles of baseline hemoglobin were not related to the treatment benefit of vericiguat (compared with placebo) for the primary outcome (Figure B). Additionally, analysis of the time-updated hemoglobin values revealed no association with the treatment effect of vericiguat (compared with placebo) on the primary outcome.
Conclusions
Anemia was present at baseline in over one-third of patients in the VICTORIA trial and was generally mild. Lower hemoglobin was associated with greater frequency of clinical events. Although vericiguat modestly lowered hemoglobin by 16 weeks, this effect did not further progress nor influence the association of benefit of vericiguat.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Merck & Co., Inc. and Bayer
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Affiliation(s)
| | - Y Zheng
- University of Alberta, Edmonton, Canada
| | | | - V Melenovsky
- Institute for Clinical and Experimental Medicine-IKEM, Prague, Czechia
| | - J Escobedo
- Regional Hospital No. 1, Mexico City, Mexico
| | - J Butler
- The University of Mississippi Medical Center, Jackson, United States of America
| | - A.F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - C.S.P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore, Singapore
| | - C.M O'Connor
- Inova Heart and Vascular Institute, Falls Church, United States of America
| | - B Pieske
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | | | - A.A Voors
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - C McMullan
- Merck & Co., Inc., Kenilworth, United States of America
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Butler J, Stebbins A, Melenovsky V, Sweitzer N, Cowie M, Stehlik J, Ezekowitz J, Hernandez A, Lam C, Nkulikiyinka R, O'Connor C, Pieske B, Ponikowski P, Voors A, Armstrong P. Vericiguat and health status outcomes in heart failure with reduced ejection fraction: insights from the VICTORIA trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0786] [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: 11/12/2022] Open
Abstract
Abstract
Background
In the VICTORIA trial, vericiguat compared with placebo reduced the risk of the primary endpoint of cardiovascular death (CVD) or hospitalization for heart failure (HFH) among 5050 patients with worsening HF with reduced ejection fraction (HFrEF).
Purpose
We evaluated whether the efficacy of vericiguat on clinical outcomes varied according to participants' baseline health status, as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ)-23, and how vericiguat affected health status post-randomization.
Methods
KCCQ-23 was completed at randomization and at 4, 16, and 32 weeks. Patients were grouped based on tertiles of baseline KCCQ total symptom score (TSS; <55.2, 55.2–79.2, and >79.2), clinical summary score (CSS; <52.1, 52.1–76.0, and >76.2) and overall summary score (OSS; <48.5, 48.5–70.8, and >70.8) across tertiles 1–3, respectively. Cox proportional hazard models were performed for the tertiles to evaluate the effects of vericiguat on the primary outcomes.
Results
Overall 4741, 4664, and 4470 participants had KCCQ-TSS (median 68.8 [interquartile range 47.9, 85.4]), KCCQ-CSS (65.6 [45.8, 81.8]) and KCCQ-OSS (59.9 [42.0, 77.1]) available at baseline. Vericiguat reduced CVD or HFH risk across baseline KCCQ-TSS (P=0.21), KCCQ-CSS (P=0.13) and KCCQ-OSS (P=0.65) tertiles (Table). The effect of vericiguat on HFH alone was also not modified by baseline KCCQ-TSS, CSS and OSS (all P>0.05) scores. At 4 weeks after randomization, improvement in both vericiguat and placebo arms was seen in KCCQ-TSS (vericiguat 6.3 vs. placebo 6.3; P=0.85), KCCQ-CSS (vericiguat: 5.7 vs. placebo 5.7, P=0.54), and KCCQ-OSS (vericiguat 6.3 vs. placebo 5.7, P=0.36). Similar results were seen at weeks 16 and 32.
Conclusion
Vericiguat reduced the risk of the composite outcome of CVD or HFH as well as HFH alone across the range of baseline health status. Addition of vericiguat to best standard of care did not significantly improve health status compared with standard of care alone in HF patients with a recent worsening event. The early improvement in KCCQ seen in both randomized groups underscore the need to assess trajectory of health status changes in the spectrum of patients with HFrEF.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Merck & Co., Inc. and Bayer
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Affiliation(s)
- J Butler
- The University of Mississippi Medical Center, Jackson, United States of America
| | - A Stebbins
- Duke Clinical Research Institute, Durham, United States of America
| | - V Melenovsky
- Institute for Clinical and Experimental Medicine-IKEM, Prague, Czechia
| | - N Sweitzer
- University of Arizona, Sarver Heart Center, Tucson, United States of America
| | - M.R Cowie
- Imperial College London, London, United Kingdom
| | - J Stehlik
- University of Utah, Salt Lake City, United States of America
| | | | - A.F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - C.S.P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore, Singapore
| | | | - C.M O'Connor
- Inova Heart and Vascular Institute, Falls Church, United States of America
| | - B Pieske
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | | | - A.A Voors
- University Medical Center Groningen, Groningen, Netherlands (The)
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27
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Feeley A, Feeley I, Clesham K, Butler J. 1046 Anterior Lumbar Interbody Fusion Approaches: A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal; transperitoneal; open; and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. We aim to elucidate the comparative rates of complications across approach type.
Method
A systematic review of the search databases Pubmed; google scholar; and OVID Medline was made in November 2020 to identify studies related to complications associated with anterior lumbar interbody fusion. PRISMA guidelines were utilised for this review. Studies eligible for inclusion were agreed by two independent reviewers. Meta-analysis was used to compare intra- and postoperative complications with ALIF for each approach.
Results
4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of Retrograde Ejaculation (RE) (p < 0.001; CI = 0.05-0.21) and overall rates of complications (p = 0.05; CI = 0.00-0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI=-0.04-0.07). Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01).
Conclusions
Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intra- and postoperative complications, although confounders including use of BMP and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays, however its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.
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Affiliation(s)
- A Feeley
- Midlands Regional Hospital Tullamore, Tullamore, Ireland
| | - I Feeley
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Clesham
- Cappagh National Orthopaedic Hospital, Dublin, Ireland
| | - J Butler
- Mater Misericordiae University Hospital, Dublin, Ireland
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28
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Marshall C, Butler J. 519 Outcomes of Management with Ilizarov Frames in Bone Infection: An Observational Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
The successful treatment and eradication of bone infection requires a multifaceted approach and may recur even after excision if resultant bone void is not managed effectively. This paper aims to review the clinical effectiveness of antibiotic-impregnated bone void filler and current empirical antibiotic guidelines.
Method
We report a retrospective study of 18 patients with chronic osteomyelitis following injury or surgery managed via Ilizarov Ring Fixator (IRF). All patients were managed by IRF stabilisation procedures with debridement, microbiological sampling, and bone void filling with antibiotic-impregnated biocomposite material, in addition to culture-specific systemic antimicrobial therapy.
Results
Patients were followed up for a mean of 15.9 months. Infection was eradicated in 94.1% of patients in a grossly comorbid demographic. Comorbidities associated with increased risk of osteomyelitis were noted in 72.2% of patients. Anaerobic bacteria were identified in culture for four (22.2%) of the 18 patients.
Conclusions
We detected a higher than suspected growth of anaerobes in our samples, suggesting the need for metronidazole in empirical antibiotic treatment. This study would suggest that the use of STIMULAN® may be preferable in this National Health Service from a cost-effect perspective, as our results are comparable to those using other bone void fillers.
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Affiliation(s)
- C Marshall
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - J Butler
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
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29
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Phoon KM, Ward A, O'Dowd D, Pitcher F, Amos L, Butler J, Brewer P, Davies M, Chadwick C, Davies H, Blundell C. 965 Complication Rates in Operatively Managed Ankle Fracture/Dislocations - The Effect of Pre-Reduction Imaging and Compliance with BOAST 12 Guidance. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
The BOAST-12 guidelines for the management of ankle fractures aims to optimise functional recovery and reduce complications. They advise against having radiographs prior to urgent reduction of clinically deformed ankles as it could cause an unacceptable delay to subsequent management. Our study aimed to assess the effect of time to acceptable reduction on the risk of complications and time to definitive reduction.
Method
This was a retrospective observational study of patients with ankle fracture-dislocations between 2013 to 2017 at the Northern General Hospital’s Emergency Department (ED). Information collected from 2 patient groups (with and without pre-reduction radiographs), included patient demographics, time to accepted reduction, number of manipulations, operations, and subsequent complications.
Results
242 patients were identified. Time from arrival in ED to acceptable reduction was significantly longer in patients with pre-reduction radiographs versus patients without (184.5 vs 82 minutes, p < 0.00), but did not increase the overall risk of complications (p = 0.62). Pre-reduction radiographs were associated with insignificantly higher rates of post-traumatic osteoarthritis (p = 0.17) and slightly longer wait time for definitive intervention (1 vs 2 days, p = 0.72). However, this had no relationship with the number of manipulations (p = 0.53).
Conclusions
The use of pre-reduction radiographs significantly increased time to acceptable reduction of ankle fracture-dislocations. However, this was not associated with increased risk of complications or time to definitive management.
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Affiliation(s)
- K M Phoon
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - A Ward
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - D O'Dowd
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - F Pitcher
- The University of Sheffield Medical School, Sheffield, United Kingdom
| | - L Amos
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - J Butler
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - P Brewer
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - M Davies
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - C Chadwick
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - H Davies
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - C Blundell
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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30
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Feeley A, Feeley I, Butler J. 1044 Impact of Obesity on Complications from Anterior Lumbar Interbody Fusion. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Anterior Lumbar Interbody Fusion is a procedure growing in popularity for conditions including degenerative disc disease, and discogenic back pain. Obesity is a significant risk factor in the development of back pain, with patients with raised BMIs at increased of complications using the posterior approach. This review aims to evaluate the risk profile of this patient cohort using the anterior approach for lumbar interbody fusion.
Method
A systematic review of the search databases Pubmed; google scholar; and OVID Medline was carried out between September 2020-November 2020. Studies evaluating the risks associated with obesity during Anterior Lumbar Interbody Fusion (ALIF) were identified and included for review according to PRISMA guidelines. Studies eligible for inclusion were agreed by two independent reviewers. Meta-analysis was used to compare intra- and postoperative complications in patients with increased BMI during ALIF.
Results
Search terms yielded 435 articles for evaluation. 13 studies were included in this review after applying inclusion and exclusion criteria. Meta-analysis of studies demonstrated a significantly increased risk profile for overall complications in the obese patient cohort (CI = 0.04-0.16, p = 0.002) with significant heterogeneity (I2=86%). Patients with increased BMI were not significantly more likely to develop Vascular complications (CI= -.03-0.02, p = 0.62). Simple pooling demonstrated significant association between increased BMI and blood loss.
Conclusions
Obesity was demonstrated to have an impact on overall complication rates in Anterior Lumbar Interbody Fusion procedures, with postoperative complications including wound infections and lower fusion rates more common in patients in increased BMIs.
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Affiliation(s)
- A Feeley
- Midlands Regional Hospital Tullamore, Tullamore, Ireland
| | - I Feeley
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Butler
- Mater Misericordiae University Hospital, Dublin, Ireland
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31
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Butler J. Die Befragung LISA II – Lebensqualität, Interessen und Selbstständigkeit im Alter – eine Befragung im Bezirk Mitte von Berlin. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732095] [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: 10/20/2022]
Affiliation(s)
- J Butler
- Bezirksamt Mitte von Berlin, Abteilung Stadtentwicklung, Soziales und Gesundheit
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32
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Schuster SJ, Dickinson M, Dreyling M, Martinez‐Lopez J, Kolstad A, Butler J, Ghosh M, Popplewell L, Chavez JC, Bachy E, Kato K, Harigae H, Kersten MJ, Andreadis C, Riedell PA, Abdelhady A, Zia A, Morisse MC, Fowler NH, Thieblemont C. EFFICACY AND SAFETY OF TISAGENLECLEUCEL (TISA‐CEL) IN ADULT PATIENTS (PTS) WITH RELAPSED/REFRACTORY FOLLICULAR LYMPHOMA (R/R FL): PRIMARY ANALYSIS OF THE PHASE 2 ELARA TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.85_2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S. J. Schuster
- Perelman Center for Advanced Medicine University of Pennsylvania Philadelphia USA
| | - M. Dickinson
- Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne Australia
| | - M. Dreyling
- Medizinische Klinik III, LMU Klinikum Munich Germany
| | - J. Martinez‐Lopez
- Hospital 12 De Octubre Madrid Complutense University CNIO Madrid Spain
| | - A. Kolstad
- Department of Oncology Oslo University Hospital Oslo Norway
| | - J. Butler
- Haematology and Bone Marrow Transplantation Royal Brisbane Hospital Herston Australia
| | - M. Ghosh
- Department of Internal Medicine Michigan Medicine University of Michigan Ann Arbor USA
| | - L. Popplewell
- Department of Hematology & Hematopoietic Cell Transplantation City of Hope National Medical Center Duarte USA
| | - J. C. Chavez
- Department of Malignant Hematology Moffitt Cancer Center Tampa USA
| | - E. Bachy
- Department of Hematology Hospices Civils de Lyon and Université Claude Bernard Lyon 1 Lyon France
| | - K. Kato
- Department of Hematology Kyushu University Hospital Fukuoka Japan
| | - H. Harigae
- Department of Hematology Tohoku University Hospital Sendai Japan
| | - M. José Kersten
- Cancer Center Amsterdam Amsterdam UMC University of Amsterdam on behalf of HOVON/LLPC Amsterdam Netherlands
| | - C. Andreadis
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco San Francisco USA
| | - P. A. Riedell
- Department of Medicine University of Chicago Chicago USA
| | - A. Abdelhady
- Oncology Novartis Pharmaceuticals Corporation East Hanover USA
| | - A. Zia
- Biostatistics Novartis Pharma AG Basel Switzerland
| | - M. C. Morisse
- Oncology Novartis Pharmaceuticals Corporation East Hanover USA
| | - N. H. Fowler
- MD Anderson Cancer Center The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - C. Thieblemont
- Department of Hemato‐Oncology Hôpital Saint‐Louis‐Université de Paris Paris France
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33
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Fowler NH, Dickinson M, Martinez‐Lopez J, Kolstad A, Schuster SJ, Dreyling M, Ghosh M, Harigae H, Kersten MJ, Bachy E, Popplewell L, Chavez JC, Ho PJ, Butler J, Kato K, Tresckow B, Ferreri AJM, Simón JAP, Patten PEM, Andreadis C, Riedell PA, McGuirk JP, Nastoupil LJ, Teshima T, Offner F, Petzer A, Viardot A, Zinzani PL, Malladi R, Zhang J, Tiwari R, Bollu V, Masood A, Thieblemont C. PATIENT‐REPORTED QUALITY OF LIFE (QOL) FOLLOWING TISAGENLECLEUCEL (TISA‐CEL) INFUSION IN ADULT PATIENTS (PTS) WITH RELAPSED/REFRACTORY FOLLICULAR LYMPHOMA (R/R FL). Hematol Oncol 2021. [DOI: 10.1002/hon.178_2880] [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]
Affiliation(s)
- N. H. Fowler
- The University of Texas MD Anderson Cancer Center Department of Lymphoma‐Myeloma Houston Texas USA
| | - M. Dickinson
- Royal Melbourne Hospital Peter MacCallum Cancer Centre Melbourne Australia
| | | | - A. Kolstad
- Oslo University Hospital Department of Oncology Oslo Norway
| | - S. J. Schuster
- University of Pennsylvania Lymphoma Program Philadelphia Pennsylvania USA
| | - M. Dreyling
- LMU Klinikum Medizinische Klinik III Munich Germany
| | - M. Ghosh
- University of Michigan Michigan Medicine Ann Arbor Michigan USA
| | - H. Harigae
- Tohoku University Hospital Department of Hematology and Rheumatology Sendai Japan
| | - M. José Kersten
- Amsterdam UMC University of Amsterdam on behalf of HOVON/LLPC Department of Hematology Amsterdam Netherlands
| | - E. Bachy
- Université Claude Bernard Lyon 1 Hospices Civils de Lyon Lyon France
| | - L. Popplewell
- City of Hope National Medical Center Department of Hematology & Hematopoietic Cell Transplantation Duarte California USA
| | - J. C. Chavez
- Moffitt Cancer Center Department of Malignant Hematology Tampa Florida USA
| | - P. J. Ho
- Royal Prince Alfred Hospital and University of Sydney Institute of Haematology Camperdown Australia
| | - J. Butler
- Royal Brisbane Hospital Haematology and Bone Marrow Transplant Unit Herston Australia
| | - K. Kato
- Kyushu University Hospital Hematology, Oncology, & Cardiovascular Medicine Fukuoka Japan
| | - B. Tresckow
- University Hospital Essen University of Duisburg‐Essen Clinic for Hematology and Stem Cell Transplantation West German Cancer Center Essen Germany
| | - A. J. M. Ferreri
- IRCCS Ospedale San Raffaele Department of Onco‐hematology Milan Italy
| | - J. A. P. Simón
- University Hospital Virgen del Rocío Instituto de Biomedicina de Sevilla (IBIS / CSIC / CIBERONC) Universidad de Sevilla Department of Hematology Sevilla Spain
| | - P. E. M. Patten
- King’s College Hospital and King’s College London Division of Cancer Studies London UK
| | - C. Andreadis
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center San Francisco California USA
| | - P. A. Riedell
- University of Chicago Medical Center Department of Medicine Chicago Illinois USA
| | - J. P. McGuirk
- University of Kansas Medical Center Division of Hematologic Malignancies and Cellular Therapeutics Kansas City Kansas USA
| | - L. J. Nastoupil
- The University of Texas MD Anderson Cancer Center Department of Lymphoma‐Myeloma Houston Texas USA
| | - T. Teshima
- Hokkaido University Hospital Department of Hematology Sapporo Japan
| | - F. Offner
- UZ Gent Department of Hematology Gent Belgium
| | - A. Petzer
- Ordensklinikum Linz GmbH Elisabethinen Internal Medicine I Linz Austria
| | - A. Viardot
- University Hospital of Ulm Department of Internal Medicine III Ulm Germany
| | - P. L. Zinzani
- University of Bologna Institute of Hematology “Seràgnoli” Bologna Italy
| | - R. Malladi
- Cambridge University Hospitals NHS Foundation Trust Centre for Clinical Haematology Cambridge UK
| | - J. Zhang
- Novartis Pharmaceuticals Corporation Global Value and Access East Hanover New Jersey USA
| | - R. Tiwari
- Novartis Healthcare Pvt. Ltd Biostatistics Hyderabad India
| | - V. Bollu
- Novartis Pharmaceuticals Corporation Health Economics and Outcomes Research East Hanover New Jersey USA
| | - A. Masood
- Novartis Pharmaceuticals Corporation Clinical Development East Hanover New Jersey USA
| | - C. Thieblemont
- Hôpital Saint‐Louis‐Université de Paris Service d'Hématologie‐Oncologie Paris France
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Kelly LA, O'Dea MI, Zareen Z, Melo AM, McKenna E, Strickland T, McEneaney V, Donoghue V, Boylan G, Sweetman D, Butler J, Vavasseur C, Miletin J, El-Khuffash AF, O'Neill LAJ, O'Leary JJ, Molloy EJ. Altered inflammasome activation in neonatal encephalopathy persists in childhood. Clin Exp Immunol 2021; 205:89-97. [PMID: 33768526 PMCID: PMC8209598 DOI: 10.1111/cei.13598] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/03/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022] Open
Abstract
Neonatal encephalopathy (NE) is characterized by altered neurological function in term infants and inflammation plays an important pathophysiological role. Inflammatory cytokines interleukin (IL)‐1β, IL‐1ra and IL‐18 are activated by the nucleotide‐binding and oligomerization domain (NOD)‐, leucine‐rich repeat domain (LRR)‐ and NOD‐like receptor protein 3 (NLRP3) inflammasome; furthermore, we aimed to examine the role of the inflammasome multiprotein complex involved in proinflammatory responses from the newborn period to childhood in NE. Cytokine concentrations were measured by multiplex enzyme‐linked immunosorbent assay (ELISA) in neonates and children with NE in the absence or presence of lipopolysaccharide (LPS) endotoxin. We then investigated expression of the NLRP3 inflammasome genes, NLRP3, IL‐1β and ASC by polymerase chain reaction (PCR). Serum samples from 40 NE patients at days 1 and 3 of the first week of life and in 37 patients at age 4–7 years were analysed. An increase in serum IL‐1ra and IL‐18 in neonates with NE on days 1 and 3 was observed compared to neonatal controls. IL‐1ra in NE was decreased to normal levels at school age, whereas serum IL‐18 in NE was even higher at school age compared to school age controls and NE in the first week of life. Percentage of LPS response was higher in newborns compared to school‐age NE. NLRP3 and IL‐1β gene expression were up‐regulated in the presence of LPS in NE neonates and NLRP3 gene expression remained up‐regulated at school age in NE patients compared to controls. Increased inflammasome activation in the first day of life in NE persists in childhood, and may increase the window for therapeutic intervention.
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Affiliation(s)
- L A Kelly
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - M I O'Dea
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - Z Zareen
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland.,Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland
| | - A M Melo
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - E McKenna
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - T Strickland
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - V McEneaney
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - V Donoghue
- Radiology, National Maternity Hospital, Dublin, Ireland
| | - G Boylan
- Department of Pediatrics and Child Health, University College Cork, Cork, Ireland.,Infant Research Centre, Cork University Hospital, Cork, Ireland
| | - D Sweetman
- National Maternity Hospital, Dublin, Ireland
| | - J Butler
- Meso-Scale Diagnostics, Manchester, UK
| | - C Vavasseur
- National Maternity Hospital, Dublin, Ireland
| | - J Miletin
- Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | - L A J O'Neill
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - J J O'Leary
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland
| | - E J Molloy
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin and Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland.,Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland.,Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland.,CHI at Crumlin, Dublin, Ireland
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Butler J, Welford T. 108 A Multidisciplinary Team Initiative to End PJ Paralysis Was Successful in Achieving Cultural Change on An Acute Geriatric Ward. Age Ageing 2021. [PMCID: PMC7989623 DOI: 10.1093/ageing/afab030.69] [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] Open
Abstract
Introduction Prolonged bedrest amongst the elderly causes deconditioning leading to; increased hospital length of stay, additional social costs and decreased quality of life. An audit on an acute geriatric ward in November 2018, found that over a third of patients medically fit (PMF) to sit out remained in bed all day. Therefore, a service development initiative was undertaken, addressing the misconception that keeping elderly patients in bed is safe, when in fact, unintentional harm results. Method In a root cause analysis, four main reasons for bedrest were identified: risk aversion, unknown function, widespread “bed is safe” culture and lack of equipment. The project tasked getting PMF out of bed each day and was audited daily from November 2018 to present, involving all members of the multi-disciplinary team (MDT) and using a “plan, do, study, act” approach. Results Initially, the project showed an increase in percentage of PMF sitting out each day, but this subsequently decreased with winter pressures. However, for a whole year (February 2019–February 2020) a sustained and significant improvement was achieved (64.3%–89.7%). The pre-COVID19 period (February–March 2020) saw fluctuations in PMF sitting out. Data collection halted during the COVID19 peak, although observationally most patients remained in bed. Auditing resumed from June 2020 (COVID19 recovery phase) which showed a steady increase in PMF out of bed, with recent figures surpassing pre-COVID19 levels (97.8%). Conclusion Cultural change takes time to embed and needs persistent reviewing by a dedicated and engaged MDT. Improvements were made through more accessible doctor’s advice, better MDT education and communication, daily feedback of data and sourcing additional equipment. Disruption to working patterns over the COVID19 period made this unachievable and the project lost impetus. In the COVID19 recovery phase, the specialized MDT reformed and worked successfully to restore the cultural change as evidenced by audited data.
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Affiliation(s)
- J Butler
- Kingston Hospital NHS Foundation Trust
| | - T Welford
- Kingston Hospital NHS Foundation Trust
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Shoeib M, Singh SA, James R, Butler J, Asif M, Kostoulas N, Kirk A, Bilancia R. P52.07 Nodal Disease and Pneumonectomy: Always a Bad Combination? A Single High Volume Centre Experience of Long Term Outcomes. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Butler J, Gregg L, Calam R, Wittkowski A. Exploring Staff Implementation of a Self-directed Parenting Intervention for Parents with Mental Health Difficulties. Community Ment Health J 2021; 57:247-261. [PMID: 32445074 PMCID: PMC7835308 DOI: 10.1007/s10597-020-00642-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 05/18/2020] [Indexed: 12/02/2022]
Abstract
Parents with mental health difficulties face significant barriers in accessing evidence-based parenting interventions. Self-directed approaches may be a destigmatising, accessible alternative. Evidence has suggested that Triple P Positive Parenting Programme's self-directed format is as effective as more time- and cost-intensive delivery methods. The aim of the current study was to establish whether staff were able to use this intervention with parents with mental health difficulties and to explore staff experiences of implementation. Triple P self-help workbooks were provided to practitioners across three teams. Data were collected regarding workbook uptake and use. Interviews with staff exploring their experiences of implementation were analysed using thematic analysis. Overall, 41 participants were recruited, of which 12 (29.27%) also consented to interviews. Overall, six practitioners (14.63%) reported that they utilised the workbook. Uptake and utilisation were varied, but practitioners who used the workbook reported positive outcomes. Interviews revealed themes regarding practitioner concerns, views of the intervention and implementation issues. Self-directed Triple remains a promising intervention but its feasibility is dependent on addressing barriers to implementation and facilitating a family-focused approach to meet the needs of these parents and their children.
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Affiliation(s)
- J Butler
- School of Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - L Gregg
- School of Health Sciences, University of Manchester, Manchester, UK
| | - R Calam
- School of Health Sciences, University of Manchester, Manchester, UK
| | - A Wittkowski
- School of Health Sciences, University of Manchester, Manchester, UK. .,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK. .,Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, England, UK.
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Sahgal A, Myrehaug S, Siva S, Masucci L, Foote M, Brundage M, Butler J, Chow E, Fehlings M, Gabos Z, Greenspoon J, Kerba M, Lee Y, Liu M, Maralani P, Thibault I, Wong R, Hum M, Ding K, Parulekar W. CCTG SC.24/TROG 17.06: A Randomized Phase II/III Study Comparing 24Gy in 2 Stereotactic Body Radiotherapy (SBRT) Fractions Versus 20Gy in 5 Conventional Palliative Radiotherapy (CRT) Fractions for Patients with Painful Spinal Metastases. Int J Radiat Oncol Biol Phys 2020; 108:1397-1398. [DOI: 10.1016/j.ijrobp.2020.09.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wisenberg G, Thiessen JD, Pavlovsky W, Butler J, Wilk B, Prato FS. Same day comparison of PET/CT and PET/MR in patients with cardiac sarcoidosis. J Nucl Cardiol 2020; 27:2118-2129. [PMID: 30603887 PMCID: PMC7749056 DOI: 10.1007/s12350-018-01578-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/11/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inflammatory cardiac disorders, in particular, sarcoidosis, play an important role in left ventricular dysfunction, conduction abnormalities, and arrhythmias. In this study, we compared the imaging characteristics and diagnostic information obtained when patients were imaged sequentially with PET/CT and then with hybrid PET/MRI on the same day following a single 18F-FDG injection. METHODS Ten patients with known or suspected sarcoidosis underwent imaging in sequence of (a) 99mTc-MIBI, (b) 18F-FDG with PET/CT, and (c) 18F-FDG with 3T PET/MRI. Images were compared quantitatively by determination of SUVmax and SUV on a voxel by voxel basis, and qualitatively by two experienced observers. RESULTS When both platforms were compared quantitatively, similar data for the evaluation of enhanced 18F-FDG uptake were obtained. Qualitatively, there were (1) several instances of normal perfusion with delayed enhancement and/or focal 18F-FDG uptake, (2) comparable enhanced 18F-FDG uptake on PET/CT vs. PET/MRI, and (3) diversity in disease patterns with delayed enhancement only, increased 18F-FDG uptake only, or both. CONCLUSION In this limited patient study, PET/CT and PET/MR provided similar diagnostic data for 18F-FDG uptake, and the concurrent acquisition of MR images provided further insight into the disease process.
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Affiliation(s)
- G Wisenberg
- Departments of Medicine, Medical Imaging, and Medical Biophysics, Western University, London, ON, Canada.
- MyHealth Centre, 21589 Richmond Street, Arva, ON, N0M 1C0, Canada.
| | - J D Thiessen
- Departments of Medical Biophysics, Medical Imaging and Physics and Astronomy, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - W Pavlovsky
- Department of Medical Imaging, Western University, London, ON, Canada
| | - J Butler
- Division of Nuclear Medicine, St. Joseph's Hospital, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - B Wilk
- Lawson Health Research Institute, London, ON, Canada
| | - F S Prato
- Departments of Medical Biophysics, Medical Imaging and Physics and Astronomy, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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Verma S, Mazer C, Inzucchi S, Wanner C, Ofstad A, Johansen O, Zwiener I, George J, Butler J, Zinman B. Impact of polyvascular disease and renal dysfunction on cardiovascular outcomes in diabetes: post hoc analyses from EMPA-REG OUTCOME. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3352] [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: 11/12/2022] Open
Abstract
Abstract
Background
Individuals with polyvascular disease and impaired renal function are at high risk of cardiovascular (CV) events, but this relationship is not well investigated in people with type 2 diabetes (T2D). Furthermore, the impact of polyvascular disease plus renal dysfunction on the risk for hospitalisation for heart failure (HHF) remains unclear.
Purpose
We investigated this in a post hoc analysis of the EMPA-REG OUTCOME trial in which empagliflozin reduced risk of CV death and HHF versus placebo in people with T2D and vascular disease. In addition, we explored the treatment effect of empagliflozin on CV, HF and mortality outcomes across the spectrum of baseline polyvascular disease and impaired renal function.
Methods
Patients with T2D, CV disease and estimated glomerular filtration rate (eGFR) of ≥30 ml/min/1.73 m2 received empagliflozin 10 mg, 25 mg, or placebo. Vascular beds (VBs) were defined as coronary artery disease, peripheral artery disease, and cerebrovascular disease (Fig). By use of Cox regression, we explored the association between baseline eGFR < or ≥60 ml/min/1.73 m2, with or without polyvascular disease (1 vs ≥2 VBs involved), and CV death, HHF, CV death (excl. fatal stroke)/HHF, and all-cause mortality (ACM), as well as the treatment effect of empagliflozin versus placebo on these outcomes.
Results
Patients with ≥2 VBs involved and eGFR <60 ml/min/1.73 m2 [n=463], were slightly older (mean age 68.2 vs. 64.3 or 62.6 years), had T2D duration >10 years more often (73.4% vs. 63.2% or 54.9%), and a higher HF prevalence at baseline (19.4% vs. 11.1% or 9.2%) versus those with ≥2 VBs involved and eGFR ≥60 ml/min/1.73 m2 [n=866], or those with only 1 VB involved regardless of eGFR [n=5630], respectively. However, characteristics were generally balanced between treatment groups. Notably, co-existing polyvascular disease and eGFR <60 ml/min/1.73 m2 was strongly associated with increased risk of all outcomes. The placebo incidence rates per 1000 patient-years for CV death were 14.4 (95% CI 10.9, 18.3) and 19.6 (12.8, 27.8) in those with 1 VB involved and eGFR ≥60 or eGFR <60, respectively, and 32.7 (21.7, 45.8), and 52.4 (32.9, 76.5) in those with 2 VBs and eGFR ≥60 or eGFR <60 ml/min/1.73 m2, respectively. Importantly, empagliflozin reduced the risk for all outcomes regardless of number of VBs affected and kidney function (Fig).
Conclusions
Co-existing polyvascular disease and eGFR <60 ml/min/1.73 m2 confer an extremely high risk of CV and all-cause mortality, and HHF. Empagliflozin lowered this risk consistently compared with placebo, regardless of polyvascular disease and impaired kidney function.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance
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Affiliation(s)
- S Verma
- St Michael's Hospital, Division of Cardiac Surgery, University of Toronto, Toronto, Canada
| | - C.D Mazer
- St. Michael's Hospital, Department of Anesthesia, Toronto, Canada
| | - S.E Inzucchi
- Yale University School of Medicine, New Haven, United States of America
| | - C Wanner
- Würzburg University Clinic, Würzburg, Germany
| | - A.P Ofstad
- Boehringer Ingelheim Norway Ks, Asker, Norway
| | | | - I Zwiener
- Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - J.T George
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - J Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, United States of America
| | - B Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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Johnston M, Butler J, Clark H, Locock L, Murray AD, Robertson L, Hannaford P, Iversen L, Skea Z, Black C. Co-design of data collection with participants of the Aberdeen Children of the 1950s cohort study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Aberdeen Children of the 1950s (ACONF) cohort comprises 12,150 people born in Scotland in the 50s. It contains rich early life data, questionnaire data from mid-life and linked electronic health records. Involving participants in designing future data collection is key to ensure research is acceptable and reflects public priorities.
Aim
Gather ACONF members views to inform how to: research healthy ageing, optimise recruitment and maximise participation.
Methods
3 co-design workshops with 30 ACONF members. A discussion was led by a facilitator using guidance questions developed by the study team. Workshops were recorded and transcribed.
Results
Participants viewed healthy ageing as keeping socially and physically active, taking responsibility for oneself and having a positive attitude to ageing. Research priorities were dementia, improvements in the social care system and engaging hard-to-reach groups. Members were keen for future research involvement. Recruitment may be maximised by: more information online, involving participants in recruiting other study members and clarity about potential benefits to themselves or others. It was acceptable to ask their offspring to participate. There were high levels of trust in researchers, but ongoing data protection is vital. Participation may be improved by regular contact (informing members of results, engagement events, phone “apps”). Participants viewed various data collection methods (questionnaires, applications, wearable devices, in-person tests, DNA collection and electronic record linkage) as acceptable.
Conclusions
Participant involvement is a fundamental part of securing a social license for research. Participants were in favour of ongoing research, including recruitment of their children. The workshops highlighted key considerations for future research and data collection.
Key messages
Co-design is vital for highlighting research topics which are important and relevant to the general population. Co-design can highlight strategies for maximising research participation and securing a social license for research.
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Affiliation(s)
- M Johnston
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | - J Butler
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | - H Clark
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - L Locock
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - A D Murray
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - L Robertson
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | - P Hannaford
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - L Iversen
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Z Skea
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - C Black
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
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Hughes H, Macken M, Butler J, Synnott K. Uncomfortably numb: suicide and the psychological undercurrent of COVID-19. Ir J Psychol Med 2020; 37:159-160. [PMID: 32436491 PMCID: PMC7332752 DOI: 10.1017/ipm.2020.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/16/2020] [Indexed: 11/14/2022]
Affiliation(s)
- H. Hughes
- Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - M. Macken
- Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - J. Butler
- Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - K. Synnott
- Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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Kim JO, Hanumanthappa N, Chung YT, Beck J, Koul R, Bashir B, Cooke A, Dubey A, Butler J, Nashed M, Hunter W, Ong A. Does dissemination of guidelines alone increase the use of palliative single-fraction radiotherapy? Initial report of a longitudinal change management campaign at a provincial cancer program. Curr Oncol 2020; 27:190-197. [PMID: 32905177 PMCID: PMC7467795 DOI: 10.3747/co.27.6193] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Despite level 1 evidence demonstrating the equivalence of single-fraction radiotherapy (sfrt) and multiple-fraction radiotherapy (mfrt) for the palliation of painful bone metastases, sfrt remains underused. In 2015, to encourage the sustainable use of palliative radiation oncology resources, CancerCare Manitoba disseminated, to each radiation oncologist in Manitoba, guidelines from Choosing Wisely Canada (cwc) that recommend sfrt. We assessed whether dissemination of the guidelines influenced sfrt use in Manitoba in 2016, and we identified factors associated with mfrt. Methods All patients treated with palliative radiotherapy for bone metastasis in Manitoba from 1 January 2016 to 31 December 2016 were identified from the provincial radiotherapy database. Patient, treatment, and disease characteristics were extracted from the electronic medical record and tabulated by fractionation schedule. Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with mfrt. Results In 2016, 807 patients (mean age: 70 years; range: 35-96 years) received palliative radiotherapy for bone metastasis, with 69% of the patients having uncomplicated bone metastasis. The most common primary malignancies were prostate (27.1%), lung (20.6%), and breast cancer (15.9%). In 62% of cases, mfrt was used-a proportion that was unchanged from 2015. On multivariable analysis, a gastrointestinal [odds ratio (or): 5.3] or lung primary (or: 3.3), complicated bone metastasis (or: 4.3), and treatment at a subsidiary site (or: 4.4) increased the odds of mfrt use. Conclusions Dissemination of cwc recommendations alone did not increase sfrt use by radiation oncologists in 2016. A more comprehensive knowledge translation effort is therefore warranted and is now underway to encourage increased uptake of sfrt in Manitoba.
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Affiliation(s)
- J O Kim
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | | | - Y T Chung
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg
| | - J Beck
- Medical Physics, CancerCare Manitoba, Winnipeg
| | - R Koul
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - B Bashir
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - A Cooke
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - A Dubey
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - J Butler
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - M Nashed
- Radiation Oncology, CancerCare Manitoba, Winnipeg
| | - W Hunter
- Radiation Oncology, Western Manitoba Cancer Centre, Brandon, MB
| | - A Ong
- Radiation Oncology, CancerCare Manitoba, Winnipeg
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Valakos D, d'Avossa G, Mylonas D, Butler J, Klein C, Smyrnis N. P300 response modulation reflects breaches of non-probabilistic expectations. Sci Rep 2020; 10:10254. [PMID: 32581245 PMCID: PMC7314850 DOI: 10.1038/s41598-020-67275-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/07/2020] [Indexed: 11/09/2022] Open
Abstract
In oddball paradigms, infrequent stimuli elicit larger P300 event related potentials (ERPs) than frequent ones. One hypothesis is that P300 modulations reflect the degree of “surprise” associated with unexpected stimuli. That is the P300 represents how unlikely the stimulus is and this signal is then used to update the observer’s expectations. It could be hypothesized that P300 is modulated by any factor affecting an observer’s expectations, not only target probability. Alternatively, the P300 may reflect an evaluative process engaged whenever a discrepancy between task context and sensory inputs arises, irrespective of the latter probability. In previous ERP studies, stimulus probability was often the only determinant of task set confounding the effects of stimulus probability and set stimulus discrepancy. In this study, we used a speeded luminance detection task. The target was preceded by a central cue that predicted its location. The probability that the target was valid, i.e. would appear at the cued location was manipulated by varying the reliability of the cue. Reaction times were modulated by probabilistic expectations based on cue reliability and target validity while P300 was affected by target validity only. We conclude that increased P300 amplitude reflects primarily breaches of non-probabilistic expectations, rather than target probability.
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Affiliation(s)
- D Valakos
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece.,Faculty of Biology, National and Kapodistrian University of Athens, Panepistimioupoli Zografou, Athens, Greece
| | - G d'Avossa
- Department of Psychology, Bangor University, Bangor, UK
| | - D Mylonas
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - J Butler
- School of Psychology, Faculty of Health and Wellbeing, University of Sunderland, Sunderland, UK
| | - C Klein
- Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece.,Department of Child and Adolescent Psychiatry, University of Freiburg, Freiburg, Germany.,Department of Child and Adolescent Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | - N Smyrnis
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece. .,Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece.
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Butler J, Gregg L, Calam R, Wittkowski A. Parents' Perceptions and Experiences of Parenting Programmes: A Systematic Review and Metasynthesis of the Qualitative Literature. Clin Child Fam Psychol Rev 2020; 23:176-204. [PMID: 31820298 PMCID: PMC7192883 DOI: 10.1007/s10567-019-00307-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
Supporting parents to meet the challenges of their caregiving role is identified as a public health concern and a priority in policies internationally. Quantitative research has established the efficacy of parenting programmes but less is understood about the key aspects that make interventions meaningful and helpful to families. We aimed to explore parents' experiences and perceptions of parenting programmes in order to highlight the parent voice and identify key factors that parents perceive to be meaningful and improve our understanding of the acceptability and perceived benefits of parenting programmes. Six key electronic databases were searched systematically for qualitative research and eligibility for inclusion was established. A thematic synthesis was undertaken. Twenty-six studies were included, spanning 17 years of parenting research and involving 822 parents. Three main themes and nine subthemes were identified: (1) a family's journey (prior to the parenting programme, outcomes (including changes in the parent, child and wider family) and post-intervention), (2) aspects perceived to be important or valuable (group leader or facilitator, programme content and delivery and value of the group) and (3) challenges or difficulties (barriers to engagement or attendance, programme content and suggestions for improvement). Reported outcomes of parenting programmes included changes in the parent alongside changes in the child and family more widely. Key recommendations to improve provision of accessible, clinically and cost-effective interventions for parents include ensuring high-quality training and supervision of facilitators, balancing flexibility and fidelity to ensure tailored content to meet individual needs, a sensitivity to parental adversity, the need for wider familial support and the availability of ongoing support following the end of a parenting programme.
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Affiliation(s)
- J Butler
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, England, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - L Gregg
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, England, UK
| | - R Calam
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, England, UK
| | - A Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester, M13 9PL, England, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Singla R, Wall D, Anderson S, Zia N, Korte J, Kravets L, McKiernan G, Butler J, Gammilonghi A, Arora J, Wright M, Solomon B, Hicks R, Cain T, Darcy P, Cullinane C, Neeson P, Ramanathan R, Shukla R, Bansal V, Harrison S. First in Human Study of In-vivo Imaging of Ex-Vivo Labelled CAR T Cells with Dual PET-MR. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.04.074] [Citation(s) in RCA: 1] [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: 10/24/2022]
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Tweed K, Agrawal B, Messer S, Clements L, Butler J, Catarino P, Large S. Feasibility of Coronary Computed Tomography Angiography Assessment of Explanted Donor Hearts. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Fitzgerald E, Foley D, McNamara R, Barrett E, Boylan C, Butler J, Morgan S, Okafor I. Trends in Mental Health Presentations to a Paediatric Emergency Department. Ir Med J 2020; 113:20. [PMID: 32401083] [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: 06/11/2023]
Abstract
Aims This study aimed to analyse trends in mental health presentations to the Emergency Department (ED), which anecdotally had increased over the past decade. Methods The ED's electronic 'Symphony' system was used to identify the annual number of presentations categorised as having a mental health complaint from 2006-2017. A detailed analysis was performed on presentations over a one-year period. Results The number of presentations increased from 69 in 2006 to a peak of 432 in 2016 (526% increase). The overall admission rate was 33.3%(n=99), while 52.5%(n=156) of presentations occurred outside of standard working hours. Similar increases were documented by other ED's worldwide, and the WHO estimate that neuropsychiatric disorders will become one of the top five causes of morbidity, mortality and disability among children by 2020. Conclusion With the number of mental health presentations dramatically increasing, carefully designed and integrated strategies are required to pro-actively tackle this growing epidemic.
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Affiliation(s)
- E Fitzgerald
- Emergency Department, Children's University Hospital, Temple Street, Dublin
| | - D Foley
- Emergency Department, Children's University Hospital, Temple Street, Dublin
| | - R McNamara
- Emergency Department, Children's University Hospital, Temple Street, Dublin
| | - E Barrett
- Department of Psychiatry, Children's University Hospital, Temple Street, Dublin
| | - C Boylan
- Department of Psychiatry, Children's University Hospital, Temple Street, Dublin
| | - J Butler
- Department of Psychiatry, Children's University Hospital, Temple Street, Dublin
| | - S Morgan
- St. Patrick's University Hospital, Dublin
| | - I Okafor
- Emergency Department, Children's University Hospital, Temple Street, Dublin
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Gogna S, Latifi R, Policastro A, Prabhakaran K, Anderson P, Con J, Choi J, Samson DJ, Butler J. Complex abdominal wall hernia repair with biologic mesh in elderly: a propensity matched analysis. Hernia 2020; 24:495-502. [PMID: 31981009 PMCID: PMC7223233 DOI: 10.1007/s10029-019-02068-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/04/2019] [Indexed: 12/18/2022]
Abstract
Background Complex abdominal wall reconstruction (CAWR) has become a common surgical procedure both in non-elderly and elderly patients. Objective The aim of this study is to analyze the outcomes of the elderly compared to nonelderly undergoing CAWR using propensity score matching. Methods All patients who underwent CAWR using porcine-derived, non-crosslinked acellular dermal matrix (ADM) (Strattice™) between January 2014 and July 2017 were studied retrospectively. Propensity matched analysis was performed for risk adjustment in multivariable analysis and for one-to-one matching. The outcomes were analyzed for differences in postoperative complications, reoperations, mortality, hospital length of stay and adverse discharge disposition. Results One hundred-thirty-six patients were identified during the study period. Non-elderly (aged 18–64 years) constituted 70% (n = 95) and elderly (aged ≥ 65 years) comprised 30% of the overall patient population (n = 41). Seventy-three (56.7%) were females. After adjustment through the propensity score, which included 35 pairs, the surgical site infection (p = 1.000), wound necrosis (p = 1.000), the need for mechanical ventilation (p = 0.259), mortality (p = 0.083), reoperation rate (p = 0.141), hospital length of stay (p = 0.206), and discharge disposition (p = 0.795) were similar. Conclusion Elderly patients undergoing CAWR with biological mesh have comparable outcomes with non-elderly patients when using propensity matching score.
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Affiliation(s)
- S Gogna
- Department of Surgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Taylor Pavilion, E-348, Valhalla, NY, 10595, USA
| | - R Latifi
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY, 10595, USA.
| | - A Policastro
- Medical Director SICU, PCU, Trauma and Critical Care, Department of Surgery, Westchester Medical center, School of Medicine, New York Medical College, 100 Woods Road, Taylor Pavilion, Office E-136, Valhalla, NY, 10595, USA
| | - K Prabhakaran
- Division of Trauma, Acute Care Surgery and Burns, Department of Surgery, Westchester Medical center, School of Medicine, New York Medical College, 100 Woods Road, Taylor Pavilion, Office E-150, Valhalla, NY, 10595, USA
| | - P Anderson
- Trauma Intensive Care Unit, Department of Surgery, Westchester Medical center, School of Medicine, New York Medical College, 100 Woods Road, Taylor Pavilion, Office E-145, Valhalla, NY, 10595, USA
| | - J Con
- Department of Surgery, Westchester Medical center, School of Medicine, New York Medical College, 100 Woods Road, Taylor Pavilion, E-131, Office #E145, Valhalla, NY, 10595, USA
| | - J Choi
- Department of Surgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Taylor Pavilion, E-348, Valhalla, NY, 10595, USA
| | - D J Samson
- Department of Surgery, Clinical Research Unit, Westchester Medical Center, 100 Woods Road, Taylor Pavilion, Office E-348, Valhalla, NY, 10595, USA
| | - J Butler
- Clinical Research Unit, Westchester Medical Center, 100 Woods Road, Taylor Pavilion, Office E-348, Valhalla, NY, 10595, USA
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Sharma A, Butler J, Zieroth S, Giannetti N, Verma S. Treatment of heart failure with sodium glucose co-transporter-2 inhibitors in people with type 2 diabetes mellitus: current evidence and future directions. Diabet Med 2019; 36:1550-1561. [PMID: 31536660 DOI: 10.1111/dme.14140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Accepted: 09/16/2019] [Indexed: 12/16/2022]
Abstract
Diabetes is one the most common comorbidities among people with established heart failure. Interest in heart failure as an outcome among people with diabetes has emerged since it was shown that there was an association between increased risk of hospitalization for heart failure with use of thiazolidinediones and some dipeptidyl peptidase-4 inhibitors. Recently, sodium-glucose co-transporter-2 inhibitors were shown to lead to a reduction in the risk of cardiovascular death and hospitalization for heart failure in people with Type 2 diabetes mellitus and either cardiovascular risk factors or atherosclerotic cardiovascular disease. These findings appear to be consistent in people both with and without a baseline history of heart failure. Based on current evidence there are several clinical scenarios in which the use of sodium-glucose co-transporter-2 inhibitors would be justified for people with heart failure and atherosclerotic cardiovascular disease: (1) in people with a new diagnosis of Type 2 diabetes and for whom anti-hyperglycaemic management strategies are being considered; (2) in people with sub-optimal glycaemic control, regardless of baseline antihyperglycaemic therapy; and (3) in people with symptomatic heart failure (or other high-risk features such as recent hospitalization for heart failure), if glycaemic control is optimized and the individual is on a sulfonylurea or dipeptidyl peptidase-4 inhibitor; here, it may be reasonable to consider substituting one of those therapies for a sodium-glucose co-transporter-2 inhibitor. There are now a number of ongoing trials evaluating the role of sodium-glucose co-transporter-2 inhibitors as therapy for people with established heart failure (with preserved or with reduced ejection fraction) and regardless of the presence of diabetes. These trials will provide the evidence for the safety and efficacy of sodium-glucose co-transporter-2 inhibitors among people with established heart failure.
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Affiliation(s)
- A Sharma
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada
| | - J Butler
- Department of Medicine, University of Mississippi Medical Centre, Jackson, MI, USA
| | - S Zieroth
- Department of Medicine, St Boniface Hospital, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - N Giannetti
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada
| | - S Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
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