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Hudson D, Lakhani R, MacDonald J, Chande N, McDonald JW. A177 METHOTREXATE FOR THE INDUCTION OF REMISSION IN ULCERATIVE COLITIS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.175] [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
Obtaining steroid-free remission in Ulcerative Colitis (UC) is a clinically important parameter that can mitigate the development of disease-related complications and lead to improved quality of life.
Aims
A systematic review to assess the effects and safety of methotrexate for induction in patients with UC.
Methods
MEDLINE, EMBASE, CENTRAL were searched from inception to August 20, 2020. Randomized controlled trials (RCTs) comparing methotrexate with placebo or an active comparator in patients with active ulcerative colitis were considered for inclusion. The primary outcome measure was the proportion of patients who achieved clinical remission and withdrawal from steroids as defined by the studies and expressed as a percentage of the total number of patients randomized (intention-to-treat analysis). The overall quality of the evidence supporting the primary outcome was assessed using the GRADE criteria.
Results
Three studies (n=212) were included in the review. Two studies were randomized controlled trials comparing methotrexate to placebo for induction of remission of active ulcerative colitis. The first study (n = 67) compared oral methotrexate (12.5 mg/week) to placebo. Forty-seven percent (14/30) of methotrexate patients achieved clinical remission and complete withdrawal from steroids during the study period compared to 49% (18/37) of placebo patients (RR 0.96, 95% CI 0.58 to 1.59). A GRADE analysis indicated that the overall quality of the evidence supporting this outcome was low due to very sparse data. The second study (n=111) compared subcutaneous/intramuscular methotrexate 25 mg/week to placebo. The primary outcome, steroid-free remission at week 16, was present in 32% (19/60) of patients on methotrexate in comparison to 20%(10/51) of patients in the placebo arm (RR 1.62; 95% CI 0.83 to 3.15; P-value of 0.15). A GRADE analysis indicated downgrading of the evidence to low given very sparse data (29 events). An additional head-to-head randomised controlled study (n = 34) compared oral methotrexate (15 mg/week) to 6-mercaptopurine (1.5 mg/kg/day) and 5-aminosalicylic acid (3 g/day). This final study was judged to be at high risk of bias due to an open-label design. At 30 weeks, 58% (7/12) of methotrexate patients achieved clinical remission and withdrawal from steroids compared to 79% (11/14) of 6-mercaptopurine patients (RR 0.74, 95% CI 0.43 to 1.29) and 25% (2/8) of 5-aminosalicylic acid patients (RR 2.33, 95% CI 0.64 to 8.49). GRADE analyses indicated that the overall quality of the evidence was very low due to very sparse data and high risk of bias.
Conclusions
Methotrexate demonstrated no benefit over placebo or active comparators for the induction of steroid-free remission. Future research is ongoing to explore the utility of combination therapy with monoclonal antibody biologic therapy for the treatment of active ulcerative colitis.
Funding Agencies
None
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Affiliation(s)
- D Hudson
- The University of Western Ontario, London, ON, Canada
| | - R Lakhani
- The University of Western Ontario, London, ON, Canada
| | | | - N Chande
- The University of Western Ontario, London, ON, Canada
| | - J W McDonald
- The University of Western Ontario, London, ON, Canada
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Thiex NJ, Anderson S, Gildemeister B, Adcock W, Boedigheimer J, Bogren E, Coffin R, Conway K, DeBaker A, Frankenius E, Gramse M, Hogan P, Knese T, MacDonald J, M�ller J, Royle R, Russell M, Shafiee F, Shreve B, Sieh J, Spann M, Töpler E, Watts M. Crude Fat, Diethyl Ether Extraction, in Feed, Cereal Grain, and Forage (Randall/Soxtec/Submersion Method): Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.5.888] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [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
A method for determining crude fat in animal feed, cereal grain, and forage (plant tissue) was collaboratively studied. Crude fat was extracted from the animal feed, cereal grain, or forage material with diethyl ether by the Randall method, also called the Soxtec method or the submersion method. The proposed submersion method considerably decreases the extraction time required to complete a batch of samples. The increase in throughput is very desirable in the quest for faster turnaround times and the greater efficiency in the use of labor. In addition, this method provides for reclamation of the solvent as a step of the method. The submersion method for fat extraction was previously studied for meat and meat products and was accepted as AOAC Official Method 991.36. Fourteen blind samples were sent to 12 collaborators in the United States, Sweden, Canada, and Germany. The within-laboratory relative standard deviation (repeatability) ranged from 1.09 to 9.26% for crude fat. Among-laboratory (including within) relative standard deviation (reproducibility) ranged from 1.0 to 21.0%. The method is recommended for Official First Action.
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Affiliation(s)
- Nancy J Thiex
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
| | | | - Bryan Gildemeister
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
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Thiex NJ, Anderson S, Gildemeister B, Adcock W, Boedigheimer J, Bogren E, Coffin R, Conway K, DeBaker A, Frankenius E, Gramse M, Hogan P, Knese T, MacDonald J, M�ller J, Royle R, Russell M, Shafiee F, Shreve B, Sieh J, Spann M, Töpler E, Watts M. Crude Fat, Hexanes Extraction, in Feed, Cereal Grain, and Forage (Randall/Soxtec/Submersion Method): Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.5.899] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [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
A method for determining crude fat in animal feed, cereal grain, and forage (plant tissue) was collaboratively studied. Crude fat was extracted from the animal feed, cereal grain, or forage material with hexanes by the Randall method, also called the Soxtec method or the submersion method. The use of hexanes provides for an alternative to diethyl ether for fat extractions. The proposed submersion method considerably decreases the extraction time required to complete a batch of samples compared to Soxhlet. The increase in throughput is very desirable in the quest for faster turnaround times and the greater efficiency in the use of labor. In addition, this method provides for reclamation of the solvent as a step of the method. The submersion method for fat extraction was previously studied for meat and meat products and was accepted as AOAC Official Method 991.36. Fourteen blind samples were sent to 14 collaborators in the United States, Sweden, Canada, and Germany. The within-laboratory relative standard deviation (repeatability) ranged from 1.23 to 5.80% for crude fat. Among-laboratory (including within) relative standard deviation (reproducibility) ranged from 1.88 to 14.1%. The method is recommended for Official First Action.
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Affiliation(s)
- Nancy J Thiex
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
| | | | - Bryan Gildemeister
- South Dakota State University, Oscar E. Olson Biochemistry Laboratories, Box 2170, ASC 151, Brookings, SD 57007
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MacDonald A, Pinto A, Evans S, Ashmore C, MacDonald J, Daly A. Home delivery service of low protein foods in inherited metabolic disorders: Does it help? Mol Genet Metab Rep 2019; 19:100466. [PMID: 30963029 PMCID: PMC6434332 DOI: 10.1016/j.ymgmr.2019.100466] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/16/2019] [Indexed: 11/27/2022] Open
Abstract
Background In the UK, the customary method of obtaining special low protein (LP) foods was by dispensing through a pharmacist (until 2010) for patients with inherited metabolic disorders (IMD) requiring LP diets. Recently, different home delivery services have been introduced to support patient access of low protein foods, but the effectiveness of these services is unclear. Aim A prospective, longitudinal, observational study to examine the effectiveness and safety of patient home delivery services for LP foods over 12 months in IMD patients requiring a LP diet. Methods IMD patients/caregivers had the choice of 2 home delivery services (Homeward® and Vitaflo at Home®) as well as access to primary care pharmacy services. Both home delivery services provided a limited range of LP foods. Over a 12-month period, a member of the IMD dietetic team conducted 4 home visits to IMD patients on LP diets using home delivery services for low protein foods. At each visit, caregivers completed a questionnaire consisting of 20 multiple choice and open questions about their prescription experience with special LP foods. The researchers also completed stock checks, assessed 'use by dates' and adequacy of home storage for LP foods. Results In total, 58 patients participated in this study. Over 12 months, 95% (n = 55/58) of caregivers used their local pharmacy, 93% (n = 54/58) Homeward® and 78% (n = 45/58) Vitaflo at Home® to access LP foods. Two home delivery services were used by 41 (71%) caregivers and the remaining 17 (29%) only used one of the home delivery service companies. Each patient only stored a median of 6 (range 0-22) different LP foods at home. Overall, 45% (n = 26/58) of caregivers reported problems with their GP prescriptions. 30% (n = 16/53) of caregivers received at least one incorrect prescription when using their pharmacy (e.g. gluten-free foods instead of LP, incorrect product or incorrect product amount), 6% errors (n = 3/53) with Homeward® and 2% (n = 1/48) with Vitaflo at Home®. 49% (n = 26/53) of caregivers said they experienced delayed receipt of LP foods from their pharmacy, compared with 11% (n = 6/55) from Homeward® and 8% (n = 4/48) Vitaflo at Home®. Conclusions Although home delivery services for special LP foods are associated with less errors and delay compared with pharmacies, inaccuracies and inefficiencies still occur and the overall system is complex. We suggest a new, simpler, less fragmented system whereby metabolic dietitians prescribe LP foods. This is likely to result in less burden on NHS resources and ensure a better treatment delivered to IMD patients.
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Affiliation(s)
- A MacDonald
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - A Pinto
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - S Evans
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - C Ashmore
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - J MacDonald
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - A Daly
- Birmingham Women's and Children's Hospital, Birmingham, UK
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MacDonald J, Heisler C, Otley A, Currie B, Phalen-Kelly K, Jones J. A206 INVESTIGATING IBD TRANSITION READINESS AND FAMILY DYNAMICS: THE ADOLESCENT AND PRIMARY CAREGIVER PERSPECTIVE. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - C Heisler
- Gastroenterology, Research Services, QEII Health Sciences Centre, Halifax, NS, Canada
| | - A Otley
- Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - B Currie
- QEII Health Sciences Centre, Halifax, NS, Canada
| | - K Phalen-Kelly
- Gastroenterology, Research Services, QEII Health Sciences Centre, Halifax, NS, Canada
| | - J Jones
- Medicine, Dalhousie University, Halifax, NS, Canada
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Muddiman E, Bullock AD, Hampton JM, Allery L, MacDonald J, Webb KL, Pugsley L. Disciplinary boundaries and integrating care: using Q-methodology to understand trainee views on being a good doctor. BMC Med Educ 2019; 19:59. [PMID: 30770777 PMCID: PMC6377780 DOI: 10.1186/s12909-019-1493-2] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/12/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND Rising numbers of patients with multiple-conditions and complex care needs mean that it is increasingly important for doctors from different specialty areas to work together, alongside other members of the multi-disciplinary team, to provide patient centred care. However, intra-professional boundaries and silos within the medical profession may challenge holistic approaches to patient care. METHODS We used Q methodology to examine how postgraduate trainees (n = 38) on a range of different specialty programmes in England and Wales could be grouped based on their rankings of 40 statements about 'being a good doctor'. Themes covered in the Q-set include: generalism (breadth) and specialism (depth), interdisciplinarity and multidisciplinary team working, patient-centredness, and managing complex care needs. RESULTS A by-person factor analysis enabled us to map distinct perspectives within our participant group (P-set). Despite high levels of overall commonality, three groups of trainees emerged, each with a clear perspective on being a good doctor. We describe the first group as 'generalists': team-players with a collegial and patient-centred approach to their role. The second group of 'general specialists' aspired to be specialists but with a generalist and patient-centred approach to care within their specialty area. Both these two groups can be contrasted to those in the third 'specialist' group, who had a more singular focus on how their specialty can help the patient. CONCLUSIONS Whilst distinct, the priorities and values of trainees in this study share some important aspects. The results of our Q-sort analysis suggest that it may be helpful to understand the relationship between generalism and specialism as less of a dichotomy and more of a continuum that transcends primary and secondary care settings. A nuanced understanding of trainee views on being a good doctor, across different specialties, may help us to bridge gaps and foster interdisciplinary working.
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Affiliation(s)
- E Muddiman
- Cardiff University School of Social Sciences, Cardiff, UK.
| | - A D Bullock
- Cardiff University School of Social Sciences, Cardiff, UK
| | - J M Hampton
- Cardiff University School of Social Sciences, Cardiff, UK
| | - L Allery
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
| | - J MacDonald
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
| | - K L Webb
- Cardiff University School of Social Sciences, Cardiff, UK
| | - L Pugsley
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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MacDonald J, Drewnoski M, Carlson Z. 276 Systems approaches to beef cattle production: maximizing use of alternative forages to optimize agricultural ecosystems. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J MacDonald
- University of Nebraska - Lincoln,Lincoln, NE, United States
| | - M Drewnoski
- University of Nebraska - Lincoln,Lincoln, NE, United States
| | - Z Carlson
- University of Nebraska - Lincoln,Lincoln, NE, United States
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Currie K, King C, McAloney-Kocaman K, Roberts NJ, MacDonald J, Dickson A, Cairns S, Khanna N, Flowers P, Reilly J, Price L. Barriers and enablers to meticillin-resistant Staphylococcus aureus admission screening in hospitals: a mixed-methods study. J Hosp Infect 2018; 101:100-108. [PMID: 30098382 DOI: 10.1016/j.jhin.2018.08.006] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND To reduce the risk of transmission of meticillin-resistant Staphylococcus aureus (MRSA), international guidelines recommend admission screening to identify hospital patients at risk of colonization. However, routine monitoring indicates that optimum screening compliance levels are not always achieved. In order to enhance compliance, we must better understand those factors which influence staff screening behaviours. AIM To identify factors which influence staff compliance with hospital MRSA screening policies. METHODS A sequential two-stage mixed-methods design applied constructs from normalization process theory and the theoretical domains framework to guide data collection and analysis. Initial qualitative findings informed subsequent development of a national cross-sectional survey of nursing staff (N = 450). Multiple regression modelling identified which barriers and enablers best predict staff compliance. FINDINGS Three factors were significant in predicting optimum (>90%) compliance with MRSA screening: having MRSA screening routinized within the admission process; category of clinical area; feedback of MRSA screening compliance within the clinical area. Integration of data-sets indicated that organizational systems which 'make doing the right thing easy' influence compliance, as does local ward culture. Embedded values and beliefs regarding the relative (de)prioritization of MRSA screening are important. CONCLUSION To our knowledge, this is the first study to provide original evidence of barriers and enablers to MRSA screening, applying both sociological and psychological theory. As antimicrobial resistance is a global health concern, these findings have international relevance for screening programmes. Future policy recommendations or behaviour change interventions, based on the insights presented here, could have significant impact upon improving screening compliance.
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Affiliation(s)
- K Currie
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK.
| | - C King
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - K McAloney-Kocaman
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - N J Roberts
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - J MacDonald
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - A Dickson
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - S Cairns
- NHS Health Protection Scotland, Glasgow, UK
| | - N Khanna
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - P Flowers
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - J Reilly
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK; NHS Health Protection Scotland, Glasgow, UK
| | - L Price
- Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
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Xie J, Nettel-Aguirre A, Lee BE, Chui L, Pang XL, Zhuo R, Parsons B, Vanderkooi OG, Tarr PI, Ali S, Dickinson JA, Hagen E, Svenson LW, MacDonald SE, Drews SJ, Tellier R, Graham T, Lavoie M, MacDonald J, Freedman SB. Relationship between enteric pathogens and acute gastroenteritis disease severity: a prospective cohort study. Clin Microbiol Infect 2018; 25:454-461. [PMID: 29964235 DOI: 10.1016/j.cmi.2018.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/28/2018] [Accepted: 06/09/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the relationship between individual bacterial and viral pathogens and disease severity. METHODS Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up). RESULTS Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease. CONCLUSIONS In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.
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Affiliation(s)
- J Xie
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - A Nettel-Aguirre
- Departments of Pediatrics and of Community Health Sciences, Cumming School of Medicine, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, O'Brien Population Health Institute, University of Calgary, Calgary, Alberta, Canada
| | - B E Lee
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - L Chui
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - X L Pang
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - R Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - B Parsons
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - O G Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences and the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - P I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - S Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - J A Dickinson
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - E Hagen
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - L W Svenson
- Analytics and Performance Reporting, Alberta Health Division of Preventive Medicine, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - S E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Canada; School of Public Health, University of Alberta, Edmonton, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - S J Drews
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - R Tellier
- Provincial Laboratory for Public Health, Alberta, Canada; Departments of Pathology and Laboratory Medicine and Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - T Graham
- Alberta Health Services, Edmonton Zone, Alberta, Canada; Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Lavoie
- Population and Public Health, Fraser Health, Surrey, British Columbia, Canada
| | - J MacDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Deol N, Nguyen T, Parker CE, Khanna R, MacDonald J, Feagan BG, Jairath V. A111 INFLIXIMAB FOR INDUCTION OF REMISSION IN CROHN’S DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Deol
- Gastroenterology, Western University, London, ON, Canada
| | - T Nguyen
- Robarts Clinical Trials, London, ON, Canada
| | | | - R Khanna
- Department of Medicine, London, ON, Canada
| | | | - B G Feagan
- Department of Medicine, London, ON, Canada
| | - V Jairath
- Department of Medicine, London, ON, Canada
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Evans S, Daly A, MacDonald J, Pinto A, MacDonald A. Fifteen years of using a second stage protein substitute for weaning in phenylketonuria: a retrospective study. J Hum Nutr Diet 2017; 31:349-356. [PMID: 28940742 DOI: 10.1111/jhn.12510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In phenylketonuria (PKU), during weaning, it is necessary to introduce a second stage phenylalanine (Phe)-free protein substitute (PS) to help meet non-Phe protein requirements. Semi-solid weaning Phe-free PS have been available for >15 years, although no long-term studies have reported their efficacy. METHODS Retrospective data from 31 children with PKU who commenced a weaning PS were collected from clinical records from age of weaning to 2 years, on: gender; birth order; weaning age; anthropometry; blood Phe levels; age commenced and dosage of weaning PS and Phe-free infant L-amino acid formula; natural protein intake; and issues with administration of PS or food. RESULTS Median commencement age for weaning was 17 weeks (range 12-25 weeks) and, for weaning PS, 20 weeks (range 13-37 weeks). Median natural protein was 4 g day-1 (range 3-11 g day-1 ) and total protein intake was >2 g kg-1 day-1 from weaning to 2 years of age. Children started on 2-4 g day-1 protein equivalent (5-10 g day-1 of powder) from weaning PS, increasing by 0.2 g kg-1 day-1 (2 g day-1 ) monthly to 12 months of age. Teething and illness adversely affected the administration of weaning PS and the acceptance of solid foods. Altogether, 32% of children had delayed introduction of more textured foods, associated with birth order (firstborn 80% versus 38%; P = 0.05) and food refusal when teething (80% versus 29%; P = 0.02). CONCLUSIONS Timing of introduction of solid foods and weaning PS, progression onto more textured foods and consistent feeding routines were important in aiding their acceptance. Any negative behaviour with weaning PS was mainly associated with food refusal, teething and illness. Parental approach influenced the acceptance of weaning PS.
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Affiliation(s)
- S Evans
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - A Daly
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - J MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - A Pinto
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - A MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
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Muddiman E, Bullock AD, MacDonald J, Allery L, Webb KL, Pugsley L. 'It's surprising how differently they treat you': a qualitative analysis of trainee reflections on a new programme for generalist doctors. BMJ Open 2016; 6:e011239. [PMID: 27601487 PMCID: PMC5020751 DOI: 10.1136/bmjopen-2016-011239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES An increase in patients with long-term conditions and complex care needs presents new challenges to healthcare providers around the developed world. In response, more broad-based training programmes have developed to better prepare trainees for the changing landscape of healthcare delivery. This paper focuses on qualitative elements of a longitudinal, mixed-methods evaluation of the postgraduate, post-Foundation Broad-Based Training (BBT) programme in England. It aims to provide a qualitative analysis of trainees' evaluations of whether the programme meets its intentions to develop practitioners adept at managing complex cases, patient focused care, specialty integration and conviction in career choice. We also identify unintended consequences. SETTING 9 focus groups of BBT trainees were held over a 12-month period. Discussions were audio-recorded and subjected to directed content analysis. Data were collected from trainees across all 7 participating regions: East Midlands; West Midlands; Severn; Northern; North Western; Yorkshire and Humber; Kent, Surry and Sussex. PARTICIPANTS Focus group participants (61 in total) from the first and second cohorts of BBT. RESULTS Evidence from trainees indicated that the programme was meeting its aims: trainees valued the extra time to decide on their onward career specialty, having a wider experience and developing a more integrated perspective. They thought of themselves as different and perceived that others they worked alongside also saw them as different. Being different meant benefitting from novel training experiences and opportunities for self-development. However, unintended consequences were feelings of isolation, and uncertainty about professional identity. CONCLUSIONS By spanning boundaries between specialties, trainee generalists have the potential to improve experiences and outcomes for patients with complex health needs. However, the sense of isolation will inhibit this potential. We employ the concept of 'belongingness' to identify challenges related to the implementation of generalist training programmes within existing structures of healthcare provision.
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Affiliation(s)
- E Muddiman
- Cardiff Unit for Research and Evaluation into Medical and Dental Education (CUREMeDE), Cardiff University School of Social Sciences, Cardiff, UK
| | - A D Bullock
- Cardiff Unit for Research and Evaluation into Medical and Dental Education (CUREMeDE), Cardiff University School of Social Sciences, Cardiff, UK
| | - J MacDonald
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
| | - L Allery
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
| | - K L Webb
- Cardiff Unit for Research and Evaluation into Medical and Dental Education (CUREMeDE), Cardiff University School of Social Sciences, Cardiff, UK
| | - L Pugsley
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
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Abstract
A PBI and thyroxine iodine manual method (Oxford Laboratories) have been compared with a serum thyroxine method based on competitive protein-binding. The thyroxine iodine technique appeared to be more reliable and practicable than the PBI method, except that the latter has the advantage that it can be automated. The close correlation between results from the serum thyroxineiodine and thyroxine methods makes the former a useful addition to the range of tests employed in the investigation of thyroid function.
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Affiliation(s)
- J. MacDonald
- Sub-department of Endocrine Pathology, Liverpool Clinic, Liverpool L7 7DE
| | - L. J. Hipkin
- Sub-department of Endocrine Pathology, Liverpool Clinic, Liverpool L7 7DE
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Abstract
This study aimed to assess the value of periodic review by an occupational therapist (OT) of elderly patients with rheumatoid arthritis (RA). Twenty-four patients aged over 65 years who had longstanding RA and had had at least one previous contact with an OT completed a modified health assessment questionnaire (HAQ)1.2 to give an assessment of their self perceived functional ability then had a formal OT assessment. Two months later the patients completed a second HAQ to assess the effect of the OT assessment and assistance. Only three of the 24 patients were felt by the OT to have no need of intervention by her; 17 of the patients felt that the OT contact had been useful. Possible intervention to improve quality of life was not predicted by the patient's perception of limitations nor by the HAQ score. There were no significant changes in HAQ scores despite OT assessment and intervention. Other assessments of disability or wellbeing merit investigation in the context of OT intervention but the need for OT review of elderly patients with RA is clear.
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Affiliation(s)
- CH McAlpine
- Department of Rheumatology, Gathavel General Hospital
| | - E. Woodhouse
- Department of Occupational Therapy, Gatrtnavel General Hospital
| | - J. MacDonald
- Department of Geriatric Medicine, Gartnavel General Hospital
| | - J. Hunter
- Department of Rheumatology, Gartnavel General Hospital, Glasgow
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Cleveland B, Bower C, Jones T, MacDonald J, Sullivan G. Effect of feeding distillers grains and supplementing antioxidants on lipid oxidation of ground beef. Meat Sci 2016. [DOI: 10.1016/j.meatsci.2015.08.122] [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: 11/16/2022]
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Pannucci C, Swistun L, MacDonald J, Brooke B, Henke P. The 2005 Caprini Score Predicts Both Baseline Venous Thromboembolism Risk and Effectiveness of Chemoprophylaxis: A Meta-Analysis of 13,412 Surgical Patien. J Vasc Surg Venous Lymphat Disord 2016. [DOI: 10.1016/j.jvsv.2015.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Evans S, Daly A, Chahal S, MacDonald J, MacDonald A. Food acceptance and neophobia in children with phenylketonuria: a prospective controlled study. J Hum Nutr Diet 2015; 29:427-33. [DOI: 10.1111/jhn.12346] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S. Evans
- Dietetic Department, Birmingham Children's Hospital; Birmingham UK
| | - A. Daly
- Dietetic Department, Birmingham Children's Hospital; Birmingham UK
| | - S. Chahal
- Dietetic Department, Birmingham Children's Hospital; Birmingham UK
| | - J. MacDonald
- Dietetic Department, Birmingham Children's Hospital; Birmingham UK
| | - A. MacDonald
- Dietetic Department, Birmingham Children's Hospital; Birmingham UK
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Ponce CH, Brown MS, Osterstock JB, Cole NA, Lawrence TE, Soto-Navarro S, MacDonald J, Lambert BD, Maxwell C. Effects of wet corn distillers grains with solubles on visceral organ mass, trace mineral status, and polioencephalomalacia biomarkers of individually-fed cattle. J Anim Sci 2014; 92:4034-46. [PMID: 25023807 DOI: 10.2527/jas.2014-7695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Twenty-four steers (initial BW = 385 ± 1.1 kg) were blocked by BW and randomly assigned to 3 dietary treatments (0, 30, or 60% wet distillers grains with solubles [WDGS]; DM basis) and were fed individually to determine the effect of WDGS on live growth and carcass performance, visceral organ mass, trace mineral status, and polioencephalomalacia biomarkers. Steers were slaughtered at 125, 150, 164, and 192 d (2 blocks/slaughter date) when external fat depth was approximately 1.3 cm based on visual appraisal. Steers fed 30% WDGS had greater DMI than those fed 0 or 60% WDGS (P < 0.05), and steers fed 60% WDGS had the lowest carcass-adjusted ADG (P < 0.09) of the 3 treatments. Nonetheless, WDGS concentration did not alter feed efficiency (P > 0.41) on either live or carcass-adjusted basis. Steers fed 30% WDGS had greater liver S and Mn concentrations (DM basis) and lower liver Fe concentrations than control steers (P < 0.10; initial values used as a covariate), and feeding 60% WDGS decreased liver Cu and increased liver Fe (P < 0.10) compared with feeding 30% WDGS. Cytochrome c oxidase (COX) activity in brain tissue tended to be decreased with 60 vs. 30% WDGS (P = 0.12), and COX activity decreased linearly (P = 0.06) in lung tissue as dietary WDGS concentration increased. Likewise, gut fill linearly increased (P = 0.01) with increasing WDGS concentration. Feeding 30% WDGS increased fractional mass (g/kg of empty BW) of the small intestine (P < 0.10) compared with controls, whereas 60% WDGS increased fractional kidney mass (P < 0.10) compared with 30% WDGS. Overall, results suggest that gut fill, Cu status, and COX activity seem to be compromised by WDGS when fed at 60% of diet DM in diets based on steam-flaked corn, which suggests a greater susceptibility to polioencephalomalacia.
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Affiliation(s)
- C H Ponce
- West Texas A&M University, Canyon, TX
| | - M S Brown
- West Texas A&M University, Canyon, TX
| | | | | | | | | | - J MacDonald
- Department of Animal Sciences, Tarleton State University, Stephenville, TX
| | | | - C Maxwell
- West Texas A&M University, Canyon, TX
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Singh J, Wells G, Christensen R, Tanjong E, MacDonald J, Tugwell P, Buchbinder R. SAT0461 Adverse effects of biologics: a network meta-analysis and cochrane overview. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.3407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Dings R, Levine J, Astorgues-Xerri L, Kumar N, Serova M, MacDonald J, Raymond E, Hoye T, Mayo K. 568 Design of PTX008 That Allosterically Targets Galectin-1 to Inhibit Tumor Growth in Mice. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72365-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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MacPherson IR, Bissett D, Petty RD, Tait B, Samuel LM, MacDonald J, Smith M, Birse-Archbold JA, Barnett AL, Wolf CR, Elcombe CR, Jeynes-Ellis A, Evans TRJ. A first-in-human phase I clinical trial of CXR1002 in patients (pts) with advanced cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Khanal A, Gillespie J, MacDonald J. Adoption of technology, management practices, and production systems in US milk production. J Dairy Sci 2010; 93:6012-22. [DOI: 10.3168/jds.2010-3425] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 08/20/2010] [Indexed: 11/19/2022]
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26
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Holmuhamedov EL, Teplova VV, Johnson CB, MacDonald J. A study of the effect of ethanol on the synthesis of serine and the exchange of methyl groups in hepatocytes by NMR spectroscopy. Biophysics (Nagoya-shi) 2010. [DOI: 10.1134/s0006350910060138] [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: 11/23/2022] Open
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27
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Kholmukhamedov EL, Teplova VV, Johnson CB, MacDonald J. [Effect of ethanol on synthesis of serine and exchange of methyl groups in hepatocytes by NMR spectroscopy]. Biofizika 2010; 55:1057-1062. [PMID: 21268350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The method of NMR spectroscopy was used to investigate the role of voltage-dependent anion channels in the outer mitochondrial membrane in the mechanism of ethanol hepatotoxicity using the synthesis of serine and exchange of methyl groups in hepatocytes metabolizing 13C-labeled glycine. Here we present and describe a methodological approach developed for the independent monitoring of the synthesis of serine in two intracellular compartments: the cytoplasm and mitochondria of intact hepatocytes, and quantification of different serine isotopomers synthesized in hepatocytes from 13C-labeled glycine. The data obtained indicate that the treatment of cells with ethanol as well as cysteamine (specific inhibitor of mitochondrial synthesis of serine) suppressed the level of mitochondria but not cytoplasmic serine isotopomers. It is concluded that the decrease in the production of mitochondrial serine isotopomers in hepatocytes exposed to ethanol can be caused not only by decreased permeability of the outer mitochondrial membrane due to the closure of voltage-dependent anion channels and suppression of the exchange of substrates of serine synthesis in mitochondria but also by the restoration of the cytoplasmic and/or mitochondrial pool of pyridine nucleotides (NADH) during the oxidation of ethanol. Our work reveals a new mechanism of action of ethanol (alcohol intoxication) in hepatocytes through the regulation of glycine metabolism and opens new possibilities in the treatment of alcohol poisoning.
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Berger A, Winter K, Hoffman J, Regine W, Abrams R, Safran H, Freedman G, Benson A, MacDonald J, Willet C. Five Year Results of US Intergroup/RTOG 9704 with Postoperative Ca 19-9 ≤90 and Comparison to the Conko-001 Trial. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Macpherson M, Bissett D, Tait B, Samuel L, MacDonald J, Barnett A, Wolf C, Elcombe C, Jeynes-Ellis A, Evans T. 391 A phase I clinical trial of CXR1002 in patients (pts) with advanced cancer. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)72098-x] [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: 10/18/2022] Open
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30
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Holmuhamedov EL, Czerny C, Lovelace G, Beeson CC, Baker T, Johnson CB, Pediaditakis P, Teplova VV, Tikunov A, MacDonald J, Lemasters JJ. Role of voltage-dependent anion channels of the mitochondrial outer membrane in regulation of cell metabolism. Biophysics (Nagoya-shi) 2010. [DOI: 10.1134/s0006350910050088] [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: 11/23/2022] Open
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31
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Kholmukhamedov EL, Czerny C, Lovelace G, Beeson KC, Baker T, Johnson CB, Pediaditakis P, Teplova VV, Tikunov A, MacDonald J, Lemasters JJ. [The role of the voltage-dependent anion channels in the outer membrane of mitochondria in the regulation of cellular metabolism]. Biofizika 2010; 55:822-833. [PMID: 21033348 PMCID: PMC4547860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The role of voltage-dependent anion channels (VDAC/porins) of the mitochondrial outer membrane in the regulation of cell metabolism is assessed using an experimental model of ethanol toxicity in cultured hepatocytes. It is demonstrated that ethanol inhibits the phosphorylating and the uncoupled mitochondrial respiration, decreases the accessibility of mitochondrial adenylate kinase in the intermembrane space, and suppresses ureagenic respiration in the cells. Treatment with digitonin at high concentrations (>80 μM)—which creates pores in the mitochondrial outer membrane, allowing bypass of closed VDAC—restores all the processes suppressed with ethanol. It is concluded that the effect of ethanol in hepatocytes leads to global loss of mitochondrial function because of closure of VDAC, which limits the free diffusion of metabolites into the intermembrane space. Our studies also reveal the role of VDAC in the regulation of liver-specific intracellular processes such as ureagenesis. The data obtained can be used in development of pharmaceuticals that would prevent VDAC closure in mitochondria of ethanol-oxidizing liver, thus protecting liver tissue from the hepatotoxic action of alcohol.
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Wong K, Hughes CA, Plitt S, Foisy M, MacDonald J, Johnson M, Singh AE. HIV non-occupational postexposure prophylaxis in a Canadian province: treatment completion and follow-up testing. Int J STD AIDS 2010; 21:617-21. [DOI: 10.1258/ijsa.2008.008482] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Provincial guidelines for HIV non-occupational postexposure prophylaxis (NPEP) were implemented on January 2005 in Alberta, Canada. Human immunodeficiency virus (HIV) NPEP was provided free of charge following approval by a medical officer of health. Between 1 January 2005 and 30 June 2007, 174 individuals were prescribed NPEP; 135 (78%) were women with a median age of 24 years. Sexual assaults accounted for 68% of exposures. NPEP was completed in 49% of cases. Individuals who completed NPEP were less likely to have been exposed by sexual assault ( P = 0.04) and more likely to have received HIV follow-up testing ( P = 0.03).Individuals who received at least one HIV follow-up test were older ( P = 0.03) and more likely to have been exposed percutaneously ( P = 0.003). Those who received no follow-up testing were less likely to have filled an NPEP prescription ( P = 0.0001). New strategies are required to improve follow-up of individuals receiving NPEP, especially younger persons or sexual assault survivors.
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Affiliation(s)
- K Wong
- Alberta Health Services, Capital Health
| | - C A Hughes
- Alberta Health Services, Capital Health
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta
- Northern Alberta HIV Program, Edmonton, Alberta
| | - S Plitt
- Public Health Agency of Canada, Ottawa, Ontario
| | - M Foisy
- Alberta Health Services, Capital Health
- Northern Alberta HIV Program, Edmonton, Alberta
| | - J MacDonald
- Alberta Health Services, Calgary Health Region, Calgary
| | - M Johnson
- Alberta Health Services, Capital Health
| | - A E Singh
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Abstract
The purpose of this study is to determine the appropriate arterial pump flow /cardiac index (CI) utilizing a mini-bypass system. The unique feature of most mini-bypass systems is that the centrifugal pump combines the function of kinetic venous drainage with arterial pump flow. Therefore, if drainage is reduced, arterial pump flow is also reduced. Managing this system can present challenges to the clinical perfusionist. We reviewed fifteen cases, using the Medtronic Resting Heart System (RHS). This retrospective study examined the arterial pump flow, measured as cardiac index (CI), mean arterial pressure, inlet venous saturation, urine output, vasopressor use, and lactate production during routine cardiac surgery. The mean cardiac index for all patients was 1.90 +/- 0.14, range 1.63-2.08 L/min/m(2). The mean hemoglobin on cardiopulmonary bypass (CPB) was 10.6 +/- 1.2, with a range of 9.2-13.3 g/dL. The lactate produced on CPB was 2.03 +/-0.67 with a range of 1.5-3.5 mmol/L. The mean change in lactate measured from pre CPB to post CPB was 0.85 +/- 0.71 with a median lactate of 0.6 mmol/L. The venous saturation was 65.53 +/- 6.03% with a median of 65% and a range of 57-82%. The mean arterial pressure was 67.04 +/- 10.45 mmHg with a median of 62.5 mmHg. The median urine output was 125 mls. The vasopressor median was 2200 microg. All patients were maintained on CPB with a mean nasopharyngeal temperature of 35.43 degrees Celsius. Despite using lower than predicted flows, it would appear that adequate perfusion is provided. The higher hemoglobin content achieved through reduced hemodilution and reduced inflammation appears to enable this system to deliver adequate flow and perfusion at reduced cardiac indices. This research provides evidence which challenges longstanding beliefs that a cardiac index of 2.4 L/min/m(2) is required for all cases.
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Affiliation(s)
- P Fernandes
- London Health Sciences Centre, Clinical Perfusion Services, London, Ontario, Canada.
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34
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Moore WR, DeVries J, MacDonald J, Hare L, Carson J, Chaudhari P, DeVries J, Fontana J, Golz P, King J, MacDonald J, McCullough C, Noggle, S, Rasgorshek E, Schorn S, Skogerson L, Sullins D, Sullivan D, Sussman M, Weibel M. Assessing Analytical Variability of Measurement of Vitamin A in Corn-Soy Blend. J AOAC Int 2010. [DOI: 10.1093/jaoac/93.2.638] [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
Two multilaboratory investigations were conducted by SUSTAIN to assess variability in the measurement of vitamin A, the marker used to verify levels of vitamin premix addition to enriched/fortified food aid products, including the widely distributed corn-soy blend (CSB). CSB specifications identify AACC Approved Method 86-06 or equivalent methods for vitamin A analysis, however there is no requirement to demonstrate equivalency. CSB samples with known and blinded levels of vitamin A and a reference standard were analyzed by 16 laboratories using their respective methods. Calculated coefficients of variation across all laboratories and methods for unknown samples and reference standard were 35 and 7.1, respectively, suggesting the largest source of variation is the vitamin extraction procedure. Laboratories generally overestimated low levels and underestimated high levels of vitamin A within the range of 6000 and 16 000 IU/lb. Only two laboratories demonstrated excellent internal precision (300 IU vitamin A/lb) and reported values within 95 confidence interval for all blinded samples. Results of this study have implications both for quality control in food aid products (due to the use of vitamin A as a marker) and for regulatory oversight of vitamin A content in commercial food products.
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Affiliation(s)
- Wayne R Moore
- SUSTAIN, 2000 P St, NW, Suite 300, Washington, DC 20036
| | - Jonathan DeVries
- Medallion Laboratories, 9000 Plymouth Ave N, Minneapolis, MN 55427-3870
| | - John MacDonald
- Organic Laboratory, NP Analytical Laboratories, Checkerboard Square, St. Louis, MO 63164
| | - Lynne Hare
- Statistical Strategies, LLC, 39 Mile Dr, Chester, NJ 07930
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35
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Moore WR, DeVries J, MacDonald J, Hare L, Carson J, Chaudhari P, DeVries J, Fontana J, Golz P, King J, MacDonald J, McCullough C, Noggle S, Rasgorshek E, Schorn S, Skogerson L, Sullins D, Sullivan D, Sussman M, Weibel M. Assessing analytical variability of measurement of vitamin A in corn-soy blend. J AOAC Int 2010; 93:638-49. [PMID: 20480912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Two multilaboratory investigations were conducted by SUSTAIN to assess variability in the measurement of vitamin A, the marker used to verify levels of vitamin premix addition to enriched/fortified food aid products, including the widely distributed corn-soy blend (CSB). CSB specifications identify AACC Approved Method 86-06 or equivalent methods for vitamin A analysis, however there is no requirement to demonstrate equivalency. CSB samples with known and blinded levels of vitamin A and a reference standard were analyzed by 16 laboratories using their respective methods. Calculated coefficients of variation across all laboratories and methods for unknown samples and reference standard were 35 and 7.1%, respectively, suggesting the largest source of variation is the vitamin extraction procedure. Laboratories generally overestimated low levels and underestimated high levels of vitamin A within the range of 6000 and 16 000 IU/lb. Only two laboratories demonstrated excellent internal precision (+/- 300 IU vitamin A/lb) and reported values within 95% confidence interval for all blinded samples. Results of this study have implications both for quality control in food aid products (due to the use of vitamin A as a marker) and for regulatory oversight of vitamin A content in commercial food products.
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Affiliation(s)
- Wayne R Moore
- SUSTAIN, 2000 P St, NW, Suite 300, Washington, DC 20036, USA.
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36
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Abstract
Introduction: The purpose of the study is to clinically evaluate minimally invasive mitral valve surgeries (MIMVS) using a mini bypass circuit. The challenge to perfusion is to keep pace with MIMVS, with demonstrated improvements in perfusion-related technologies. Methods: From October 28, 2005 to September 10, 2008, we retrospectively evaluated thirty-four elective cases which used the mini-circuit (Medtronic Resting Heart System®), with respect to safety, efficacy, cannulation technique, blood usage, resultant hemoglobin, length of ICU and hospital stay, and complications. Conclusion: The Medtronic Resting Heart System® alleviates many factors, such as high shear stress, turbulence, air to blood interface and decreased oncotic pressure caused by hemodilution, providing more efficient perfusion to our MIMVS patients. We demonstrate, with minor circuit modifications and attention to venous air issues, that this mini-circuit can be used safely and effectively, while being associated with improvements in patient outcomes.
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Affiliation(s)
- P. Fernandes
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada,
| | - J. MacDonald
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
| | - A. Cleland
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
| | - R. Mayer
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
| | - S. Fox
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
| | - B. Kiaii
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
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37
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MacDonald J. George Alexander Cockburn Esson. West J Med 2009. [DOI: 10.1136/bmj.b535] [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: 11/03/2022]
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38
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Mandrusiak A, MacDonald J, Watter P. The International Classification of Functioning, Disability and Health: an effective model for describing young people with cystic fibrosis. Child Care Health Dev 2009; 35:2-4. [PMID: 19522999 DOI: 10.1111/j.1365-2214.2008.00903.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Begley LA, Kasina S, MacDonald J, Macoska JA. The inflammatory microenvironment of the aging prostate facilitates cellular proliferation and hypertrophy. Cytokine 2008; 43:194-9. [PMID: 18572414 DOI: 10.1016/j.cyto.2008.05.012] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 03/20/2008] [Accepted: 05/13/2008] [Indexed: 11/16/2022]
Abstract
Benign Prostatic Hypertrophy (BPH, also known as benign prostatic hyperplasia or benign prostatic enlargement), is one of the most common benign proliferative conditions associated with aging in men and is pathologically characterized by the proliferation of fibroblast/myofibroblast and epithelial cell types in the prostate. Previous studies from our laboratory have shown that the CXC-type chemokines, CXCL5 and CXCL12, are secreted by aging prostate stroma and promote both proliferative and transcriptional responses from prostate epithelial cells. Using array-based gene expression profiling and quantitative reverse-transcriptase polymerase chain reaction, we now show that the transcriptome of the aging prostate stroma is characterized by the up-regulation of several genes that encode secreted inflammatory mediators, including secreted CXC-type chemokines (CXCL1, CXCL2, CXCL5, CXCL6, CXCL12), interleukins (IL11, IL33), and transcripts with cytokine homology (CYTL1). At the protein level, ELISA experiments demonstrated that CXCL1, CXCL5, and CXCL6 were secreted by primary prostate stromal fibroblasts explanted from aging prostate stroma. Dose-response assays confirmed that, like CXCL5 and CXCL12, CXCL1 and CXCL6 promote low-level proliferative responses from both prostate stromal fibroblasts and epithelial cells. Taken together, these data suggest that inflammatory mediators are secreted by prostatic stroma consequent to aging, that the levels of these mediators are sufficient to promote low-level increases in the proliferative rate of both epithelial and stromal fibroblast cell types. Moreover, these processes may account for the low-level, but cumulative, proliferation of both epithelial and fibroblastic/myofibroblastic cell types that characterizes the aging-associated development of benign prostatic hypertophy.
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Affiliation(s)
- L A Begley
- Department of Urology and the Comprehensive Cancer Center, The University of Michigan, 6217 CCGC, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0944, USA
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Berger AC, Winter K, Hoffman J, Regine W, Abrams R, Safran H, Konski A, Benson A, MacDonald J, Willet C. Post-resection CA 19–9 predicts overall survival (OS) in patients treated with adjuvant chemoradiation: A secondary endpoint of RTOG 9704. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4522 Background: CA 19–9 is an important tumor marker in pancreatic adenocarcinoma. Several single institutional studies have demonstrated post-resection CA 19–9 to be an important prognostic factor. A secondary endpoint of RTOG 9704, a phase III adjuvant chemoradiation trial for pancreatic cancer, was to prospectively evaluate the ability of post-resectional CA 19–9 to predict survival. Methods: A total of 538 patients were accrued to this trial, of which 385 had evaluable CA 19–9 levels. These were analyzed using ELISA GI-MA kits provided by Diagnostic Products Corporation, a Siemens Company. CA 19–9 expression was analyzed as a dichotomized variable (<180 vs. =180). Cox proportional hazards models were utilized to characterize the contribution of CA 19–9 expression on OS. The following additional variables were included in the multivariate analysis: treatment, nodal involvement, tumor diameter (< or > 3cm), and margin status. Actuarial estimates for OS were calculated using Kaplan-Meier methods. Results: Most patients had CA 19–9 < 180 (n=220, 57%), while 34% were Lewis Antigen negative (unable to express CA 19–9) and 33 (9%) patients had levels >180. Survival was statistically significantly improved among patients with CA 19–9 <180 compared with those whose CA 19–9 =180 (HR=3.58(95% CI=2.40–5.34), p<0.0001) ( table ). This corresponds to a 72% reduction in the risk of death. This improvement was observed among patients with pancreas head and non-head tumors when analyzed separately. The multivariate analysis confirms that CA 19–9 is a highly significant predictor of OS in patients with resected pancreatic cancer. Conclusions: This prospective analysis of CA 19–9 in 385 patients treated with adjuvant chemoradiation definitively confirms the importance of post-resectional CA 19–9 in pancreatic cancer patients who have undergone resection. Patients with post-resection CA 19–9 >180 should be considered for additional therapy. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- A. C. Berger
- Thomas Jefferson Univ, Philadelphia, PA; Radiation Therapy Oncology Group, Philadelphia, PA; Fox Chase Cancer Center, Philadelphia, PA; University of Maryland Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Brown University, Providence, RI; Northwestern University, Chicago, IL; St. Vincent’s Cancer Center, Castine, ME; Duke University Medical Center, Durham, NC
| | - K. Winter
- Thomas Jefferson Univ, Philadelphia, PA; Radiation Therapy Oncology Group, Philadelphia, PA; Fox Chase Cancer Center, Philadelphia, PA; University of Maryland Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Brown University, Providence, RI; Northwestern University, Chicago, IL; St. Vincent’s Cancer Center, Castine, ME; Duke University Medical Center, Durham, NC
| | - J. Hoffman
- Thomas Jefferson Univ, Philadelphia, PA; Radiation Therapy Oncology Group, Philadelphia, PA; Fox Chase Cancer Center, Philadelphia, PA; University of Maryland Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Brown University, Providence, RI; Northwestern University, Chicago, IL; St. Vincent’s Cancer Center, Castine, ME; Duke University Medical Center, Durham, NC
| | - W. Regine
- Thomas Jefferson Univ, Philadelphia, PA; Radiation Therapy Oncology Group, Philadelphia, PA; Fox Chase Cancer Center, Philadelphia, PA; University of Maryland Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Brown University, Providence, RI; Northwestern University, Chicago, IL; St. Vincent’s Cancer Center, Castine, ME; Duke University Medical Center, Durham, NC
| | - R. Abrams
- Thomas Jefferson Univ, Philadelphia, PA; Radiation Therapy Oncology Group, Philadelphia, PA; Fox Chase Cancer Center, Philadelphia, PA; University of Maryland Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Brown University, Providence, RI; Northwestern University, Chicago, IL; St. Vincent’s Cancer Center, Castine, ME; Duke University Medical Center, Durham, NC
| | - H. Safran
- Thomas Jefferson Univ, Philadelphia, PA; Radiation Therapy Oncology Group, Philadelphia, PA; Fox Chase Cancer Center, Philadelphia, PA; University of Maryland Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Brown University, Providence, RI; Northwestern University, Chicago, IL; St. Vincent’s Cancer Center, Castine, ME; Duke University Medical Center, Durham, NC
| | - A. Konski
- Thomas Jefferson Univ, Philadelphia, PA; Radiation Therapy Oncology Group, Philadelphia, PA; Fox Chase Cancer Center, Philadelphia, PA; University of Maryland Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Brown University, Providence, RI; Northwestern University, Chicago, IL; St. Vincent’s Cancer Center, Castine, ME; Duke University Medical Center, Durham, NC
| | - A. Benson
- Thomas Jefferson Univ, Philadelphia, PA; Radiation Therapy Oncology Group, Philadelphia, PA; Fox Chase Cancer Center, Philadelphia, PA; University of Maryland Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Brown University, Providence, RI; Northwestern University, Chicago, IL; St. Vincent’s Cancer Center, Castine, ME; Duke University Medical Center, Durham, NC
| | - J. MacDonald
- Thomas Jefferson Univ, Philadelphia, PA; Radiation Therapy Oncology Group, Philadelphia, PA; Fox Chase Cancer Center, Philadelphia, PA; University of Maryland Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Brown University, Providence, RI; Northwestern University, Chicago, IL; St. Vincent’s Cancer Center, Castine, ME; Duke University Medical Center, Durham, NC
| | - C. Willet
- Thomas Jefferson Univ, Philadelphia, PA; Radiation Therapy Oncology Group, Philadelphia, PA; Fox Chase Cancer Center, Philadelphia, PA; University of Maryland Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Brown University, Providence, RI; Northwestern University, Chicago, IL; St. Vincent’s Cancer Center, Castine, ME; Duke University Medical Center, Durham, NC
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Hart L, Hainsworth J, Ciuleanu T, Oudard S, Berger E, Alexandre J, Chi K, Ruether D, Kahatt C, MacDonald J. 299 POSTER Randomized phase II trial of irofulven/prednisone, irofulven/capecitabine/prednisone, or mitoxantrone/prednisone in hormone refractory prostate cancer (HRPC) patients failing first-line docetaxel: preliminary results. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70304-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
We examined the safety and feasibility of elective outpatient transradial coronary angioplasty (PCI). Four hundred and forty two patients underwent procedures over a 4-year period. Over 95% had an excellent angiographic result and 85% were discharged the same day. Radial access was successful in 417 (94%) patients. There were no major vascular complications. One patient died of a subacute stent thrombosis. Outpatient transradial PCI is safe and feasible for the majority of elective PCI cases.
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Affiliation(s)
- A Wiper
- Blackpool Victoria Hospital, Blackpool, Lancashire, England, United Kingdom.
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43
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Bates P, MacDonald J, Sidiropoulos V, Kontopoulou M. Comparison of experimental and analytical vibration welding meltdown-time profiles for nylon 66 and polypropylene. POLYM ENG SCI 2005. [DOI: 10.1002/pen.20333] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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44
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Walsh DJ, Bernard H, Murray BA, MacDonald J, Pentzien AK, Wright GA, Wal JM, Struthers AD, Meisel H, Fitzgerald RJ. In Vitro Generation and Stability of the Lactokinin β-Lactoglobulin Fragment (142–148). J Dairy Sci 2004; 87:3845-57. [PMID: 15483169 DOI: 10.3168/jds.s0022-0302(04)73524-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The objectives of this study were to investigate the generation of beta-lactoglobulin fragment (142-148) (beta-LG f(142-148) during the hydrolysis of whey proteins, and the in vitro stability of this fragment upon incubation with gastrointestinal and serum proteinases and peptidases. An enzyme immunoassay (EIA) protocol was developed for the quantification of beta-LG f(142-148) in whey protein hydrolysates and in human blood serum. The minimum detection limit was 3 ng/mL. The level of the peptide in whey protein hydrolysates was influenced by the degree of hydrolysis (DH). As expected, highest levels of this peptide were found in hydrolysates generated with trypsin. Sequential incubation of hydrolysates at different DH values with pepsin and Corolase PP, to simulate gastrointestinal digestion, generally resulted in the degradation of beta-LG f(142-148) as determined by EIA. Reversed-phase HPLC and angiotensin-I-converting enzyme (ACE) activity assays demonstrated that synthetic beta-LG f(142-148) was rapidly degraded upon incubation with human serum. Furthermore, beta-LG f(142-148) could not be detected by EIA in the sera of 2 human volunteers following its oral ingestion or in sera from these volunteers subsequently spiked with beta-LG f(142-148). These in vitro results indicate that beta-LG f(142-148) is probably not sufficiently stable to gastrointestinal and serum proteinases and peptidases to act as an hypotensive agent in humans following oral ingestion. The in vitro methodology described herein has general application in evaluating the hypotensive potential of food protein-derived ACE inhibitory peptides.
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Affiliation(s)
- D J Walsh
- Department of Life Sciences, University of Limerick, Ireland
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45
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Walsh DJ, Bernard H, Murray BA, MacDonald J, Pentzien AK, Wright GA, Wal JM, Struthers AD, Meisel H, Fitzgerald RJ. In vitro generation and stability of the lactokinin beta-lactoglobulin fragment (142-148). J Dairy Sci 2004; 87:3845-3857. [PMID: 15483169 DOI: 10.3168/jds.s0022-0302(04)73524-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The objectives of this study were to investigate the generation of beta-lactoglobulin fragment (142-148) (beta-LG f(142-148) during the hydrolysis of whey proteins, and the in vitro stability of this fragment upon incubation with gastrointestinal and serum proteinases and peptidases. An enzyme immunoassay (EIA) protocol was developed for the quantification of beta-LG f(142-148) in whey protein hydrolysates and in human blood serum. The minimum detection limit was 3 ng/mL. The level of the peptide in whey protein hydrolysates was influenced by the degree of hydrolysis (DH). As expected, highest levels of this peptide were found in hydrolysates generated with trypsin. Sequential incubation of hydrolysates at different DH values with pepsin and Corolase PP, to simulate gastrointestinal digestion, generally resulted in the degradation of beta-LG f(142-148) as determined by EIA. Reversed-phase HPLC and angiotensin-I-converting enzyme (ACE) activity assays demonstrated that synthetic beta-LG f(142-148) was rapidly degraded upon incubation with human serum. Furthermore, beta-LG f(142-148) could not be detected by EIA in the sera of 2 human volunteers following its oral ingestion or in sera from these volunteers subsequently spiked with beta-LG f(142-148). These in vitro results indicate that beta-LG f(142-148) is probably not sufficiently stable to gastrointestinal and serum proteinases and peptidases to act as an hypotensive agent in humans following oral ingestion. The in vitro methodology described herein has general application in evaluating the hypotensive potential of food protein-derived ACE inhibitory peptides.
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Affiliation(s)
- D J Walsh
- Department of Life Sciences, University of Limerick, Ireland
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46
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Cvitkovic E, Kahatt C, Senzer N, Tombal B, Culine S, Raymond E, Alexandre J, Weems G, MacDonald J. Clinical activity of irofulven in hormone refractory prostate cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Cvitkovic
- Cvitkovic & Associes Consultants, Kremlin-Bicetre, France; US Oncology; Mary Crowley Medical Research Center, Dallas, TX; UCLC Saint-Luc, Brussels, Belgium; C.R.L.C. Val d'Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; Hopital Cochin, Paris, France; MGI Pharma, Inc., Bloomington, MN; MGI Pharma, Inc, Bloomington, MN
| | - C. Kahatt
- Cvitkovic & Associes Consultants, Kremlin-Bicetre, France; US Oncology; Mary Crowley Medical Research Center, Dallas, TX; UCLC Saint-Luc, Brussels, Belgium; C.R.L.C. Val d'Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; Hopital Cochin, Paris, France; MGI Pharma, Inc., Bloomington, MN; MGI Pharma, Inc, Bloomington, MN
| | - N. Senzer
- Cvitkovic & Associes Consultants, Kremlin-Bicetre, France; US Oncology; Mary Crowley Medical Research Center, Dallas, TX; UCLC Saint-Luc, Brussels, Belgium; C.R.L.C. Val d'Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; Hopital Cochin, Paris, France; MGI Pharma, Inc., Bloomington, MN; MGI Pharma, Inc, Bloomington, MN
| | - B. Tombal
- Cvitkovic & Associes Consultants, Kremlin-Bicetre, France; US Oncology; Mary Crowley Medical Research Center, Dallas, TX; UCLC Saint-Luc, Brussels, Belgium; C.R.L.C. Val d'Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; Hopital Cochin, Paris, France; MGI Pharma, Inc., Bloomington, MN; MGI Pharma, Inc, Bloomington, MN
| | - S. Culine
- Cvitkovic & Associes Consultants, Kremlin-Bicetre, France; US Oncology; Mary Crowley Medical Research Center, Dallas, TX; UCLC Saint-Luc, Brussels, Belgium; C.R.L.C. Val d'Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; Hopital Cochin, Paris, France; MGI Pharma, Inc., Bloomington, MN; MGI Pharma, Inc, Bloomington, MN
| | - E. Raymond
- Cvitkovic & Associes Consultants, Kremlin-Bicetre, France; US Oncology; Mary Crowley Medical Research Center, Dallas, TX; UCLC Saint-Luc, Brussels, Belgium; C.R.L.C. Val d'Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; Hopital Cochin, Paris, France; MGI Pharma, Inc., Bloomington, MN; MGI Pharma, Inc, Bloomington, MN
| | - J. Alexandre
- Cvitkovic & Associes Consultants, Kremlin-Bicetre, France; US Oncology; Mary Crowley Medical Research Center, Dallas, TX; UCLC Saint-Luc, Brussels, Belgium; C.R.L.C. Val d'Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; Hopital Cochin, Paris, France; MGI Pharma, Inc., Bloomington, MN; MGI Pharma, Inc, Bloomington, MN
| | - G. Weems
- Cvitkovic & Associes Consultants, Kremlin-Bicetre, France; US Oncology; Mary Crowley Medical Research Center, Dallas, TX; UCLC Saint-Luc, Brussels, Belgium; C.R.L.C. Val d'Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; Hopital Cochin, Paris, France; MGI Pharma, Inc., Bloomington, MN; MGI Pharma, Inc, Bloomington, MN
| | - J. MacDonald
- Cvitkovic & Associes Consultants, Kremlin-Bicetre, France; US Oncology; Mary Crowley Medical Research Center, Dallas, TX; UCLC Saint-Luc, Brussels, Belgium; C.R.L.C. Val d'Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; Hopital Cochin, Paris, France; MGI Pharma, Inc., Bloomington, MN; MGI Pharma, Inc, Bloomington, MN
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Vallejos C, Varela M, Roca E, Martinez J, Van Cutsem E, Misset JL, Louvet C, Cvitkovic E, MacDonald J, Wasserman E. Phase II trial of irofulven (IROF) and CPT-11 in metastatic colorectal cancer (MCRC) patients (pts) failing oxaliplatin (OXA)/5FU based chemotherapy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. Vallejos
- INEN, Lima, Peru; Hospital Italiano, Buenos Aires, Argentina; Hospital B. Udaondo, Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; University Hospital Gasthuisberg, Leuven, Belgium; Hôpital St Louis, Paris, France; Hôpital St Antoine, Paris, France; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc., Bloomington, MN; CAC, Buenos Aires, Argentina
| | - M. Varela
- INEN, Lima, Peru; Hospital Italiano, Buenos Aires, Argentina; Hospital B. Udaondo, Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; University Hospital Gasthuisberg, Leuven, Belgium; Hôpital St Louis, Paris, France; Hôpital St Antoine, Paris, France; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc., Bloomington, MN; CAC, Buenos Aires, Argentina
| | - E. Roca
- INEN, Lima, Peru; Hospital Italiano, Buenos Aires, Argentina; Hospital B. Udaondo, Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; University Hospital Gasthuisberg, Leuven, Belgium; Hôpital St Louis, Paris, France; Hôpital St Antoine, Paris, France; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc., Bloomington, MN; CAC, Buenos Aires, Argentina
| | - J. Martinez
- INEN, Lima, Peru; Hospital Italiano, Buenos Aires, Argentina; Hospital B. Udaondo, Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; University Hospital Gasthuisberg, Leuven, Belgium; Hôpital St Louis, Paris, France; Hôpital St Antoine, Paris, France; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc., Bloomington, MN; CAC, Buenos Aires, Argentina
| | - E. Van Cutsem
- INEN, Lima, Peru; Hospital Italiano, Buenos Aires, Argentina; Hospital B. Udaondo, Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; University Hospital Gasthuisberg, Leuven, Belgium; Hôpital St Louis, Paris, France; Hôpital St Antoine, Paris, France; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc., Bloomington, MN; CAC, Buenos Aires, Argentina
| | - J. L. Misset
- INEN, Lima, Peru; Hospital Italiano, Buenos Aires, Argentina; Hospital B. Udaondo, Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; University Hospital Gasthuisberg, Leuven, Belgium; Hôpital St Louis, Paris, France; Hôpital St Antoine, Paris, France; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc., Bloomington, MN; CAC, Buenos Aires, Argentina
| | - C. Louvet
- INEN, Lima, Peru; Hospital Italiano, Buenos Aires, Argentina; Hospital B. Udaondo, Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; University Hospital Gasthuisberg, Leuven, Belgium; Hôpital St Louis, Paris, France; Hôpital St Antoine, Paris, France; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc., Bloomington, MN; CAC, Buenos Aires, Argentina
| | - E. Cvitkovic
- INEN, Lima, Peru; Hospital Italiano, Buenos Aires, Argentina; Hospital B. Udaondo, Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; University Hospital Gasthuisberg, Leuven, Belgium; Hôpital St Louis, Paris, France; Hôpital St Antoine, Paris, France; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc., Bloomington, MN; CAC, Buenos Aires, Argentina
| | - J. MacDonald
- INEN, Lima, Peru; Hospital Italiano, Buenos Aires, Argentina; Hospital B. Udaondo, Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; University Hospital Gasthuisberg, Leuven, Belgium; Hôpital St Louis, Paris, France; Hôpital St Antoine, Paris, France; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc., Bloomington, MN; CAC, Buenos Aires, Argentina
| | - E. Wasserman
- INEN, Lima, Peru; Hospital Italiano, Buenos Aires, Argentina; Hospital B. Udaondo, Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; University Hospital Gasthuisberg, Leuven, Belgium; Hôpital St Louis, Paris, France; Hôpital St Antoine, Paris, France; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc., Bloomington, MN; CAC, Buenos Aires, Argentina
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Abstract
BACKGROUND As the number of implanted vagal nerve stimulators grows, the need for removal or revision of the devices will become more frequent. Our purpose was to demonstrate the feasibility of complete removal of the vagal nerve stimulator electrode using microsurgical technique. METHODS . Operative databases at the University of Utah (1995 through 2002), Westchester Medical Center (1995 through 2001), and University of Arizona Health Sciences Center (1995 through 1999) were retrospectively reviewed. Patients who had undergone removal or revision of a previously placed vagal nerve stimulator electrode were identified. Patients who had a vagal nerve stimulator device removed but had the lead trimmed and incompletely removed were excluded. FINDINGS Seven patients underwent complete removal of the lead. Microsurgical dissection allowed removal of the helical electrode from the vagus nerve without apparent physiological consequences. Four patients had a new electrode placed just proximal to the original lead site. The operative procedure required an additional 30 minutes to complete compared with initial device placement. The four patients who underwent replacement of the electrode demonstrated normal device function and lead resistance at the time of postoperative follow-up. Each experienced a return to prior stimulation response and seizure control. CONCLUSIONS This series suggests that the electrode can be removed from the vagus nerve and repositioned without significant consequence in most cases.
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Affiliation(s)
- J MacDonald
- Department of Neurosurgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
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Frost A, Stewart S, Kerr D, MacDonald J, D'Arcy B. Agricultural environmental management; case studies from theory to practice. Water Sci Technol 2004; 49:71-79. [PMID: 15053101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Six farms were examined, each from a different sector of Scottish agriculture. Surveys were carried out to identify both diffuse pollution risks and options for habitat conservation and enhancement. Financial data were also gathered to determine the current sources of farm income, both from sale of produce and from grants. Whole farm plans were produced aimed at bringing about reductions in diffuse pollution to water, soil and air and also habitat improvements. The assembled information was used to devise a possible agri-environment grant scheme to aid the implementation of the whole farm plans.
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Affiliation(s)
- A Frost
- Soil and Water, Scotland, 4 Bayswell Road, Dunbar, EH42 1AB, Scotland
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50
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Abstract
Several porcelain samples from almost directly beneath the atomic explosion at Hiroshima on 6 August 1945, have been scanned for induced fission tracks, produced mostly by the thermal neutrons from the bomb due to interactions with trace uranium in their glass coatings. The ability to use porcelain opens a new and abundant material for retrospective dosimetry. Four different samples had thermal neutron fluences in 1945 of 1.0, 3.8, 4.1, and 8.9 x 10(12) cm(-2). The different values are not caused by track fading, but are likely to result from differing shielding at different nearby positions. Assuming that the three highest fluences, which have overlapping uncertainties, are at locations of minimum shielding, the statistically weighted thermal fluence in the air at ground level and ground zero was 4.8 x 10(12) cm(-2) with a statistical uncertainty of 15%. This value lies between the calculated value of 6.5 x 10(12) given in DS86 and the 3.7 x 10(12) inferred from induced radionuclides by Hoshi et al. (1998).
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Affiliation(s)
- J MacDonald
- Department of Geology, Union College, Schenectady, NY 12308, USA
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