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Fitzpatrick N, Herczeg S, Hong K, Seaver F, Rosalejos L, Boles U, Jauvert G, Keelan E, O’Brien J, Tahin T, Galvin J, Széplaki G. Long-term results of ablation index guided atrial fibrillation ablation: insights after 5+ years of follow-up from the MPH AF Ablation Registry. Front Cardiovasc Med 2024; 10:1332868. [PMID: 38292455 PMCID: PMC10825003 DOI: 10.3389/fcvm.2023.1332868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
Background Catheter ablation (CA) for symptomatic atrial fibrillation (AF) offers the best outcomes for patients. Despite the benefits of CA, a significant proportion of patients suffer a recurrence; hence, there is scope to potentially improve outcomes through technical innovations such as ablation index (AI) guidance during AF ablation. We present real-world 5-year follow-up data of AI-guided pulmonary vein isolation. Methods We retrospectively followed 123 consecutive patients who underwent AI-guided CA shortly after its introduction to routine practice. Data were collected from the MPH AF Ablation Registry with the approval of the institutional research board. Results Our patient cohort was older, with higher BMI, greater CHA2DS2-VASc scores, and larger left atrial sizes compared to similar previously published cohorts, while gender balance and other characteristics were similar. The probability of freedom from atrial arrhythmia with repeat procedures is as follows: year 1: 0.95, year 2: 0.92, year 3: 0.85, year 4: 0.79, and year 5: 0.72. Age >75 years (p = 0.02, HR: 2.7, CI: 1.14-6.7), BMI >35 kg/m2 (p = 0.0009, HR: 4.6, CI: 1.8-11.4), and left atrial width as measured on CT in the upper quartile (p = 0.04, HR: 2.5, CI: 1-5.7) were statistically significant independent predictors of recurrent AF. Conclusion AI-guided CA is an effective treatment for AF, with 95.8% of patients remaining free from atrial arrhythmia at 1 year and 72.3% at 5 years, allowing for repeat procedures. It is safe with a low major complication rate of 1.25%. Age >75 years, BMI >35 kg/m2, and markedly enlarged atria were associated with higher recurrence rates.
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Affiliation(s)
- N. Fitzpatrick
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - S. Herczeg
- Department of Cardiology, Heart and Vascular Centre of Semmelweis University, Budapest, Hungary
| | - K. Hong
- Health Sciences Centre, UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - F. Seaver
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - L. Rosalejos
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - U. Boles
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - G. Jauvert
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - E. Keelan
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - J. O’Brien
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - T. Tahin
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
| | - J. Galvin
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
- Health Sciences Centre, UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - G. Széplaki
- Atrial Fibrillation Institute, Mater Private Hospital, Dublin, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Park J, Galvin J. FACTOR STRUCTURE OF PRE-LOSS GRIEF-12 IN CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.017] [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: 12/24/2022] Open
Abstract
Abstract
While several studies on post-loss grief have been conducted, little research has examined assessment and treatment for pre-loss grief in family caregivers of persons living with dementia (PLWD). A total of 699 caregivers of PLWD were recruited through relevant dementia associations. The recruitment e-mail provided information about the study and instructions on how to participate by a link to the online survey. Confirmatory factor analysis (CFA) was performed to test the fit of the data from the caregivers and to assess the factor structure of the Prolonged Grief-12 (PG-12) to evaluate pre-loss grief accurately by identifying relevant items and eliminating items that are not appropriate for caregivers of PLWD to assess pre-loss grief accurately. CFA was conducted via the Full Information Maximum Likelihood estimation method to test the unidimensional model of the PG-12 in the study population. The initial model was modified to develop a better-fitting model and to detect misfitting parameters in the PG-12 by deleting irrelevant items for caregivers of PLWD. The adjusted dementia-specific 10-item version (PG-10-D) had significantly improved fit indices with RMSEA = .064, CFI = .972, and GFI = .963. An overall assessment of fit indicated that the model adequately approximated the data. Factor loadings ranged from 0.53 to 0.85. This study suggests that the dementia-specific, unidimensional PG-10-D, modifying the original PG-12, may be useful and parsimonious in assessing and quantifying pre-loss grief in caregivers. Further research is required to establish psychometric properties, including factorial validity and reliability, factorial invariance analysis and further factor analysis.
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Affiliation(s)
- JuYoung Park
- Florida Atlantic University College of Social Work and Criminal Justice , Boca Raton, Florida , United States
| | - James Galvin
- University of Miami School of Medicine , Miami, Florida , United States
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3
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Tolea M, Cohen I, Camacho S, Galvin J. MINDFULNESS AND CAREGIVING EXPERIENCE IN ADRD CAREGIVERS. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.1772] [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: 12/24/2022] Open
Abstract
Abstract
Mindfulness (being present in the moment without judgement) has been linked to greater caregiver emotional health. Recent mindfulness-based interventions report improved coping skills, mood, and reduced stress in dementia caregivers. In this cross-sectional study of 141 ADRD caregivers, we assessed whether the relationship between caregiver mindfulness and caregiver experience varies by caregiver gender, relationship to patient (spouse-vs-child), etiology (AD-vs-LBD), or stage (MCI-vs-dementia). A stratified univariate analytic approach was used. Four mindfulness parameters (AMPS scale) were used: global score (GS), decentering (F1), positive (F2), and negative emotional regulation (F3). Outcomes included positive and negative appraisals of caregiving (PANAC), preparedness, care confidence, and depression. GS was linked to positive outcomes in male (rPANAC+=0.32/p=0.005), spouse caregivers (rPANAC+)=0.32/p=0.006 ) of ADRD patients regardless of etiology (rPANAC+=0.31/p=0.013 for AD; rconfidence=0.31/p=0.036 for LBD) and stage (rPANAC+=0.33/p=0.010 and rpreparedness=0.38,/p=0.008 for MCI; rPANAC+=0.29/p=0.011 and rconfidence=0.31/p=0.007 for dementia). Inverse relationships were observed with negative outcomes in male (rPANAC-=-0.46/p=0.002 and rdepression=-0.41/p=0.005), spouse caregivers (rPANAC-=-0.25/p=0.035 and rdepression=-0.30/p=0.009) of AD patients (rPANAC-=-0.25/p=0.043 and rdepression=-0.33/p=0.009) in early stages (rdepression=-0.41/p=0.001). F2 contributed to most relationships, with F3 and F1 significant in some but not all caregiver groups. Specifically, male spouse caregivers of AD patients regardless of stage may benefit from full-scope (F1-F3) programs while those of LBD patients from programs focused on improving emotional regulation (F2-F3). Wives of AD and LBD patients may in turn benefit from programs to improve positive emotional regulation (F2). Findings suggest that tailoring mindfulness-based interventions to specific caregiver groups may be effective in improving caregiver experience and mood.
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Affiliation(s)
- Magdalena Tolea
- University of Miami Miller School of Medicine , Boca Raton, Florida , United States
| | - Iris Cohen
- University of Miami Miller School of Medicine , Boca Raton, Florida , United States
| | - Simone Camacho
- University of Miami Miller School of Medicine , Boynton Beach, Florida , United States
| | - James Galvin
- University of Miami School of Medicine , Miami, Florida , United States
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Camacho S, Tolea M, Mendez N, Zambrano JJ, Galvin J. THE RELATIONSHIP BETWEEN ADVANCE CARE PLANNING AND COGNITIVE FUNCTION IN A MULTICULTURAL COHORT. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2508] [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: 12/24/2022] Open
Abstract
Abstract
Engagement in Advance care planning (ACP) – the process of communicating preferences for future medical decisions, has been linked to increasing age, greater decision-making capacity, and higher education, and is more prevalent in White older adults. To advance knowledge of ACP in multicultural populations, we examined variations in the relationship between sociodemographics, cognitive functionality and ACP. A total of 303 older (mean-age: 69.4±10.5; 69.9% females; 29.6% Non-Hispanic White, 21.2% African American, and 49.2% Hispanic) participants in a community-based dementia screening program were included. ACP measures included life insurance, disability insurance, long-term care (LTC) insurance, power of attorney (POA), living will, and having a health care proxy (HCP). Although most participants had health insurance (92.4%, no differences by race), low rates of ACP engagement were found in racial/ethnic minorities across multiple ACP measures (all ≤40%). Black older adults had the highest use of life insurance (p<.001). Higher ACP rates (i.e., LTC, HCP, living will) were associated with better global cognition (MoCA; p< 0.05). Higher POA rates were associated with lower AD8 scores (30.1% in AD8< 2 vs 15.4% in AD8≥2, p=0.003). Finally, ACP rates varied across racial-SES groups being highest in high SES White participants and lowest in minorities with low SES, regardless of subjective or objective cognitive performance. Findings link ACP to greater cognitive functionality and highlight racial and SES disparities in ACP engagement, particularly related to non-insurance-based planning. Understanding cultural differences in decision making can lead to targeted interventions to increase early ACP in cognitive aging and dementia for older adults.
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Affiliation(s)
- Simone Camacho
- University of Miami Miller School of Medicine , Boynton Beach, Florida , United States
| | - Magdalena Tolea
- University of Miami Miller School of Medicine , Boca Raton, Florida , United States
| | - Nicole Mendez
- University of Miami Miller School of Medicine , Miami, Florida , United States
| | | | - James Galvin
- University of Miami School of Medicine , Miami, Florida , United States
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Treanor C, Brogan S, Burke Y, Curley A, Galvin J, McDonagh L, Murnaghan C, Mc Donnell P, O'Reilly N, Ryan K, French HP. Prospective observational study investigating the predictive validity of the STarT Back tool and the clinical effectiveness of stratified care in an emergency department setting. Eur Spine J 2022; 31:2866-2874. [PMID: 35786771 DOI: 10.1007/s00586-022-07264-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 02/24/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the predictive validity of the STarT Back tool (SBT) undertaken at baseline and 6 weeks to classify Emergency Department (ED) patients with LBP into groups at low, medium or high risk of persistent disability at 3 months. A secondary aim was to evaluate the clinical effectiveness of pragmatic risk-matched treatment in an ED cohort at 3 months. METHODS A prospective observational multi-centre study took place in the physiotherapy services linked to the ED in four teaching hospitals in Dublin, Ireland. Patients were stratified into low, medium and high-risk groups at their baseline assessment. Participants received stratified care, where the content of their treatment was matched to their risk profile. Outcomes completed at baseline and 3 months included pain and disability. Linear regression analyses assessed if baseline or 6-week SBT score were predictive of disability at 3 months. Changes in the primary outcome of disability were dichotomised into those who achieved/ did not achieve a 30% improvement in their RMDQ at 6 weeks and 3 months. RESULTS The study enrolled 118 patients with a primary complaint of LBP ± leg pain with 67 (56.7%) completing their 6-week and 3-month follow-up. Baseline RMDQ and being in medium or high risk SBT group at 6 weeks were predictive of persistent disability at 3 months. A total of 54 (80.6%) participants reported a > 30% improvement at 3 months. CONCLUSION Disability at baseline and SBT administered at 6 weeks more accurately predicted disability at 3 months than SBT at baseline in an ED population.
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Affiliation(s)
- C Treanor
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland.
| | - S Brogan
- Physiotherapy Department, Tallaght University Hospital, Dublin, Ireland
| | - Y Burke
- Physiotherapy Department, St James's Hospital, Dublin, Ireland
| | - A Curley
- Physiotherapy Department, Tallaght University Hospital, Dublin, Ireland
| | - J Galvin
- Physiotherapy Department, St James's Hospital, Dublin, Ireland
| | - L McDonagh
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C Murnaghan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Mc Donnell
- Physiotherapy Department, Connolly Hospital, Dublin, Ireland
| | - N O'Reilly
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - K Ryan
- Physiotherapy Department, Tallaght University Hospital, Dublin, Ireland
| | - H P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Cronin H, Gallagher M, McGorrian C, Galvin J. The genetic spectrum of hypertrophic cardiomyopathy in an irish cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypertrophic cardiomyopathy (HCM) has long been described as the archetypal monogenic cardiac disease. It fulfils the criteria for Mendelian inheritance and painstaking early co-segregation studies by Seidman et al in 1990 lead to the discovery that mutations in MYH7 cause HCM. From here, the genetic architecture of HCM has been gradually assembled and thousands of individual mutations discovered. The complexity of HCM genetics continues to evolve to include the gene-negative cohort and those carrying multiple mutations. We sought to describe the genetic spectrum of HCM in an Irish population.
Methods
A retrospective examination of the proband database of a specialist cardiomyopathy clinic was undertaken to select all patients with gene-positive HCM. Their clinical data and cardiac imaging was reviewed. Mutations classified by the American College of Medical Genetics as Class 4 and 5 were considered pathogenic. Variants of uncertain significance (VUS) in candidate genes were also recorded, though not clinically actionable.
Results
The results of genetic testing for 254 HCM patients were reviewed. 94% of patients (n=238) had a single pathogenic HCM gene mutation. 5% of patients (n=13) had digenic disease. The remaining 1% (n=3) had oligogenic disease. MYBPC3 was the most commonly involved gene with 116 patients (45.6%) carrying a pathogenic variant. The p. Arg502Trp missense mutation is the most common mutation observed within the Irish cohort and has a founder effect in England. MYH7 mutations were found in 51 patients (20%). Troponin mutations were found in 20 patients (6.8%). Although formally classified as a VUS, there was an overrepresentation of FHOD3 mutations with 19 patients (7.4%) carrying a variant. 41 patients (16%) had pathogenic mutations in PRKAG2, LAMP2 and mitochondrial genes collectively.
Discussion
This Irish cohort has a similar genetic profile in sarcomeric HCM to published European registry data. There is an overrepresentation in HCM phenocopy/metabolic conditions such as mitochondrial and PRKAG2-associated cardiomyopathy. This represents a genetically homogenous small population in Ireland but also includes one of the largest Danon disease cohorts in Europe.
The genetic architecture of hypertrophic cardiomyopathy is complex and the concept of monogenic sarcomeric disease is an over-simplification. There is significant phenotypic variability due to gene-gene effects and gene-dose effects, as well as elusive epigenetic modifier effects. Our understanding of the genetic complexities continues to evolve.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Mater Foundation
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Affiliation(s)
- H Cronin
- Mater Misericordiae University Hospital , Dublin , Ireland
| | - M Gallagher
- Mater Misericordiae University Hospital , Dublin , Ireland
| | - C McGorrian
- Mater Misericordiae University Hospital , Dublin , Ireland
| | - J Galvin
- Mater Misericordiae University Hospital , Dublin , Ireland
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7
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Cronin H, Gallagher M, McGorrian C, Galvin J. Promise or peril: the ECG in HCM. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Hypertrophic cardiomyopathy is a complex disease of the myocardium characterised by left ventricular hypertrophy >15mm in any one segment, in the absence of loading conditions. The phenotypic variability and inhomogeneous nature of the condition have resulted in difficulties with diagnosis. Despite the significant progression in cardiac imaging and genetics, the electrocardiogram (ECG) remains the cornerstone of initial evaluation of patients with HCM and in the screening of families. Moreover, the ECG is in widespread use for pre-participation sports screening.
Purpose
Original and contemporary studies indicate that the ECG is normal in only 6–10% of patients with echocardiographic evidence of HCM. We hypothesised that the ECG may be normal in a significant proportion of HCM patients. This study sought to reassess the ECG as a screening tool in a HCM cohort.
Methods
112 patients were selected randomly from the database of a specialist cardiomyopathy clinic. Their most recent ECG, clinical and imaging data were reviewed. All patients had echocardiographic HCM and were carriers of pathogenic sarcomere gene mutations. Patients with phenocopies were excluded. ECG data for 100 age and sex-matched controls was also analysed. ECG interpretation was performed using international criteria.
Results
18% of patients with a clinical diagnosis of HCM by conventional diagnostic standards (LV wall thickness >15mm) had a normal ECG. A further 7% had a normal ECG with a mild HCM phenotype (LV wall thickness of 13–14mm). The most common abnormality observed was T wave inversion (TWI) in 28%. An additional unexpected finding in the HCM group was isolated TWI in lead aVL. This occurred in 27% of patients in the absence of any other repolarisation abnormalities, compared with 1% of controls. The significance of this finding is unclear. 27% of HCM patients displayed voltage criteria for left ventricular hypertrophy by either Cornell or Sokolow-Lyon criteria, with just 4% meeting criteria for both. 13% of HCM patients had corrected QT prolongation, in the absence of medications responsible for this.
Conclusion
The ECG continues to play a pivotal role in HCM diagnosis but its sensitivity to detect disease has been over-estimated. Up to a quarter of patients with HCM have a normal ECG. This is significantly higher than previously reported. The ECG in isolation therefore is not a reliable tool for screening for HCM in the general population and especially unreliable in at-risk subjects.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Mater Foundation
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Affiliation(s)
- H Cronin
- Mater Misericordiae University Hospital , Dublin , Ireland
| | - M Gallagher
- Mater Misericordiae University Hospital , Dublin , Ireland
| | - C McGorrian
- Mater Misericordiae University Hospital , Dublin , Ireland
| | - J Galvin
- Mater Misericordiae University Hospital , Dublin , Ireland
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Magnocavallo M, Della Rocca D, Van Niekerk C, Gilhofer T, Ha G, D‘Ambrosio G, Galvin J, Urbanek L, Lavalle C, Schmidt B, Geller C, Lakkireddy D, Di Biase L, Price M, Mansour M, Saw J, Horton R, Gibson D, Natale A. P95 PERI–PROCEDURAL COMPLICATIONS AND LONG–TERM OUTCOMES IN ATRIAL FIBRILLATION PATIENTS STRATIFIED FOR CHRONIC KIDNEY DISEASE SEVERITY UNDERGOING LEFT ATRIAL APPENDAGE OCCLUSION: RESULTS FROM AN INTERNATIONAL, MULTICENTER REGISTRY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thromboembolic events. CKD concomitantly contributes to several pathophysiological changes predisposing towards a pro–haemorrhagic state.
Objective
To evaluate the impact of kidney function on peri–procedural complications and clinical outcomes in AF patients undergoing left atrial appendage occlusion (LAAO) with a Watchman device.
Methods
2124 consecutive AF patients undergoing Watchman implantation at 8 different centers were categorized into CKD stage 1 + 2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary efficacy endpoint included a composite of cardiovascular (CV) mortality, stroke, transient ischemic attack, peripheral thromboembolism (TE), and major bleeding.
Results
A non–significant higher incidence of major peri–procedural adverse events (1.7% vs. 2.3% vs. 4.1% vs. 4.3%) was observed with worsening baseline kidney function (p = 0.14). The mean follow–up period was 13 ± 7 months [2226 patient–years (PY)]. In comparison to CKD stage 1 + 2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log–rank p–value= 0.04), CKD stage 4 (log–rank p–value= 0.01), and CKD stage 5 (log–rank p–value= 0.001) (Fig. 1A). A non–significant increase in event rates for stroke/TIA and clinically relevant bleeding was observed among the four groups. LAAO led to a TE risk reduction of 72%, 66%, 62%, and 41% in each group (Fig. 1B). The relative risk reduction in the incidence of major bleeding was 58%, 44%, 51%, and 52%, respectively (Fig. 1C).
Conclusion
Patients with moderate–to–severe CKD had a higher incidence of the primary composite endpoint. The relative risk reduction in the incidence of TE and major bleeding was consistent across CKD groups, irrespective of the very different risk profiles at baseline.
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Affiliation(s)
- M Magnocavallo
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - D Della Rocca
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - C Van Niekerk
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - T Gilhofer
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - G Ha
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - G D‘Ambrosio
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - J Galvin
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - L Urbanek
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - C Lavalle
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - B Schmidt
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - C Geller
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - D Lakkireddy
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - L Di Biase
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - M Price
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - M Mansour
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - J Saw
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - R Horton
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - D Gibson
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
| | - A Natale
- POLICLINICO UMBERTO I, ROMA; TEXAS CARDIAC ARRHYTHMIA INSTITUTE, AUSTIN; SCRIPPS CLINIC, LA JOLLA; VANCOUVER GENERAL HOSPITAL, VANCOUVER; MASSACHUSETTS GENERAL HOSPITAL, BOSTON; ZENTRALKLINIK BAD BERKA, BAD BERKA; CARDIOANGIOLOGISCHES CENTRUM BETHANIEN, FRANKFURT; OTTO–VON–GUERICKE UNIVERSITY SCHOOL OF MEDICINE, MAGDEBURG; KANSAS CITY HEART RHYTHM INSTITUTE AND RESEARCH FOUNDATION, OVERLAND PARK
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9
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Bowden J, Starke A, Galvin J, Carroll M, Smyth G, Morris S. PD-0236 Auto Beam Hold intrafraction monitoring performance for prostate radiotherapy with a hydrogel spacer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02791-8] [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]
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10
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Galvin J, Tiberi S, Akkerman O, Kerstjens HAM, Kunst H, Kurhasani X, Ambrosino N, Migliori GB. Pulmonary tuberculosis in intensive care setting, with a focus on the use of severity scores, a multinational collaborative systematic review. Pulmonology 2022; 28:297-309. [PMID: 35227650 PMCID: PMC9420544 DOI: 10.1016/j.pulmoe.2022.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background and aim Tuberculosis (TB) is associated with a high mortality in the intensive care unit (ICU), especially in subjects with Acute Respiratory Distress Syndrome (ARDS) requiring mechanical ventilation. Despite its global burden on morbidity and mortality, TB is an uncommon cause of ICU admission, however mortality is disproportionate to the advances in diagnosis and treatment made. Herein we report a systematic review of published studies. Methods Our Literature search was conducted to identify studies on outcomes of individuals with TB admitted to ICU. We report and review in-hospital mortality, predictors of poorer outcomes, usefulness of severity scoring systems and potential benefits of intravenous antibiotics. Searches from Pubmed, Embase, Cochrane and Medline were conducted from inception to March 2020. Only literature in English was included. Results Out of 529 potentially relevant articles, 17 were included. Mortality across all studies ranged from 29-95% with an average of 52.9%. All severity scores underestimated average mortality. The most common indication for ICU admission was acute respiratory failure (36.3%). Negative predictors of outcome included hospital acquired infections, need of mechanical ventilation and vasopressors, delay in initiation of anti-TB treatment, more than one organ failure and a higher severity score. Low income, high incidence countries showed a 23.4% higher mortality rate compared to high income, low TB incidence countries. Conclusion Mortality in individuals with TB admitted to ICU is high. Earlier detection and treatment initiation is needed.
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Affiliation(s)
- J Galvin
- Department of Infection, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | - S Tiberi
- Department of Infection, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | - O Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherland; University of Groningen, University Medical Center Groningen, Tuberculosis center Beatrixoord, Haren, the Netherlands
| | - H A M Kerstjens
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherland; University of Groningen, University Medical Center Groningen, Tuberculosis center Beatrixoord, Haren, the Netherlands
| | - H Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom; Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | | | - N Ambrosino
- Pneumology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS, Via Roncaccio 16, Tradate 21049, Italy.
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11
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Tolea M, Chrisphonte S, Galvin J. Vitamin D, Insulin-Like Growth Factor, and Cognitive Performance: Age and Sex Variations. Innov Aging 2021. [PMCID: PMC8681510 DOI: 10.1093/geroni/igab046.2618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Vitamin D has been consistently linked to better cognitive function in observational studies. This impact may be due in part through its influence on neurotrophins. Whether the relationships between vitamin D, neurotrophins, and cognition vary based on biological factors such as age and sex is unclear. Using data from a sample of 400 community-dwelling older (mean age=75.3±9.4; 47% female) participants in a cross-sectional study of cognitive aging, we assessed relationships between plasma 25-hydroxy-Vitamin D and performance on a neuropsychological battery modeled after the UDSv3.0. Moderation by age and sex and the impact of vitamin D on the relationship between Insulin-like Growth Factor-1 and cognitive performance were assessed by linear regression stratified by sex and age (median split at 76y). We found vitamin D to be positively linked to global cognition (MoCA: β=0.095±0.025SE, p<0.001), working memory (Number Span Forward: β=0.017±0.007SE, p=0.011; Number Span Backward: β=0.016±0.007SE, p=0.028), episodic memory (Immediate Recall : β=0.089±0.027SE, p=0.001; Delayed Recall: β=0.047±0.015SE, p=0.002), attention and processing speed (Trail Making A: β=-0.365±0.163SE, p=0.026), executive function (Trail Making B: β=-0.537±0.215SE, p=0.014; Number-Symbol Coding: β=0.139±0.057SE, p=0.016), and an overall measure of cognitive function (z score: β=0.049±0.018SE, p=0.007). Most of these relationships were observed in women and younger older individuals (<76y). In addition, vitamin D increased the effect of IGF-1 on global cognition and memory by 13% and 8%, respectively. Our findings suggest that vitamin D-focused dementia prevention efforts would benefit if targeted to women and younger segments of the senior population and/or as an adjuvant to cognitive enhancement interventions.
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Affiliation(s)
- Magdalena Tolea
- University of Miami Miller School of Medicine, Boca Raton, Florida, United States
| | | | - James Galvin
- University of Miami Miller School of Medicine, Miami, Florida, United States
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12
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Wiese L, Williams I, Schoenberg N, Galvin J, Lingler J. Promoting Inclusivity in Dementia Education and Screening in an Ethnically Diverse, Rural Community During a Pandemic. Innov Aging 2021. [PMCID: PMC8679555 DOI: 10.1093/geroni/igab046.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Rural, ethnically diverse older adults experience disparities in dementia detection/management. The Covid-19 quarantine exacerbated these disparities, and threatened faith-based dementia education and screening activities. We investigated the effectiveness of a telephone-based outreach for increasing dementia knowledge and detecting cognitive risk among a rural, diverse, underserved community of 89% African American, Hispanic, and Haitian Creole residents, Faith-based health educators, trained using virtual Alzheimer’s Association resources, contacted church congregants who responded to radio worship service announcements. Participants completed telephone measures of basic dementia knowledge and cognitive risk. Of the estimated 120 persons across five churches who received an invitation, 75% (n = 90) participated in dementia education and memory screening via telephone. Twelve (80%) of the 15 participants assessed as being at risk followed up with their provider. Rural residents are known for preferring face-to-face contact. Their willingness to complete health-promoting research activities by telephone highlighted the community’s interest in dementia awareness.
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Affiliation(s)
- Lisa Wiese
- Florida Atlantic University, C.E. Lynn College of Nursing, Florida, United States
| | - Ishan Williams
- University of Virginia, Charlottesville, Virginia, United States
| | | | - James Galvin
- University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jennifer Lingler
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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13
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Murphy JM, Kirk CW, Galvin J, Ward D, Prendiville T, Lynch SA. Diagnostic yield from cardiac gene panel testing for inherited cardiac conditions in a large Irish cohort. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Inherited cardiomyopathies (hypertrophic, dilated and arrhythmogenic) and cardiac ion channelopathies (long QT, Brugada and CPVT) predispose to sudden cardiac death/sudden arrhythmic death syndrome. Given their genetically heterogenous nature, multi-gene DNA sequencing panels are useful to aid genetic diagnosis.
Purpose
Investigate the diagnostic yield from cardiac gene panel testing undertaken in patients (including molecular autopsy in deceased patients) referred to four clinical services from 2002 to 2020.
Methods
Data was collected by interrogation of departmental databases, family charts, and review of molecular genetic diagnostic reports.
Results
We evaluated molecular genetic diagnostic results from 835 individuals (461 males, 374 females) from 824 families, including 58 deceased patients who underwent molecular autopsy. The median age of the cohort was 44 years (range 0.1–86 years).
Testing for hypertrophic cardiomyopathy (HCM) and long QT syndrome (LQT) genes represented 36% and 32% of the cohort, respectively, with the remaining 32% accounting for other cardiomyopathies, arrhythmia syndromes or metabolic/syndromic diseases. The overall variant detection rate was 50% across all panel types. Three hundred and fifty patients (42%) carried a single variant, 68 patients (8%) carried multiple variants (up to a maximum of four), including two individuals who carried two actionable (pathogenic/likely pathogenic) variants each and 30 individuals (5%) with one actionable variant plus a variant of uncertain significance (VUS).
The overall diagnostic yield of at least one actionable variant was 28%. At least one VUS was detected in 27% of the cohort. Molecular autopsy yielded an actionable variant in 10% of patients, while 30% of the subcohort carried at least one VUS (up to maximum of two).
We found a positive association between female sex and the likelihood of detecting an actionable variant. By decade of age, detection of actionable variants ranged from 19% (60–69 years) to 41% (0–9 years). By panel type, actionable variants ranged from 14% (Brugada) to 35% (cardiomyopathy). The burden of VUS ranged from 22% (LQT) to 46% (dilated cardiomyopathy).
Altogether 234 actionable variants were detected in 26 genes, including seven metabolic or syndromic disease genes. From those with non-metabolic/syndromic forms of disease, 84% of actionable variants were detected in well established ICC genes. Analysis of gene-disease associations for VUS detected from HCM and LQT panels revealed that 10–25% were detected in genes now deemed to have only moderate or limited evidence of disease causation.
Conclusion
Most actionable variants in this cohort were detected in well-established ICC genes, suggesting that large gene panels offer little extra sensitivity compared to historic smaller gene panels. Despite recent gene curation efforts, the high burden of VUS remains a considerable challenge in ICC management.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): National Children's Research Centre
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Affiliation(s)
- J M Murphy
- University College Dublin, School of Medicine, Dublin, Ireland
| | - C W Kirk
- University College Dublin, School of Medicine, Dublin, Ireland
| | - J Galvin
- Mater Misericordiae University Hospital, Cardiology, Dublin, Ireland
| | - D Ward
- Tallaght University Hospital, Dublin, Ireland
| | - T Prendiville
- Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - S A Lynch
- University College Dublin, School of Medicine, Dublin, Ireland
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14
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Park J, Tolea M, Besser L, Galvin J. Intention to Receive Cognitive Screening for Alzheimer’s Disease in Nondemented Older Adults. Innov Aging 2020. [PMCID: PMC7740389 DOI: 10.1093/geroni/igaa057.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The study explored factors associated with intention to receive cognitive screening for Alzheimer’s disease (AD). It also examined whether self-efficacy mediates the relationship between knowledge about screening and the intention to be screened. A population-based, random-digit dialing survey was performed; 1,043 responses were collected from a sample of nondemented older adults living in urban, suburban, and rural areas. A majority were female (66.8%, n = 697) and White (82.7%, n = 863) with a mean age 62.6 years (SD = 10.2). Findings from regression analysis identified that being female (β = .080), being depressed (β = .149), and having a positive life orientation (β = .120) were significantly associated with the intention to receive cognitive screening, p < .05. Results indicated that older adults with a positive life orientation reported greater intention to be screened for AD, whereas depressed participants were more likely to plan to be screened for AD. Bootstrapping results identified a mediating effect of self-efficacy (β = .2668, t = 7.3137, p < .0005). Self-efficacy mediated the relationship between knowledge about screening and intention to be screened. Using self-efficacy as a mediation effect indicated that older adults with knowledge about screening understand the benefits of early screening and diagnosis and are more likely to have self-efficacy (i.e., confidence to consult with a physician), and thus are more likely to show intention to be screened. Intention to be screened for AD could increase public awareness by defining effective ways to assist older adults to seek a cognitive screen.
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Affiliation(s)
- Juyoung Park
- Florida Atlantic University, Boca Raton, Florida, United States
| | - Magdalena Tolea
- University of Miami Miller School of Medicine, Boca Raton, Florida, United States
| | - Lilah Besser
- Florida Atlantic University, Boca Raton, Florida, United States
| | - James Galvin
- University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, United States
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15
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Tolea M, Galvin J. Relationship Between Patient and Informant Assessment of Personality and Cognitive Status. Innov Aging 2020. [PMCID: PMC7740419 DOI: 10.1093/geroni/igaa057.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Personality has been linked to risk of dementia. Most studies ask individuals to rate their own personality traits or for a knowledgeable informant to perform the rating; few collect data from both. When informants are asked to give an estimate of the patient’s lifelong personality traits, they often describe personality before disease onset. When asked to self-rate, patients may instead assess their personality as they see themselves, providing a personality-state measure. The goal of this study was to assess agreement between two independent measures of personality and evaluate whether stage of cognitive impairment and characteristics of patients or caregivers impact concordance. In 79 consecutive patient-caregiver dyads presenting to our center (mean age:76.8±8.4; 44.1% female; 6% cognitively normal, 41% MCI; and 53% dementia) with in-depth psychosocial and neuropsychological evaluations, we found informants rated patients lower on openness (O) (ICC=0.434; 95%CI: 0.235-0.598) and agreeableness (A) (ICC=0.491; 95%CI: 0.302-0.643) and higher on extraversion (O) (ICC=0.396; 95%CI: 0.191-0.568) and neuroticism (N) (ICC=0.444; 95%CI: 0.247-0.607). Greater discordance was observed in established dementia (ICCE=0.497; 95%CI: 0.222-0.700; ICCA=0.337; 95%CI:0.031-0.586; ICCN=0.422; 95%CI: 0.191-0.683), compared with MCI (ICCO=0.568; 95%CI: 0.282-0.762). We explored the effect of patient and caregiver mood and caregiver burden on personality ratings. Although personality is typically described as a trait, we present evidence that in the eyes of patients, personality ratings may represent a state that changes across the spectrum of cognitive impairment. Understanding how patients and caregivers differentially perceive personality may assist in developing novel psychotherapeutic interventions and approaches dealing with behavioral manifestations of dementia.
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Affiliation(s)
- Magdalena Tolea
- University of Miami Miller School of Medicine, Boca Raton, Florida, United States
| | - James Galvin
- University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, United States
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16
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Li XA, Moughan J, White JR, Freedman GM, Arthur DW, Galvin J, Xiao Y, McNulty S, Lyons JA, Kavadi VS, Fields MT, Mitchell MP, Anderson BM, Lock MI, Kokeny KE, Bazan JG, Currey AD, Hijal T, Cheston SB, Vicini FA. Patterns of Failure Observed in the 2-Step Institution Credentialing Process for NRG Oncology/Radiation Therapy Oncology Group 1005 (NCT01349322) and Lessons Learned. Pract Radiat Oncol 2020; 10:265-273. [DOI: 10.1016/j.prro.2019.11.007] [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] [Received: 08/24/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
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17
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Park J, Tolea M, Besser L, Galvin J. Intention to Be Screened for Alzheimer's Disease in Nondemented Older Adults: Integrated Behavioral Model and Self-Efficacy as Mediation Effect. J Hum Behav Soc Environ 2020; 30:778-796. [PMID: 33364731 PMCID: PMC7751942 DOI: 10.1080/10911359.2020.1752349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The study explored factors associated with intention to be screened for Alzheimer's disease (AD). The study also examined whether self-efficacy mediates the relationship between knowledge about screening and the intention to be screened for AD. A population-based, random-digit dialing survey was performed and 1,043 responses were collected from a sample of nondemented persons (50 years or older) living in urban, suburban, and rural areas in a Midwestern state. The findings showed that participants who were younger and who had higher levels of (a) perceived benefits and barriers, (b) social support, and (c) self-efficacy reported higher levels of intention to be screened for AD. Older adults with positive life orientation reported greater intention to be screened for AD, whereas depressed participants were more likely to report a plan to be screened for AD. Self-efficacy mediated the relationship between knowledge about screening and intention to be screened. Older adults were more likely to report intention to be screened when they had positive attitudes about the screen and believed that they could receive the screen. The intention to be screened for AD could serve public awareness by defining effective ways to assist older adults to seek a cognitive screen.
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Affiliation(s)
- Juyoung Park
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University
| | - Magdalena Tolea
- University of Miami, Miller School of Medicine, Department of Neurology
| | - Lilah Besser
- School of Urban & Regional Planning, Florida Atlantic University
| | - James Galvin
- University of Miami, Miller School of Medicine, Department of Neurology
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18
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Carron J, O"brien J, Gallagher M, Mcgorrian C, Galvin J. 1266Novel formin homology 2 domain containing 3 (FHOD3) mutations associated with the pathogenesis of hypertrophic cardiomyopathy (HCM) in an Irish population. Europace 2020. [DOI: 10.1093/europace/euaa162.080] [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] Open
Abstract
Abstract
Background
The genetic cause of hypertrophic cardiomyopathy (HCM) remains unexplained in a substantial proportion of cases. Recent large sequencing studies suggest that, though not previously implicated, FHOD3 (a Formin protein responsible for sarcomere assembly) may have a role in the pathogenesis of HCM, particularly variants affecting a conserved small coil-coiled domain (amino acids 622 to 655).
Aim
To investigate the relationship between novel FHOD3 mutations, previously classified as variants of uncertain significance (American College of Medical Genetics ACMG Class III), and the development of HCM.
Methods
A single center review of HCM probands carrying mutations in the FHOD3 gene was conducted. Existing HCM patients from the family heart screening clinic database were retrospectively reviewed. Frequency of FHOD3 mutations, segregation among family members and clinical characteristics of patients were reviewed. All genetic analysis was conducted via the same internationally validated next generation sequencing lab.
Results
Of 367 HCM probands identified in our center, 9 (2.45%) were found to have ACMG Class III mutations affecting the FHOD3 gene. Five of these 9 probands (56%) displayed the same p.Arg637Gln mutation, while the remaining 4 (44%) carry the same p.Ile648Thr residue alteration. Both of these are rare mutations, found to be present in <1% of controls in previous large sequencing studies and not previously reported. Among probands with the p.Ile648Thr mutation, co-segregation was confirmed in one family, another first-degree relative in the same family having suffered a sudden cardiac death (HCM confirmed on autopsy). In those with the p.Arg367Gln mutation, a strong family history was observed in two separate families, 4 first-degree members having a confirmed HCM diagnosis. Carriers of both mutation types displayed varying degrees of disease severity with rates of non-sustained ventricular tachycardia and device implantation similar to other HCM cohorts (∼40%).
Conclusions
FHOD3 is a novel gene, recently implicated in the pathogenesis of HCM, though not previously well described in the literature. Carrier frequency of FHOD3 mutations in the HCM population in our center is similar to that described in recent publication (1-2%), and all carry variants affecting the suspected small coil-coiled domain (amino-acids 622-625).
Abstract Figure.
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Affiliation(s)
- J Carron
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - J O"brien
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M Gallagher
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Mcgorrian
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Galvin
- Mater Misericordiae University Hospital, Dublin, Ireland
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Gallen R, Herczeg S, Mcgorrian C, Carron J, Walsh K, Keelan T, Galvin J, Szeplaki G, Keaney J. P333Left atrial function by echocardiography is independent of degree of left atrial electrical scar. Europace 2020. [DOI: 10.1093/europace/euaa162.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Assessment of left atrial function via transthoracic echocardiography (TTE) is performed most commonly by measuring the transmitral A wave in sinus rhythm. Left atrial (LA) fibrosis plays an important role in the pathogenesis and perpetuation of Atrial Fibrillation (AF). It may be identified by bipolar voltage (BiV) mapping, which can easily be performed at the beginning of a Pulmonary Vein Isolation (PVI) procedure. The relationship between the degree of LA fibrosis, characterised with mapping, and LA function, determined by echocardiography, has not previously been elucidated.
Methods
Patients were enrolled in a project to evaluate the degree of fibrosis during PVI procedures. Pre-procedure TTEs of those presenting in sinus rhythm were assessed and the transmitral A wave was measured and compared to the degree of scarring seen. The high density electroanatomic maps (HD-EAMs) created during the PVIs were analysed using a novel VHA algorithm after the procedure. All points with voltages < 0.5mV were defined to have electrical scar. Patients were classified into 4 quartiles based on the levels of scar seen (Figure 1).
Results
39 patients were included in the evaluation. Average age was 60.6 +/- 13.2 years. 32 (82.0%) of the patients were male. Mean CHADS2VASc score was 1.5. The mean percentage of scar was calculated as 19.6 +/- 15.9%. The average A wave was 0.62 +/- 0.18 ms-1. Pearson’s correlation coefficient showed no relationship between LA scar and either A wave velocities (r = 0.26, p = 0.11) or E:A ratio (r=-0.02, p = 0.91). A significant correlation between A wave velocity and CHADS2VASc was observed (r = 0.49, p = 0.001).
Conclusion
Our study demonstrates no relationship between degree of LA scarring and reduced LA function on TTE as assessed by the A wave. It has been established that structural remodelling in AF (such as atrial dilatation) may occur independently of the electrical remodelling. A potential explanation for our findings is that the electrical scarring in AF, which results in alterations in refractory periods, precedes the negative remodelling which ultimately results in reduced atrial function. This hypothesis would need to be further evaluated in larger studies.
Abstract Figure 1
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Affiliation(s)
- R Gallen
- Mater Misericordiae University Hospital, Department of Cardiology, Dublin, Ireland
| | - S Herczeg
- Semmelweis University, Department of Cardiology, Budapest, Hungary
| | - C Mcgorrian
- Mater Misericordiae University Hospital, Department of Cardiology, Dublin, Ireland
| | - J Carron
- Mater Misericordiae University Hospital, Department of Cardiology, Dublin, Ireland
| | - K Walsh
- Mater Misericordiae University Hospital, Department of Cardiology, Dublin, Ireland
| | - T Keelan
- Mater Misericordiae University Hospital, Department of Cardiology, Dublin, Ireland
| | - J Galvin
- Mater Misericordiae University Hospital, Department of Cardiology, Dublin, Ireland
| | - G Szeplaki
- Semmelweis University, Department of Cardiology, Budapest, Hungary
| | - J Keaney
- Mater Misericordiae University Hospital, Department of Cardiology, Dublin, Ireland
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Carron J, O"brien J, Heverin K, Gallagher M, Fitzgibbon M, Fabre A, Mcgorrian C, Galvin J. 1269The SADS heart of the matter: a review of the sudden arrhythmic death syndrome (SADS) biobank - the cornerstone of a national strategy. Europace 2020. [DOI: 10.1093/europace/euaa162.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Sudden cardiac death (SCD) in the young (age 1-35) is commonly attributed to structural and arrhythmogenic syndromes, for which there is often an underlying genetic basis. Expert recommendation emphasises the importance of genetic testing in such cases, however to date this remains the first and only national programme in Europe to facilitate this.
Aim
To review detection rates of genetic variants in samples tested via the SADS BioBank and possibly demonstrate the merits of this novel resource for primary prevention for family members.
Methods
Family screening and consent for genetic testing was carried out in the Family Heart Screening Clinic. Result analysis of samples sent for molecular autopsy via the BioBank from its induction in January 2015 was performed. Genetic analysis was conducted via the same internationally accredited next generation sequencing lab.
Results
From January 2015 to July 2019, 161 samples had been stored in the SADS BioBank following confirmed SADS death on autopsy; 33% female and 67% male. Of these, 24 (14.9%) samples were sent for genetic testing: 21 for a 380 gene molecular autopsy and 3 for a targeted hypertrophic cardiomyopathy panel (173 genes). Of 24 samples tested, 10 (42%) yielded positive genetic variants: 4 American College of Medical Genetics (ACMG) Class IV or V mutations considered pathogenic, and 6 ACMG class III variants of uncertain significance (VUS). Familial cascade screening following confirmed pathogenic mutations resulted in detection of 3 (33.3%) positive genotypes in 9 first-degree relatives. Screening of relatives of Class III positive probands resulted in diagnosis of an Inherited Cardiac Condition (ICC) in 25% of first-degree relatives. 8.2% of first-degree relatives of probands with negative gene testing were given an ICC diagnosis following clinical screening.
Conclusions
This short study demonstrates the unique potential the SADS BioBank has to offer in terms of identifying those most at risk and optimising prevention strategies for relatives, thus highlighting the role for such a resource in terms of preventative screening in the future.
Pathogenic Variant (ACMG Class IV & V) Variant of Uncertain Significance(ACMG Class III) No Gene Variant Identified Number Detected (n = 24) 4 6 14 1st Degree Relatives Screened (n = 86) 17 20 49 2nd Degree Relatives Screened (n = 46) 4 23 19 Genotype Detected (n = 4) 3 1 0 Phenotype Detected (n = 10) 1 5 4 Breakdown of clinical and genetic results of family screening by ACMG class.
Abstract Figure.
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Affiliation(s)
- J Carron
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - J O"brien
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Heverin
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M Gallagher
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M Fitzgibbon
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Fabre
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Mcgorrian
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Galvin
- Mater Misericordiae University Hospital, Dublin, Ireland
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21
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Rogers CL, Won M, Vogelbaum MA, Perry A, Ashby LS, Modi JM, Alleman AM, Galvin J, Fogh SE, Youssef E, Deb N, Kwok Y, Robinson CG, Shu HK, Fisher BJ, Panet-Raymond V, McMillan WG, de Groot JF, Zhang P, Mehta MP. High-risk Meningioma: Initial Outcomes From NRG Oncology/RTOG 0539. Int J Radiat Oncol Biol Phys 2019; 106:790-799. [PMID: 31786276 DOI: 10.1016/j.ijrobp.2019.11.028] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/06/2019] [Accepted: 11/15/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Phase 2 cooperative group meningioma trial assessing the safety and efficacy of risk-adaptive management strategies. This is the initial analysis of the high-risk cohort. METHODS AND MATERIALS High-risk patients were those with a new or recurrent World Health Organization (WHO) grade III meningioma of any resection extent, recurrent WHO grade II of any resection extent, or new WHO grade II after subtotal resection. Patients received intensity-modulated radiotherapy (IMRT) using a simultaneous integrated boost technique (60 Gy high dose and 54 Gy low dose in 30 fractions). Three-year progression-free survival (PFS) was the primary endpoint. Adverse events (AEs) were scored per NCI Common Terminology Criteria for Adverse Events version 3. RESULTS Of 57 enrolled patients, 53 received protocol treatment. Median follow-up was 4.0 years (4.8 years for living patients). Two patients withdrew without progression before year 3; for the remaining 51 patients, 3-year PFS was 58.8%. Among all 53 protocol-treated patients, 3-year PFS was 59.2%. Three-year local control was 68.9%, and overall survival was 78.6%. Of 51 patients, 1 patient (1.9%) experienced a late grade-5 necrosis-related AE. All other acute (23 of 53 patients) and late (21 of 51 patients) AEs were grades 1 to 3. CONCLUSIONS Patients with high-risk meningioma treated with IMRT (60 Gy/30) experienced 3-year PFS of 58.8%. Combined acute and late AEs were limited to grades 1 to 3, except for a single necrosis-related grade 5 event. These results support postoperative IMRT for high-risk meningioma and invite ongoing investigations to improve outcomes further.
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Affiliation(s)
- C Leland Rogers
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
| | - Minhee Won
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
| | | | - Arie Perry
- University of California-San Francisco, San Francisco, California
| | - Lynn S Ashby
- Saint Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Anthony M Alleman
- The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Shannon E Fogh
- University of California-San Francisco, San Francisco, California
| | - Emad Youssef
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nimisha Deb
- Department of Radiation Oncology, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Young Kwok
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | | | | | | | | | - William G McMillan
- Juravinski Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John F de Groot
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peixin Zhang
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
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Tolea MI, Park J, Galvin J. MINDFULNESS AND COGNITIVE FUNCTION IN PATIENTS WITH COGNITIVE IMPAIRMENT. Innov Aging 2019. [PMCID: PMC6846639 DOI: 10.1093/geroni/igz038.2444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mental health benefits of mindfulness, the attribute of being aware and present in the moment, have long been acknowledged. Mindfulness has also been linked to improved cognitive performance and improvements in AD neuropathology (↓hippocampal atrophy, ↑brain connectivity) in MCI or early-stage AD patients. This study was designed to: investigate the relationship between mindfulness and cognitive function in a patient population with varying degrees of cognitive impairment; identify the specific mindfulness components that provide benefits; and explore differences by sex and disease severity. Patients (N=112; 43% female; 77.0±7.7yrs; 11% cognitively normal, 27% MCI, and 67% dementia) attending a university-based dementia clinic were administered the Applied Mindfulness Process Scale (AMPS) and underwent neuropsychological testing. Cognition was linearly regressed on AMPS with adjustment for age, gender, education, and disease stage, in the entire sample and stratified by sex and stage. In fully adjusted models, higher mindfulness was associated with lower AD8 scores (β=-0.05±0.02(p = 0.003)), better animal naming (AN)(β=0.11±0.04(p = 0.008)), and faster TMA times (β=-0.72±0.32(p=0.025)). All three mindfulness factors (F1=decentering; F2=positive emotional regulation; F3=negative emotional regulation) were significantly linked to AD8, while F3 was not predictive of AN, and F1 was not predictive of TMA. In addition, mindfulness significantly predicted subjective cognitive impairment (SCI)(βF2AD8=-0.18±0.07(p=0.011)) and TMA in men βTMA=-1.14±0.42(p=0.011); βF2TMA=-2.63±1.26(p=0.043); βF3TMA=-2.74±1.12(p=0.019) and dementia patients (βF1AD8=-0.19±0.08(p=0.021); βF2AD8=-0.14±0.07(p=0.044); βTMA=-0.09±0.51(p=0.039)); and AN in women ((βAN=0.12±0.06(p=0.047);βF2AN=0.34±0.16(p=0.036)) and MCI patients (βAN=0.13±0.06, p=0.033; βF3AN=0.36±0.16(p=0.035)). Our findings suggest that effectiveness of mindfulness-based interventions may be enhanced by a focus on emotional regulation and sex- and stage-specific cognitive targets.
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Affiliation(s)
| | - Juyoung Park
- Florida Atlantic University, Boca Raton, Florida, United States
| | - James Galvin
- Florida Atlantic University, Boca Raton, Florida, United States
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23
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Timmerman RD, Paulus R, Pass HI, Gore EM, Edelman MJ, Galvin J, Straube WL, Nedzi LA, McGarry RC, Robinson CG, Schiff PB, Chang G, Loo BW, Bradley JD, Choy H. Stereotactic Body Radiation Therapy for Operable Early-Stage Lung Cancer: Findings From the NRG Oncology RTOG 0618 Trial. JAMA Oncol 2019; 4:1263-1266. [PMID: 29852037 DOI: 10.1001/jamaoncol.2018.1251] [Citation(s) in RCA: 226] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Stereotactic body radiation therapy (SBRT) has become a standard treatment for patients with medically inoperable early-stage lung cancer. However, its effectiveness in patients medically suitable for surgery is unclear. Objective To evaluate whether noninvasive SBRT delivered on an outpatient basis can safely eradicate lung cancer and cure selected patients with operable lung cancer, obviating the need for surgical resection. Design, Setting, and Participants Single-arm phase 2 NRG Oncology Radiation Therapy Oncology Group 0618 study enrolled patients from December 2007 to May 2010 with median follow-up of 48.1 months (range, 15.4-73.7 months). The setting was a multicenter North American academic and community practice cancer center consortium. Patients had operable biopsy-proven peripheral T1 to T2, N0, M0 non-small cell tumors no more than 5 cm in diameter, forced expiratory volume in 1 second (FEV1) and diffusing capacity greater than 35% predicted, arterial oxygen tension greater than 60 mm Hg, arterial carbon dioxide tension less than 50 mm Hg, and no severe medical problems. The data analysis was performed in October 2014. Interventions The SBRT prescription dose was 54 Gy delivered in 3 18-Gy fractions over 1.5 to 2.0 weeks. Main Outcomes and Measures Primary end point was primary tumor control, with survival, adverse events, and the incidence and outcome of surgical salvage as secondary end points. Results Of 33 patients accrued, 26 were evaluable (23 T1 and 3 T2 tumors; 15 [58%] male; median age, 72.5 [range, 54-88] years). Median FEV1 and diffusing capacity of the lung for carbon monoxide at enrollment were 72.5% (range, 38%-136%) and 68% (range, 22%-96%) of predicted, respectively. Only 1 patient had a primary tumor recurrence. Involved lobe failure, the other component defining local failure, did not occur in any patient, so the estimated 4-year primary tumor control and local control rate were both 96% (95% CI, 83%-100%). As per protocol guidelines, the single patient with local recurrence underwent salvage lobectomy 1.2 years after SBRT, complicated by a grade 4 cardiac arrhythmia. The 4-year estimates of disease-free and overall survival were 57% (95% CI, 36%-74%) and 56% (95% CI, 35%-73%), respectively. Median overall survival was 55.2 months (95% CI, 37.7 months to not reached). Protocol-specified treatment-related grade 3, 4, and 5 adverse events were reported in 2 (8%; 95% CI, 0.1%-25%), 0, and 0 patients, respectively. Conclusions and Relevance As given, SBRT appears to be associated with a high rate of primary tumor control, low treatment-related morbidity, and infrequent need for surgical salvage in patients with operable early-stage lung cancer. Trial Registration ClinicalTrials.gov Identifier: NCT00551369.
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Affiliation(s)
- Robert D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Rebecca Paulus
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University School of Medicine, New York
| | - Elizabeth M Gore
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee
| | - Martin J Edelman
- Department of Hematology/Oncology, University of Maryland, Marlene and Stewart Greenebaum Cancer Center, Baltimore.,now with Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - James Galvin
- Imaging and Radiation Oncology Core (IROC), Philadelphia, Pennsylvania
| | | | - Lucien A Nedzi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Ronald C McGarry
- Department of Radiation Oncology, University of Kentucky, Lexington
| | - Cliff G Robinson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Peter B Schiff
- Department of Radiation Oncology, New York University School of Medicine, New York
| | - Garrick Chang
- Sutter General Hospital accrual under Mercy San Juan Radiation Oncology Center, Carmichael, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Jeffrey D Bradley
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Hak Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
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24
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Timmerman RD, Hu C, Michalski JM, Bradley JC, Galvin J, Johnstone DW, Choy H. Long-term Results of Stereotactic Body Radiation Therapy in Medically Inoperable Stage I Non-Small Cell Lung Cancer. JAMA Oncol 2019; 4:1287-1288. [PMID: 29852036 DOI: 10.1001/jamaoncol.2018.1258] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Robert D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.,Sydney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Jeffrey C Bradley
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - James Galvin
- Imaging and Radiation Oncology Core, Philadelphia, Pennsylvania
| | - David W Johnstone
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee
| | - Hak Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
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Affiliation(s)
- E B Hunt
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
| | - A Sullivan
- The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland
| | - J Galvin
- The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland
| | - J MacSharry
- The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland
| | - D M Murphy
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
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26
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Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ, Jordan RCK, Zhao W, Sturgis EM, Burtness B, Ridge JA, Ringash J, Galvin J, Yao M, Koyfman SA, Blakaj DM, Razaq MA, Colevas AD, Beitler JJ, Jones CU, Dunlap NE, Seaward SA, Spencer S, Galloway TJ, Phan J, Dignam JJ, Le QT. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet 2019; 393:40-50. [PMID: 30449625 PMCID: PMC6541928 DOI: 10.1016/s0140-6736(18)32779-x] [Citation(s) in RCA: 752] [Impact Index Per Article: 150.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma have high survival when treated with radiotherapy plus cisplatin. Whether replacement of cisplatin with cetuximab-an antibody against the epidermal growth factor receptor-can preserve high survival and reduce treatment toxicity is unknown. We investigated whether cetuximab would maintain a high proportion of patient survival and reduce acute and late toxicity. METHODS RTOG 1016 was a randomised, multicentre, non-inferiority trial at 182 health-care centres in the USA and Canada. Eligibility criteria included histologically confirmed HPV-positive oropharyngeal carcinoma; American Joint Committee on Cancer 7th edition clinical categories T1-T2, N2a-N3 M0 or T3-T4, N0-N3 M0; Zubrod performance status 0 or 1; age at least 18 years; and adequate bone marrow, hepatic, and renal function. We randomly assigned patients (1:1) to receive either radiotherapy plus cetuximab or radiotherapy plus cisplatin. Randomisation was balanced by using randomly permuted blocks, and patients were stratified by T category (T1-T2 vs T3-T4), N category (N0-N2a vs N2b-N3), Zubrod performance status (0 vs 1), and tobacco smoking history (≤10 pack-years vs >10 pack-years). Patients were assigned to receive either intravenous cetuximab at a loading dose of 400 mg/m2 5-7 days before radiotherapy initiation, followed by cetuximab 250 mg/m2 weekly for seven doses (total 2150 mg/m2), or cisplatin 100 mg/m2 on days 1 and 22 of radiotherapy (total 200 mg/m2). All patients received accelerated intensity-modulated radiotherapy delivered at 70 Gy in 35 fractions over 6 weeks at six fractions per week (with two fractions given on one day, at least 6 h apart). The primary endpoint was overall survival, defined as time from randomisation to death from any cause, with non-inferiority margin 1·45. Primary analysis was based on the modified intention-to-treat approach, whereby all patients meeting eligibility criteria are included. This study is registered with ClinicalTrials.gov, number NCT01302834. FINDINGS Between June 9, 2011, and July 31, 2014, 987 patients were enrolled, of whom 849 were randomly assigned to receive radiotherapy plus cetuximab (n=425) or radiotherapy plus cisplatin (n=424). 399 patients assigned to receive cetuximab and 406 patients assigned to receive cisplatin were subsequently eligible. After median follow-up duration of 4·5 years, radiotherapy plus cetuximab did not meet the non-inferiority criteria for overall survival (hazard ratio [HR] 1·45, one-sided 95% upper CI 1·94; p=0·5056 for non-inferiority; one-sided log-rank p=0·0163). Estimated 5-year overall survival was 77·9% (95% CI 73·4-82·5) in the cetuximab group versus 84·6% (80·6-88·6) in the cisplatin group. Progression-free survival was significantly lower in the cetuximab group compared with the cisplatin group (HR 1·72, 95% CI 1·29-2·29; p=0·0002; 5-year progression-free survival 67·3%, 95% CI 62·4-72·2 vs 78·4%, 73·8-83·0), and locoregional failure was significantly higher in the cetuximab group compared with the cisplatin group (HR 2·05, 95% CI 1·35-3·10; 5-year proportions 17·3%, 95% CI 13·7-21·4 vs 9·9%, 6·9-13·6). Proportions of acute moderate to severe toxicity (77·4%, 95% CI 73·0-81·5 vs 81·7%, 77·5-85·3; p=0·1586) and late moderate to severe toxicity (16·5%, 95% CI 12·9-20·7 vs 20·4%, 16·4-24·8; p=0·1904) were similar between the cetuximab and cisplatin groups. INTERPRETATION For patients with HPV-positive oropharyngeal carcinoma, radiotherapy plus cetuximab showed inferior overall survival and progression-free survival compared with radiotherapy plus cisplatin. Radiotherapy plus cisplatin is the standard of care for eligible patients with HPV-positive oropharyngeal carcinoma. FUNDING National Cancer Institute USA, Eli Lilly, and The Oral Cancer Foundation.
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Affiliation(s)
- Maura L Gillison
- Department of Thoracic Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA.
| | - Andy M Trotti
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - David J Adelstein
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Richard C K Jordan
- Department of Orofacial Sciences, University of California San Fransisco, San Francisco, CA, USA; Department of Pathology, University of California San Fransisco, San Francisco, CA, USA
| | - Weiqiang Zhao
- Division of Molecular Pathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Division of Hematopathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; James Molecular Laboratory, Columbus, OH, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Barbara Burtness
- Department of Medicine, Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre and the University of Toronto, Toronto, ON, Canada
| | - James Galvin
- Imaging and Radiation Oncology Core Group, Philadelphia, PA, USA
| | - Min Yao
- Department of Radiation Oncology, Case Western Reserve/University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA
| | - Mohammed A Razaq
- Department of Hematology/Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Christopher U Jones
- Department of Radiation Oncology, Sutter Cancer Research Consortium, Novato, CA, USA
| | - Neal E Dunlap
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | | | - Sharon Spencer
- Department of Radiation Oncology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jack Phan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - James J Dignam
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA; NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
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27
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Gray-Miceli D, Craelius W, Patel N, Galvin J. USE OF MOBILE TECHNOLOGY TO ASSESS BALANCE IN OLDER ADULTS WITH AND WITHOUT SYMPTOMS DURING A SIT TO STAND MANUEVER. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2702] [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: 11/13/2022] Open
Affiliation(s)
| | - W Craelius
- Rutgers University School of Biomedical Engineering
| | - N Patel
- Rutgers University, School of Biomedical engineering
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Tolea M, Galvin J. CAREGIVER RELATIONSHIP TO DEMENTIA PATIENT: IMPACT ON DISEASE PROGRESSION AND CAREGIVER PSYCHOLOGICAL WELL-BEING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3175] [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: 11/14/2022] Open
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Tolea M, Park J, Rosenfeld A, Arcay V, Lopes Y, Karson J, Small K, Galvin J. NON-PHARMACOLOGICAL INTERVENTIONS TO MANAGE DEMENTIA SYMPTOMS: A CLUSTER RANDOMIZED CONTROLLED TRIAL. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.507] [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: 11/13/2022] Open
Affiliation(s)
| | - J Park
- Florida Atlantic University
| | - A Rosenfeld
- Florida Atlantic University, Charles E. Schmidt College of Medicine
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Park J, Tolea M, Rosenfeld A, Arcay V, Karson J, Lopes Y, Small K, Galvin J. FEASIBILITY AND EFFECTS OF CHAIR YOGA TO MANAGE DEMENTIA SYMPTOMS IN OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1142] [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: 11/13/2022] Open
Affiliation(s)
- J Park
- Florida Atlantic University
| | - M Tolea
- College of Medicine, Florida Atlantic University
| | - A Rosenfeld
- Florida Atlantic University, Charles E. Schmidt College of Medicine
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Wijeyeratne YD, Tanck MW, Muir A, Bos JM, Denjoy I, Galvin J, Page S, Ohno S, Veltmann C, Crotti L, Roden D, Makita N, Probst V, Aiba T, Behr ER. P3815A genetic risk score predicts Brugada syndrome phenotype in SCN5A overlap syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3815] [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: 11/15/2022] Open
Affiliation(s)
- Y D Wijeyeratne
- St George's University of London, Cardiology Clinical Academic Group, St George's Hospital, London, United Kingdom
| | - M W Tanck
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - A Muir
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - J M Bos
- Mayo Clinic, Rochester, United States of America
| | - I Denjoy
- Hospital Bichat-Claude Bernard, Paris, France
| | - J Galvin
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Page
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - S Ohno
- Shiga University of Medical Science, Shiga, Japan
| | - C Veltmann
- Hannover Medical School, Hannover, Germany
| | - L Crotti
- University of Milan, Milan, Italy
| | - D Roden
- Vanderbilt University, Nashville, United States of America
| | - N Makita
- Nagasaki University, Nagasaki, Japan
| | - V Probst
- University Hospital of Nantes, Nantes, France
| | - T Aiba
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - E R Behr
- St George's University of London, Cardiology Clinical Academic Group, St George's Hospital, London, United Kingdom
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Granic A, Mossop H, Engstrom G, Davies K, Dodds R, Galvin J, Ouslander JG, Tappen R, Sayer AA. Factors Associated With Physical Performance Measures in a Multiethnic Cohort of Older Adults. Gerontol Geriatr Med 2018; 4:2333721418778623. [PMID: 29977978 PMCID: PMC6024280 DOI: 10.1177/2333721418778623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/23/2018] [Accepted: 04/26/2018] [Indexed: 12/29/2022] Open
Abstract
Objective: To explore the association between ethnicity, sociodemographic, health, and lifestyle factors, and physical performance (PP) in ethnically diverse community-dwelling older adults from one geographic area. Method: We used multivariable linear regression to identify factors associated with upper (grip strength [GS], arm curls [AC]) and lower (chair stands [CS]) body strength and mobility (gait speed [GSp]) in 577 older adults (mean age 74 ± 8; 104 African American, 142 Afro-Caribbean, 123 Hispanic, and 208 European American) from South Florida. Results: Worse mental health was negatively associated with CS in African Americans and AC in Hispanics. Older age and higher body mass index (BMI) was associated with slower GSp in all except in Hispanics. Higher physical activity was associated with higher upper body strength in Hispanics and better mobility in African Americans and Afro-Caribbeans, but not in European Americans. Conclusion: Studies with large multiethnic cohorts are needed to further our understanding of ethnic differences in PP, which will help in tailoring interventions and recognizing unmet needs for health and social services.
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Affiliation(s)
| | | | | | | | - Richard Dodds
- Newcastle University, Newcastle upon Tyne, UK.,University of Southampton, UK
| | | | | | - Ruth Tappen
- Florida Atlantic University, Boca Raton, USA
| | - Avan A Sayer
- Newcastle University, Newcastle upon Tyne, UK.,University of Southampton, UK
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Rogers L, Zhang P, Vogelbaum MA, Perry A, Ashby LS, Modi JM, Alleman AM, Galvin J, Brachman D, Jenrette JM, De Groot J, Bovi JA, Werner-Wasik M, Knisely JPS, Mehta MP. Intermediate-risk meningioma: initial outcomes from NRG Oncology RTOG 0539. J Neurosurg 2018; 129:35-47. [PMID: 28984517 PMCID: PMC5889346 DOI: 10.3171/2016.11.jns161170] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This is the first clinical outcomes report of NRG Oncology RTOG 0539, detailing the primary endpoint, 3-year progression-free survival (PFS), compared with a predefined historical control for intermediate-risk meningioma, and secondarily evaluating overall survival (OS), local failure, and prospectively scored adverse events (AEs). METHODS NRG Oncology RTOG 0539 was a Phase II clinical trial allocating meningioma patients to 1 of 3 prognostic groups and management strategies according to WHO grade, recurrence status, and resection extent. For the intermediate-risk group (Group 2), eligible patients had either newly diagnosed WHO Grade II meningioma that had been treated with gross-total resection (GTR; Simpson Grades I-III) or recurrent WHO Grade I meningioma with any resection extent. Pathology and imaging were centrally reviewed. Patients were treated with radiation therapy (RT), either intensity modulated (IMRT) or 3D conformal (3DCRT), 54 Gy in 30 fractions. The RT target volume was defined as the tumor bed and any nodular enhancement (e.g., in patients with recurrent WHO Grade I tumors) with a minimum 8-mm and maximum 15-mm margin, depending on tumor location and setup reproducibility of the RT method. The primary endpoint was 3-year PFS. Results were compared with historical controls (3-year PFS: 70% following GTR alone and 90% with GTR + RT). AEs were scored using NCI Common Toxicity Criteria. RESULTS Fifty-six patients enrolled in the intermediate-risk group, of whom 3 were ineligible and 1 did not receive RT. Of the 52 patients who received protocol therapy, 4 withdrew without a recurrence before 3 years leaving 48 patients evaluable for the primary endpoint, 3-year PFS, which was actuarially 93.8% (p = 0.0003). Within 3 years, 3 patients experienced events affecting PFS: 1 patient with a WHO Grade II tumor died of the disease, 1 patient with a WHO Grade II tumor had disease progression but remained alive, and 1 patient with recurrent WHO Grade I meningioma died of undetermined cause without tumor progression. The 3-year actuarial local failure rate was 4.1%, and the 3-year OS rate was 96%. After 3 years, progression occurred in 2 additional patients: 1 patient with recurrent WHO Grade I meningioma and 1 patient with WHO Grade II disease; both remain alive. Among 52 evaluable patients who received protocol treatment, 36 (69.2%) had WHO Grade II tumors and underwent GTR, and 16 (30.8%) had recurrent WHO Grade I tumors. There was no significant difference in PFS between these subgroups (p = 0.52, HR 0.56, 95% CI 0.09-3.35), validating their consolidation. Of the 52 evaluable patients, 44 (84.6%) received IMRT, and 50 (96.2%) were treated per protocol or with acceptable variation. AEs (definitely, probably, or possibly related to protocol treatment) were limited to Grade 1 or 2, with no reported Grade 3 events. CONCLUSIONS This is the first clinical outcomes report from NRG Oncology RTOG 0539. Patients with intermediate-risk meningioma treated with RT had excellent 3-year PFS, with a low rate of local failure and a low risk of AEs. These results support the use of postoperative RT for newly diagnosed gross-totally resected WHO Grade II or recurrent WHO Grade I meningioma irrespective of resection extent. They also document minimal toxicity and high rates of tumor control with IMRT. Clinical trial registration no.: NCT00895622 (clinicaltrials.gov).
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Affiliation(s)
| | - Peixin Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | | - Arie Perry
- University of California-San Francisco, CA
| | | | | | | | | | | | | | - John De Groot
- University of Texas MD Anderson Cancer Center, Houston, TX
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Hamed M, Schraml F, Wilson J, Galvin J, Sabbagh MN. Occipital and Cingulate Hypometabolism are Significantly Under-Reported on 18-Fluorodeoxyglucose Positron Emission Tomography Scans of Patients with Lewy Body Dementia. ACTA ACUST UNITED AC 2018; 8. [PMID: 29657900 PMCID: PMC5898402 DOI: 10.4172/2161-0460.1000428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To determine whether occipital and cingulate hypometabolism is being under-reported or missed on 18-fluorodeoxyglucose positron emission tomography (FDG-PET) CT scans in patients with Dementia with Lewy Bodies (DLB). Background Recent studies have reported higher sensitivity and specificity for occipital and cingulate hypometabolism on FDG-PET of DLB patients. Methods This retrospective chart review looked at regions of interest (ROI’s) in FDG-PET CT scan reports in 35 consecutive patients with a clinical diagnosis of probable, possible, or definite DLB as defined by the latest DLB Consortium Report. ROI’s consisting of glucose hypometabolism in frontal, parietal, temporal, occipital, and cingulate areas were tabulated and charted separately by the authors from the reports. A blinded Nuclear medicine physician read the images independently and marked ROI’s separately. A Cohen’s Kappa coefficient statistic was calculated to determine agreement between the reports and the blinded reads. Results On the radiology reports, 25.71% and 17.14% of patients reported occipital and cingulate hypometabolism respectively. Independent reads demonstrated significant disagreement with the proportion of occipital and cingulate hypometabolism being reported on initial reads: 91.43% and 85.71% respectively. Cohen’s Kappa statistic determinations demonstrated significant agreement only with parietal hypometabolism (p<0.05). Conclusion Occipital and cingulate hypometabolism is under-reported and missed frequently on clinical interpretations of FDG-PET scans of patients with DLB, but the frequency of hypometabolism is even higher than previously reported. Further studies with more statistical power and receiver operating characteristic analyses are needed to delineate the sensitivity and specificity of these in vivo biomarkers.
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Affiliation(s)
- Moath Hamed
- Alzheimer's and Memory Disorders Division, Department of Neurology and Nuclear Medicine, Barrow Neurological Institute, USA
| | - Frank Schraml
- Alzheimer's and Memory Disorders Division, Department of Neurology and Nuclear Medicine, Barrow Neurological Institute, USA
| | - Jeffrey Wilson
- Barrett Honors College and W. P. Carey School of Business, University of Arizona State, USA
| | - James Galvin
- Schmidt College of Medicine,University of Florida Atlantic, Boca Raton, FL, USA
| | - Marwan N Sabbagh
- Alzheimer's and Memory Disorders Division, Department of Neurology and Nuclear Medicine, Barrow Neurological Institute, USA.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas NV, USA
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Hunt EB, Sullivan A, Galvin J, MacSharry J, Murphy DM. Gastric Aspiration and Its Role in Airway Inflammation. Open Respir Med J 2018; 12:1-10. [PMID: 29456774 PMCID: PMC5806178 DOI: 10.2174/1874306401812010001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/22/2017] [Accepted: 01/01/2018] [Indexed: 12/15/2022] Open
Abstract
Gastro-Oesophageal Reflux (GOR) has been associated with chronic airway diseases while the passage of foreign matter into airways and lungs through aspiration has the potential to initiate a wide spectrum of pulmonary disorders. The clinical syndrome resulting from such aspiration will depend both on the quantity and nature of the aspirate as well as the individual host response. Aspiration of gastric fluids may cause damage to airway epithelium, not only because acidity is toxic to bronchial epithelial cells but also due to the effect of digestive enzymes such as pepsin and bile salts. Experimental models have shown that direct instillation of these factors to airways epithelia cause damage with a consequential inflammatory response. The pathophysiology of these responses is gradually being dissected, with better understanding of acute gastric aspiration injury, a major cause of acute lung injury, providing opportunities for therapeutic intervention and potentially, ultimately, improved understanding of the chronic airway response to aspiration. Ultimately, clarification of the inflammatory pathways which are related to micro-aspiration via pepsin and bile acid salts may eventually progress to pharmacological intervention and surgical studies to assess the clinical benefits of such therapies in driving symptom improvement or reducing disease progression.
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Affiliation(s)
- E B Hunt
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
| | - A Sullivan
- The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland
| | - J Galvin
- The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland
| | - J MacSharry
- The APC Microbiome Institute, Schools of Medicine and Microbiology, University College Cork, Ireland
| | - D M Murphy
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
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Rogers L, Zhang P, Vogelbaum M, Perry A, Ashby LS, Modi J, Alleman A, Galvin J, Fogh S, Youssef E, Deb N, Kwok Y, Robinson CG, Shu HK, Fisher BJ, Panet-Raymond V, McMillan W, de Groot J, Mehta MP. MNGI-08. HIGH-RISK MENINGIOMA: INITIAL OUTCOMES FROM NRG ONCOLOGY/RTOG-0539. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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37
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Hensey M, Cronin M, Keelan E, O'Neill J, Galvin J. A Retrospective Audit of In-Hospital 30-day Mortality from Acute Myocardial Infarction in Connolly Hospital Blanchardstown. Ir Med J 2017; 110:615. [PMID: 29168997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In 2015, The Department of Health published the first annual report of the "National Healthcare Quality Reporting System." Connolly Hospital was reported to a mortality rate within 30 days post-Acute Myocardial Infarction (AMI) of 9.87 per 100 cases which was statistically significantly higher than the national rate. We carried out a retrospective audit of patients who were HIPE-coded as having died within 30 days of AMI from 2011-2013 and identified 42 patients. On review, only 23 patients (54.8%) were confirmed as having had an AMI. We identified 12 patients who had AMI included on death certificate without any evidence for same. If the 22 patients incorrectly coded were excluded, the mortality rate within 30 days post-AMI in CHB would fall to 4.14 deaths per 100 cases, well below the national average. Inaccuracies of data collection can lead to erroneous conclusions when examining healthcare data.
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Affiliation(s)
- M Hensey
- Connolly Hospital Blanchardstown, Blanchardstown, Dublin 15
| | - M Cronin
- Connolly Hospital Blanchardstown, Blanchardstown, Dublin 15
| | - E Keelan
- Connolly Hospital Blanchardstown, Blanchardstown, Dublin 15
| | - J O'Neill
- Connolly Hospital Blanchardstown, Blanchardstown, Dublin 15
| | - J Galvin
- Connolly Hospital Blanchardstown, Blanchardstown, Dublin 15
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Mossop H, Granic A, Sayer AA, Engstrom G, Davies K, Dodds R, Galvin J, Ouslander JG, Tappen R. 41DIFFERENCES IN PHYSICAL PERFORMANCE ACROSS A MULTI-ETHNIC COHORT OF OLDER ADULTS: INSIGHTS FROM THE HEALTHY AGING RESEARCH INITIATIVE. Age Ageing 2017. [DOI: 10.1093/ageing/afx110.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McKeith IG, Boeve BF, Dickson DW, Halliday G, Taylor JP, Weintraub D, Aarsland D, Galvin J, Attems J, Ballard CG, Bayston A, Beach TG, Blanc F, Bohnen N, Bonanni L, Bras J, Brundin P, Burn D, Chen-Plotkin A, Duda JE, El-Agnaf O, Feldman H, Ferman TJ, Ffytche D, Fujishiro H, Galasko D, Goldman JG, Gomperts SN, Graff-Radford NR, Honig LS, Iranzo A, Kantarci K, Kaufer D, Kukull W, Lee VMY, Leverenz JB, Lewis S, Lippa C, Lunde A, Masellis M, Masliah E, McLean P, Mollenhauer B, Montine TJ, Moreno E, Mori E, Murray M, O'Brien JT, Orimo S, Postuma RB, Ramaswamy S, Ross OA, Salmon DP, Singleton A, Taylor A, Thomas A, Tiraboschi P, Toledo JB, Trojanowski JQ, Tsuang D, Walker Z, Yamada M, Kosaka K. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology 2017; 89:88-100. [PMID: 28592453 PMCID: PMC5496518 DOI: 10.1212/wnl.0000000000004058] [Citation(s) in RCA: 2297] [Impact Index Per Article: 328.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/30/2017] [Indexed: 12/14/2022] Open
Abstract
The Dementia with Lewy Bodies (DLB) Consortium has refined its recommendations about the clinical and pathologic diagnosis of DLB, updating the previous report, which has been in widespread use for the last decade. The revised DLB consensus criteria now distinguish clearly between clinical features and diagnostic biomarkers, and give guidance about optimal methods to establish and interpret these. Substantial new information has been incorporated about previously reported aspects of DLB, with increased diagnostic weighting given to REM sleep behavior disorder and 123iodine-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. The diagnostic role of other neuroimaging, electrophysiologic, and laboratory investigations is also described. Minor modifications to pathologic methods and criteria are recommended to take account of Alzheimer disease neuropathologic change, to add previously omitted Lewy-related pathology categories, and to include assessments for substantia nigra neuronal loss. Recommendations about clinical management are largely based upon expert opinion since randomized controlled trials in DLB are few. Substantial progress has been made since the previous report in the detection and recognition of DLB as a common and important clinical disorder. During that period it has been incorporated into DSM-5, as major neurocognitive disorder with Lewy bodies. There remains a pressing need to understand the underlying neurobiology and pathophysiology of DLB, to develop and deliver clinical trials with both symptomatic and disease-modifying agents, and to help patients and carers worldwide to inform themselves about the disease, its prognosis, best available treatments, ongoing research, and how to get adequate support.
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Walsh KA, Galvin J, Keaney JJ, Keelan E, Szeplaki G. P1458Single centre experience with a zero-fluoroscopic ablation strategy using a novel magnetic field and impedance-based 3D mapping system for supraventricular tachycardia. Europace 2017. [DOI: 10.1093/ehjci/eux158.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McNamara C, Cullen P, Rackauskas M, Kelly R, O'Sullivan KE, Galvin J, Eaton D. Left cardiac sympathetic denervation: case series and technical report. Ir J Med Sci 2017; 186:607-613. [PMID: 28238200 DOI: 10.1007/s11845-017-1577-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 02/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left cardiac sympathetic denervation (LCSD) is a surgical procedure that has been shown to have an antiarrhythmic and antifibrillatory effect. Evidence indicating its antiarrhythmic effect has been available for over 100 years. It involves the removal of the lower half of the stellate ganglion and T2-T4 of the sympathetic ganglia and is carried out as either a unilateral or bilateral procedure. With advancements in thoracic surgery, it can be safely performed via a minimally invasive Video-Assisted Thoracoscopic Surgery (VATS) approach resulting in significantly less morbidity and a shortened inpatient stay. LCSD provides a valuable treatment option for patients with life-threatening channelopathies and cardiomyopathies. AIMS AND METHODS This case series reports the preliminary paediatric and adult experience in the Republic of Ireland with LCSD and describes five cases recently treated in addition to an outline of the operative procedure employed. Of the five cases included, two were paediatric cases and three were adult cases. RESULTS One of the paediatric patients had a diagnosis of the rare catecholaminergic polymorphic ventricular tachycardia (CPVT) and the other a diagnosis of long-QT syndrome. Both paediatric patients experienced excellent outcomes. Of the three adult patients, two benefitted greatly and remain well at follow-up (one inappropriate sinus tachycardia and one CPVT). One patient with idiopathic ventricular fibrillation unfortunately passed away from intractable VF despite all attempts at resuscitation. CONCLUSION In this case series, we highlight that LCSD provides a critical adjunct to existing medical therapies and should be considered for all patients with life-threatening refractory arrhythmias especially those patients on maximal medical therapy.
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Affiliation(s)
- C McNamara
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
| | - P Cullen
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
| | - M Rackauskas
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
| | - R Kelly
- Department of Cardiothoracic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - K E O'Sullivan
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
| | - J Galvin
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D Eaton
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland.
- Department of Cardiothoracic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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Rogers L, Zhang P, Vogelbaum M, Perry A, Ashby L, Modi J, Alleman A, Galvin J, Youssef E, Bovi J, Sneed P, McMillan W, de Groot J, Shrieve D, Chen Y, Shu H, Chakravarti A, Mehta M. Low-Risk Meningioma: Initial Outcomes from NRG Oncology/RTOG 0539. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.09.051] [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: 10/20/2022]
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43
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Truong MT, Zhang Q, Rosenthal DI, List M, Axelrod R, Sherman E, Weber R, Nguyen-Tân PF, El-Naggar A, Konski A, Galvin J, Schwartz D, Trotti A, Silverman C, Singh A, Godette K, Bonner JA, Jones CU, Garden AS, Shenouda G, Matthiesen C, Le QT, Bruner D. Quality of Life and Performance Status From a Substudy Conducted Within a Prospective Phase 3 Randomized Trial of Concurrent Accelerated Radiation Plus Cisplatin With or Without Cetuximab for Locally Advanced Head and Neck Carcinoma: NRG Oncology Radiation Therapy Oncology Group 0522. Int J Radiat Oncol Biol Phys 2016; 97:687-699. [PMID: 27727066 DOI: 10.1016/j.ijrobp.2016.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 07/26/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To analyze the quality of life (QOL) and performance status (PS) (secondary outcome) in patients with stage III to IV head and neck cancer (HNC) enrolled on a prospective randomized phase 3 trial comparing radiation-cisplatin without cetuximab (CIS) or with cetuximab (CET/CIS). The QOL hypothesis proposed a between-arm difference in Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) total score of ≥10% of the instrument range from baseline to 1 year. METHODS AND MATERIALS Patients who gave consent to the QOL/PS study completed the FACT-HN, Performance Status Scale for HNC (PSS-HN), and EuroQol (EQ-5D) at baseline through to 5 years. The pretreatment QOL/PS scores were correlated with outcome and p16 status in patients with oropharyngeal cancer (OPC). RESULTS Of 818 analyzable patients, the 1-year change from baseline score for FACT-HN total was -0.41 (CIS arm) and -5.11 (CET/CIS arm) (P=.016), representing a 3.2% between-arm change of the FACT-HN total score. The mean EQ-5D index and PSS-HN scores were not significantly different between arms. The p16-positive OPC patients had significantly higher baseline and 1-year scores for PSS-HN, FACT-HN total, physical and functional subscales, and 2-years for the EQ-5D index compared with p16-negative OPC patients. Higher pretreatment PSS-HN diet, PSS-HN eating, FACT-HN, and EQ-5D index scores were associated with better overall survival (OS) and progression-free (PFS) survival on multivariate analysis. Higher baseline FACT-HN total, functional, physical subscale, and EQ-5D index scores were associated with improved OS and PFS in p16-positive OPC patients but not in p16-negative and non-OPC patients. CONCLUSION There was no clinically meaningful difference in QOL/PS between arms. The p16-positive OPC patients had significantly higher QOL/PS than did p16-negative patients. Pretreatment QOL/PS is a significant independent predictor of outcome in locally advanced HNC.
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Affiliation(s)
- Minh Tam Truong
- Boston Medical Center Minority-Based Community Clinical Oncology Program (MBCCOP), Boston, MA.
| | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | | | | - Rita Axelrod
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Eric Sherman
- Memorial Sloan-Kettering Cancer Center, New York City, NY
| | - Randal Weber
- University of Texas-MD Anderson Cancer Center, Houston, TX
| | | | - Adel El-Naggar
- University of Texas-MD Anderson Cancer Center, Houston, TX
| | - André Konski
- Penn Radiation Oncology, Pennsylvania Hospital, Philadelphia, PA
| | - James Galvin
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - David Schwartz
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Craig Silverman
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | | | - Karen Godette
- Boston Medical Center Minority-Based Community Clinical Oncology Program (MBCCOP), Boston, MA
| | - James A Bonner
- University of Alabama at Birmingham Medical Center, Birmingham, AL
| | - Christopher U Jones
- Sutter General Hospital, Formerly, Radiological Associates of Sacramento, Sacramento, CA
| | - Adam S Garden
- University of Texas-MD Anderson Cancer Center, Houston, TX
| | | | | | - Quynh-Thu Le
- Stanford University Medical Center, Stanford, CA
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Monroe J, Boparai K, Xiao Y, Followill D, Galvin J, Sohn J. SU-F-P-13: NRG Oncology Medical Physics Manpower Survey Quantifying Support Demands for Multi Institutional Clinical Trials. Med Phys 2016. [DOI: 10.1118/1.4955720] [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: 11/07/2022] Open
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Followill D, Galvin J, Michalski J, Rosen M, FitzGerald T, Knopp M. SU-F-T-237: The Imaging and Radiation Oncology Core (IROC) Cooperatives Activities Supporting the NCI's National Clinical Trial Network. Med Phys 2016. [DOI: 10.1118/1.4956376] [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: 11/07/2022] Open
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Travers J, Keelan E, Keaney J, Szeplaki G, Valentine J, Hayam G, Galvin J. 96-22: Comparison of a novel tool for automatic measurement of left atrial scar burden with visual estimation in patients undergoing ablation of atrial fibrillation. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i65a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Giaddui T, Chen W, Yu J, Lin L, Simone CB, Yuan L, Gong YUT, Wu QJ, Mohan R, Zhang X, Bluett JB, Gillin M, Moore K, O'Meara E, Presley J, Bradley JD, Liao Z, Galvin J, Xiao Y. Establishing the feasibility of the dosimetric compliance criteria of RTOG 1308: phase III randomized trial comparing overall survival after photon versus proton radiochemotherapy for inoperable stage II-IIIB NSCLC. Radiat Oncol 2016; 11:66. [PMID: 27142674 PMCID: PMC4855766 DOI: 10.1186/s13014-016-0640-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background To establish the feasibility of the dosimetric compliance criteria of the RTOG 1308 trial through testing against Intensity Modulation Radiation Therapy (IMRT) and Passive Scattering Proton Therapy (PSPT) plans. Methods Twenty-six lung IMRT and 26 proton PSPT plans were included in the study. Dose Volume Histograms (DVHs) for targets and normal structures were analyzed. The quality of IMRT plans was assessed using a knowledge-based engineering tool. Results Most of the RTOG 1308 dosimetric criteria were achieved. The deviation unacceptable rates were less than 10 % for most criteria; however, a deviation unacceptable rate of more than 20 % was computed for the planning target volume minimum dose compliance criterion. Dose parameters for the target volume were very close for the IMRT and PSPT plans. However, the PSPT plans led to lower dose values for normal structures. The dose parameters in which PSPT plans resulted in lower values than IMRT plans were: lung V5Gy (%) (34.4 in PSPT and 47.2 in IMRT); maximum spinal cord dose (31.7 Gy in PSPT and 43.5 Gy in IMRT); heart V5Gy (%) (19 in PSPT and 47 in IMRT); heart V30Gy (%) (11 in PSPT and 19 in IMRT); heart V45Gy (%) (7.8 in PSPT and 12.1 in IMRT); heart V50% (Gy) (7.1 in PSPT and 9.8 in IMRT) and mean heart dose (7.7 Gy in PSPT and 14.9 Gy in IMRT). Conclusions The revised RTOG 1308 dosimetric compliance criteria are feasible and achievable.
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Affiliation(s)
- Tawfik Giaddui
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Wenzhou Chen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jialu Yu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Liyong Lin
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Yutao U T Gong
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | | | - Kevin Moore
- University of California, San Diego, CA, USA
| | - Elizabeth O'Meara
- Imaging and Radiation Oncology Core (IROC) Philadelphia-RT QA Center, Philadelphia, PA, USA
| | - Jennifer Presley
- Imaging and Radiation Oncology Core (IROC) Philadelphia-RT QA Center, Philadelphia, PA, USA
| | | | | | - James Galvin
- Imaging and Radiation Oncology Core (IROC) Philadelphia-RT QA Center, Philadelphia, PA, USA
| | - Ying Xiao
- University of Pennsylvania, Philadelphia, PA, USA
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Gong YUT, Yu J, Pang D, Zhen H, Galvin J, Xiao Y. Automated Extraction of Dose/Volume Statistics for Radiotherapy-Treatment-Plan Evaluation in Clinical-Trial Quality Assurance. Front Oncol 2016; 6:47. [PMID: 26973814 PMCID: PMC4776636 DOI: 10.3389/fonc.2016.00047] [Citation(s) in RCA: 3] [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: 01/04/2016] [Accepted: 02/16/2016] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy clinical-trial quality assurance is a crucial yet challenging process. This note presents a tool that automatically extracts dose/volume statistics for determining dosimetry compliance review with improved efficiency and accuracy. A major objective of this study is to develop an automated solution for clinical-trial radiotherapy dosimetry review.
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Affiliation(s)
| | - Jialu Yu
- IROC, Philadelphia, PA, USA; Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Dalong Pang
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Heming Zhen
- Rush University Medical Center , Chicago, IL , USA
| | | | - Ying Xiao
- IROC, Philadelphia, PA, USA; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Son A, Biagioni M, Agarwal S, Li Y, Brys M, Di Rocco A, Galvin J. Structural changes in basal ganglia-thalamocortical circuits in Parkinson's disease with cognitive impairment. Parkinsonism Relat Disord 2016. [DOI: 10.1016/j.parkreldis.2015.10.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Galvin J, Suominen E, Morgan C, O'Connell EJ, Smith AP. Mental health nursing students' experiences of stress during training: a thematic analysis of qualitative interviews. J Psychiatr Ment Health Nurs 2015; 22:773-83. [PMID: 26459938 DOI: 10.1111/jpm.12273] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 11/28/2022]
Abstract
ACCESSIBLE SUMMARY What is known on the subject? Stress can impact students on mental health nurse training. This can have implications at the individual level (e.g. their own mental health) and at the level of the organization (e.g. sickness absence and attrition). What this paper adds to existing knowledge? We interviewed 12 mental health nursing students regarding the stress they experienced during training. Participants described how the academic demands can at times be unbearable during clinical placements. There were also issues with 'being a student' on some placements, with participants describing negative attitudes towards them from staff. The younger participants reported feeling overwhelmed on their initial placements and described some of the main challenges of mental health work for them. Raising concerns about the quality of care on wards was also described as particularly challenging for the students. What are the implications for practice? This paper can be useful to help training providers support mental health nursing students. Recommendations include reducing academic demands during clinical placements and extending and promoting existing support services beyond normal 9 am-5 pm working hours, even if these services are limited. Younger students could be better supported by being allocated to the more well-resourced placements in the early stages of their training. Raising awareness among staff of the tasks students can and cannot perform can help improve staff/student relations. Finally, students should be educated about the issues around raising concerns on placements to help the government's drive for a more open and transparent National Health Service (NHS). INTRODUCTION Previous studies investigating stress in nursing students focus on general nursing students or adopt quantitative measures. PURPOSE OF STUDY A qualitative study focusing specifically on mental health nursing students is required. METHOD One-to-one interviews were carried out with mental health nursing students (n = 12). Data were thematically analysed. RESULTS Participants reported unreasonable demands during clinical blocks, and described how control/support is lowest on placements with staff shortages. Negative attitudes towards students from staff and related issues were also discussed. Younger participants described struggling with mental health work during the early stages of training. DISCUSSION Training providers should strive to provide adequate support to students to help them manage stress during training. Implications for practice Academic demands should be reasonable during clinical blocks and support services outside normal working hours should be available for students, even if these are limited in scope. Greater consideration to the allocation of placements for younger students in the mental health branch could be helpful. Furthermore, staff on placements should be aware of the tasks students can and cannot perform, to help improve staff/student relations. Educating students on the issues of raising concerns can help the government's drive for a more open and transparent National Health Service (NHS).
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Affiliation(s)
- J Galvin
- School of Psychology, Cardiff University, Cardiff, UK
| | - E Suominen
- School of Psychology, Cardiff University, Cardiff, UK
| | - C Morgan
- School of Psychology, Cardiff University, Cardiff, UK
| | - E-J O'Connell
- School of Psychology, Cardiff University, Cardiff, UK
| | - A P Smith
- School of Psychology, Cardiff University, Cardiff, UK
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