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Page B, Fernandez K, Garrett J, Marcia M, Clements A, Schmitt N, Cunningham L. Feasibility of Portable Audiometry for Ototoxicity Monitoring in a Radiation Oncology Clinic for Head and Neck Cancer Patients Receiving Cisplatin-Based Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.289] [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: 10/23/2022]
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Chaurasia A, Brennan A, Mandia J, Garrett J, Cecil E, Kiess A, Quon H, Page B. Patient-Reported Quality of Life Outcomes after Head & Neck Cancer Radiation. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1484] [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: 10/23/2022]
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Baldonado JJAR, Amaral M, Garrett J, Moodie C, Robinson L, Keenan R, Toloza EM, Fontaine JP. Credentialing for robotic lobectomy: what is the learning curve? A retrospective analysis of 272 consecutive cases by a single surgeon. J Robot Surg 2018; 13:663-669. [PMID: 30560496 DOI: 10.1007/s11701-018-00902-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/02/2018] [Indexed: 11/25/2022]
Abstract
Credentialing processes for surgeons seeking robotic thoracic surgical privileges are not evidence-based, and the learning curve has not been reported. The goal of this study is to review our experience with robotic lobectomies and provide evidence for the development of a more uniform credentialing process. We performed a retrospective review of the first 272 consecutive robotic lobectomies performed between 2011 and 2017 by a single surgeon with prior video-assisted thoracoscopic (VATS) experience. Primary outcomes were operative duration, blood loss, chest tube duration, length of hospital stay, intraoperative complication, and conversion to thoracotomy. The patients were subdivided by surgical date into two cohorts of 120 consecutive patients to compare differences in outcomes, thereby illustrating the learning curve. Between 2011 and 2017, 272 patients (median age 67.5 years) underwent a robotic lobectomy by a single surgeon. The majority of patients (157/272) had early stage (T1N0) adenocarcinoma. For the entire cohort, median operative time was 160 min (83-317 min). The median blood loss was 75 mL (10-4000 mL). Median chest tube duration was 2 days (1-23 days) and median hospital stay was 3 days (1-25 days). Intraoperative complications occurred in seven patients. Only six patients required conversion to thoracotomy. Using multivariable logistic regression, it was found that the age, gender, and stage do not factor into conversion to thoracotomy, but BMI was found to be a significant covariate (p 0.043). As the surgeon performs more surgeries, there is a significantly shorter operative time (p < 0.001), decreased blood loss (p < 0.001), and shorter hospital stay (p < 0.014). When the first 120 and last 120 surgeries were compared, there was significantly less blood loss (234.6 vs 78.69 cc, p < 0.001), shorter operative time (181.9 vs 147.4 min, p < 0.001), shorter tube duration (3.49 vs 3.11 days, p 0.007), and shorter length of stay (4.03 vs 3.48 days, p < 0.001), respectively. More intraoperative complications were observed during the first 120 surgeries (6/120) compared to the last 120 surgeries (0/120; Fischer exact p = 0.029). Regression model plots did not show any apparent and significant change points, but rather a steady improvement. The more cases the surgeon does, the better is the outcome in terms of operative duration, blood loss, post-operative length of stay and intraoperative complications. The learning curve for robotic surgery for a surgeon with prior VATS experience is that of a continuous improvement with experience instead of a particular change point. Since most thoracic surgeons who perform robotic-assisted surgery have already gotten past their VATS learning curves, they no longer have a definable learning curve for robotic surgery. Hence, if a surgeon is already proficient and credentialed to perform VATS lung resections, he or she is no longer faced with a significant learning curve for robotic lung resections, and should be credentialed to do so once he or she has undergone the appropriate training with the equipment and technology.
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Affiliation(s)
| | - M Amaral
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J Garrett
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - C Moodie
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - L Robinson
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - R Keenan
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - E M Toloza
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J P Fontaine
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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Bartley J, Garrett J, Camargo CA, Scragg R, Vandal A, Sisk R, Milne D, Tai R, Jeon G, Cursons R, Wong C. Vitamin D 3 supplementation in adults with bronchiectasis: A pilot study. Chron Respir Dis 2018; 15:384-392. [PMID: 29490469 PMCID: PMC6234573 DOI: 10.1177/1479972318761646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/24/2018] [Indexed: 11/15/2022] Open
Abstract
Vitamin D supplementation prevents acute respiratory infections and, through modulating innate and adaptive immunity, could have a potential role in bronchiectasis management. The primary aims of this pilot study were to assess serum 25-hydroxyvitamin D (25(OH)D) levels in New Zealand adults with bronchiectasis, and their 25(OH)D levels after vitamin D3 supplementation. Adults with bronchiectasis received an initial 2.5 mg vitamin D3 oral loading dose and 0.625 mg vitamin D3 weekly for 24 weeks. The primary outcome was serum 25(OH)D levels before and after vitamin D3 supplementation. Secondary outcomes (time to first infective exacerbation, exacerbation frequency, spirometry, health-related quality of life measures, sputum bacteriology and cell counts and chronic rhinosinusitis) were also assessed. This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12612001222831). The initial, average 25(OH)D level was 71 nmol/L (95% confidence interval (CI): [58, 84]), rising to 218 nmol/L (95% CI: [199, 237]) at 12 weeks and 205 nmol/L (95% CI: [186, 224]) at 24 weeks. The initial serum cathelicidin level was 25 nmol/L (95% CI: [17, 33]), rising to 102 nmol/L (95% CI: [48, 156]) at 12 weeks and 151 nmol/L (95% CI: [97, 205]) at 24 weeks. Over the 24-week study period, we observed statistically significant changes of 1.11 (95% CI: [0.08, 2.14]) in the Leicester Cough Questionnaire and -1.97 (95% CI: [-3.71, -0.23]) in the Dartmouth COOP charts score. No significant adverse effects were recorded. Many New Zealand adults with bronchiectasis have adequate 25(OH)D levels. Weekly vitamin D3 supplementation significantly improved 25(OH)D levels.
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Affiliation(s)
- Jim Bartley
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Jeff Garrett
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Scragg
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Alain Vandal
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Ko Awatea, Counties Manukau District Health Board, Auckland, New Zealand
| | - Rose Sisk
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - David Milne
- Department of Radiology, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Ray Tai
- Department of Radiology, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Gene Jeon
- Middlemore Clinical Trials Unit, Middlemore Hospital, Auckland, New Zealand
| | - Ray Cursons
- Faculty of Science and Engineering, University of Waikato, Hamilton, New Zealand
| | - Conroy Wong
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
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Long G, Hauschild A, Santinami M, Atkinson V, Mandala M, Chiarion-Sileni V, Larkin J, Robert C, Schadendorf D, Dasgupta K, Shilkrut M, Garrett J, Brase J, Kefford R, Kirkwood J, Dummer R. Updated relapse-free survival (RFS) and biomarker analysis in the COMBI-AD trial of adjuvant dabrafenib + trametinib (D + T) in patients (pts) with resected BRAF V600–mutant stage III melanoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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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Gerard R, Nguyen D, Velez-Cubian F, Amaral M, Moodie C, Garrett J, Fontaine J, Toloza E. PD.2.04 Effect of Nodal Skip Metastasis on Outcomes after Robotic-Assisted Pulmonary Lobectomy for Primary Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.07.036] [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: 11/26/2022]
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Hiles SA, Harvey ES, McDonald VM, Peters M, Bardin P, Reynolds PN, Upham JW, Baraket M, Bhikoo Z, Bowden J, Brockway B, Chung LP, Cochrane B, Foxley G, Garrett J, Hew M, Jayaram L, Jenkins C, Katelaris C, Katsoulotos G, Koh MS, Kritikos V, Lambert M, Langton D, Lara Rivero A, Marks GB, Middleton PG, Nanguzgambo A, Radhakrishna N, Reddel H, Rimmer J, Southcott AM, Sutherland M, Thien F, Wark PAB, Yang IA, Yap E, Gibson PG. Working while unwell: Workplace impairment in people with severe asthma. Clin Exp Allergy 2018; 48:650-662. [DOI: 10.1111/cea.13153] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/22/2018] [Accepted: 03/29/2018] [Indexed: 11/27/2022]
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Broadbent E, Garrett J, Jepsen N, Li Ogilvie V, Ahn HS, Robinson H, Peri K, Kerse N, Rouse P, Pillai A, MacDonald B. Using Robots at Home to Support Patients With Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial. J Med Internet Res 2018; 20:e45. [PMID: 29439942 PMCID: PMC5829456 DOI: 10.2196/jmir.8640] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 08/04/2017] [Revised: 11/15/2017] [Accepted: 11/30/2017] [Indexed: 01/01/2023] Open
Abstract
Background Socially assistive robots are being developed for patients to help manage chronic health conditions such as chronic obstructive pulmonary disease (COPD). Adherence to medication and availability of rehabilitation are suboptimal in this patient group, which increases the risk of hospitalization. Objective This pilot study aimed to investigate the effectiveness of a robot delivering telehealth care to increase adherence to medication and home rehabilitation, improve quality of life, and reduce hospital readmission compared with a standard care control group. Methods At discharge from hospital for a COPD admission, 60 patients were randomized to receive a robot at home for 4 months or to a control group. Number of hospitalization days for respiratory admissions over the 4-month study period was the primary outcome. Medication adherence, frequency of rehabilitation exercise, and quality of life were also assessed. Implementation interviews as well as benefit-cost analysis were conducted. Results Intention-to-treat and per protocol analyses showed no significant differences in the number of respiratory-related hospitalizations between groups. The intervention group was more adherent to their long-acting inhalers (mean number of prescribed puffs taken per day=48.5%) than the control group (mean 29.5%, P=.03, d=0.68) assessed via electronic recording. Self-reported adherence was also higher in the intervention group after controlling for covariates (P=.04). The intervention group increased their rehabilitation exercise frequency compared with the control group (mean difference −4.53, 95% CI −7.16 to −1.92). There were no significant differences in quality of life. Of the 25 patients who had the robot, 19 had favorable attitudes. Conclusions This pilot study suggests that a homecare robot can improve adherence to medication and increase exercise. Further research is needed with a larger sample size to further investigate effects on hospitalizations after improvements are made to the robots. The robots could be especially useful for patients struggling with adherence. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12615000259549; http://www.anzctr.org.au (Archived by WebCite at http://www.webcitation.org/6whIjptLS)
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Affiliation(s)
- Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jeff Garrett
- Department of Respiratory Medicine, Counties Manukau District Health Board, Auckland, New Zealand
| | - Nicola Jepsen
- Acute Allied Health Department, Counties Manukau District Health Board, Auckland, New Zealand
| | - Vickie Li Ogilvie
- Acute Allied Health Department, Counties Manukau District Health Board, Auckland, New Zealand
| | - Ho Seok Ahn
- Department of Electrical and Computer Engineering, The University of Auckland, Auckland, New Zealand
| | - Hayley Robinson
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kathryn Peri
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Paul Rouse
- Department of Accounting and Finance, The University of Auckland, Auckland, New Zealand
| | - Avinesh Pillai
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Bruce MacDonald
- Department of Electrical and Computer Engineering, The University of Auckland, Auckland, New Zealand
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Glover J, Reynolds S, Echavarria M, Ng E, Velez-Cubian F, Moodie C, Garrett J, Fontaine J, Toloza E. P178 Smoking history as a risk factor for atrial fibrillation following robotic-assisted video-thoracoscopic pulmonary lobectomy. Chest 2017. [DOI: 10.1016/j.chest.2017.04.081] [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: 11/12/2022] Open
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Groshev A, Velez-Cubian F, Gerard R, Toosi K, Moodie C, Garrett J, Fontaine J, Toloza E. P189 Perioperative outcomes after robotic-assisted pulmonary lobectomy for upper versus lower lobe lung malignancies. Chest 2017. [DOI: 10.1016/j.chest.2017.04.092] [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: 10/19/2022] Open
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Groshev A, Velez-Cubian F, Gerard R, Toosi K, Moodie C, Garrett J, Fontaine J, Toloza E. P179 Outcomes for right versus left lung malignancies after robotic-assisted pulmonary lobectomy. Chest 2017. [DOI: 10.1016/j.chest.2017.04.082] [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: 11/17/2022] Open
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Reynolds S, Glover J, Echavarria M, Ng E, Velez-Cubian F, Moodie C, Garrett J, Fontaine J, Toloza E. P187 Diabetes predisposes patients to atrial fibrillation after robotic-assisted video-thoracoscopic pulmonary lobectomy. Chest 2017. [DOI: 10.1016/j.chest.2017.04.090] [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: 11/29/2022] Open
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Reynolds S, Glover J, Echavarria M, Ng E, Velez-Cubian F, Moodie C, Garrett J, Fontaine J, Toloza E. Diabetes predisposes patients to atrial fibrillation after robotic-assisted video-thoracoscopic pulmonary lobectomy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx085.005] [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: 11/12/2022] Open
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Glover J, Reynolds S, Ng E, Echavarria M, Velez-Cubian F, Moodie C, Garrett J, Fontaine J, Toloza E. Effect of age on risk for atrial fibrillation following robotic-assisted video-thoracoscopic pulmonary lobectomy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx085.008] [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: 11/12/2022] Open
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Glover J, Reynolds S, Echavarria M, Ng E, Velez-Cubian F, Moodie C, Garrett J, Fontaine J, Toloza E. Smoking history as a risk factor for atrial fibrillation following robotic-assisted video-thoracoscopic pulmonary lobectomy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx085.006] [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: 11/14/2022] Open
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Garrett J, Li Y, Li K, Chen G. WE-DE-207B-06: Artifact Reduction in Digital Breast Tomosynthesis with the Denoised Ordered-Subset Statistically Penalized Algebraic Reconstruction Technique (DOS-SPART) Algorithm. Med Phys 2016. [DOI: 10.1118/1.4957866] [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: 11/07/2022] Open
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Garrett J, Ge Y, Li K, Chen G. TU-CD-207-12: Impact of Anatomical Noise On Detection Performance of Microcalcifications in Multi-Contrast Breast Imaging. Med Phys 2015. [DOI: 10.1118/1.4925631] [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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Ng E, Rodriguez K, Velez-Cubian FO, Thau MR, Zhang WW, Moodie CC, Garrett J, Fontaine JP, Robinson L, Toloza E. P-171 * DOES SOCIO-ECOMOMIC STATUS MATTER WITH PERIOPERATIVE OUTCOMES AFTER ROBOTIC-ASSISTED PULMONARY LOBECTOMY? Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.171] [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: 11/12/2022] Open
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Toloza E, Moodie CC, Garrett J, Meredith K. P-216 * CONCURRENT ROBOTIC-ASSISTED RIGHT UPPER LOBECTOMY FOR LUNG CANCER AND ROBOTIC-ASSISTED EXCISION OF OESOPHAGEAL LEIOMYOMA: A CASE REPORT. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.216] [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: 11/13/2022] Open
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Toloza E, Splittgerber M, Zhang WW, Moodie CC, Garrett J, Hiro M, Dayicioglu D. P-233 * NOVEL APPROACHES TO COMPLEX CHEST WALL RECONSTRUCTION USING A COMBINATION OF TWO TITANIUM-BASED PLATING-SYSTEMS: A CASE REPORT. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.233] [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: 11/12/2022] Open
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Walton L, McNeill R, Stevens W, Murray M, Lewis C, Aitken D, Garrett J. Patient perceptions of barriers to the early diagnosis of lung cancer and advice for health service improvement. Fam Pract 2013; 30:436-44. [PMID: 23377608 DOI: 10.1093/fampra/cmt001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Patient and systematic factors within primary and secondary care contribute to delay in timely diagnosis of lung cancer. This qualitative study aimed to explore New Zealand service users' experiences of the pathway to lung cancer diagnosis, identify factors contributing to delay and provide advice for service improvement. METHODS Two samples were recruited. Patients who presented to a hospital emergency department with suspicious symptoms (n = 19) were interviewed individually. Those with confirmed lung cancer (n = 20) took part in a focus group. Similar semi-structured interview schedules were used. Interviews and focus groups were audiorecorded and thematic analyses performed. Evident commonality led to an integrated interpretation. RESULTS Patient delay was common but most had seen a GP before referral. No ED participant had seen a respiratory specialist prior ED admission, but after that, most had a seamless pathway. This contrasts with long waits for outpatient participants. Two central themes, 'access to health services' and 'processes of care', described factors influencing delay. Subthemes highlighted issues relating to symptom interpretation, health beliefs, provider continuity, relationships and perceived expertise that contributed to patient and GP delay. System complexity, information systems and resourcing issues were identified as barriers at the primary-secondary care interface and within secondary care. CONCLUSION Reasons for diagnostic delay are complex and multifactorial. Solutions include community initiatives to educate and resource at-risk patients to seek help, supporting and resourcing primary care to increase timely referral and implementing strategies to reduce system complexity for GPs and patients, and the employment of care coordinators.
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Affiliation(s)
- Lisa Walton
- Health Systems, School of Population Health, University of Auckland, Auckland, New Zealand
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Yap E, Chua WM, Jayaram L, Zeng I, Vandal AC, Garrett J. Can we predict sputum eosinophilia from clinical assessment in patients referred to an adult asthma clinic? Intern Med J 2013; 43:46-52. [PMID: 21790924 DOI: 10.1111/j.1445-5994.2011.02565.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/26/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is overwhelming evidence that asthma guidelines aimed at reducing airway inflammation are superior to those based on clinical symptoms alone. This involves targeting eosinophilic inflammation with inhaled corticosteroids. AIM Because induced sputum is not readily available, our study set out to investigate whether the collective or singular use of routine asthma investigations can predict sputum eosinophilia. METHODS Eighty patients underwent skin prick testing, blood tests (IgE, full blood count), spirometry, exhaled fraction nitric oxide (FeNO), PD15 to hypertonic saline, and induced sputum testing at first assessment. A predictive model for sputum eosinophilia (defined as ≥3% eosinophils) was sought using routinely available tests. RESULTS Fifty-four subjects underwent both induced sputum and FeNO testing. Seventeen (30%) revealed eosinophilic inflammation, nine (16%) neutrophilic, four (7%) mixed granulocytic and 26 (46%) paucigranulocytic. Positive predictors for sputum eosinophilia included low forced expiratory volume in 1 s (FEV(1))% predicted, raised serum eosinophil, positive smoking history, Polynesian ethnicity and negative asthma family history. There was a non-statistically significant trend for FeNO predicting sputum eosinophilia. The best combination of predictors was low FEV(1)% predicted, raised serum eosinophil, positive smoking history and negative family history of asthma. CONCLUSION This study demonstrates that the serum eosinophil count and FEV(1) combined with aspects of a clinical history may provide a simple and practical alternative to assessment of airway (sputum) eosinophilia in the clinical setting. A full blood count can be performed at a substantially lesser cost and with greater accessibility than induced sputum. We feel the time has come for the clinical utility of the serum eosinophil count to be revisited.
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Affiliation(s)
- E Yap
- Respiratory Department, Middlemore Hospital, Auckland, New Zealand.
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Li K, Garrett J, Ge Y, Chen GH. WE-G-103-03: BEST IN PHYSICS (IMAGING) - The Feasibility of An X-Ray Differential Phase Contrast Tomosynthesis System Adapted From a Clinical Digital Breast Tomosynthesis System. Med Phys 2013. [DOI: 10.1118/1.4815663] [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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Mercier RJ, Garrett J, Thorp J, Siega-Riz AM. Pregnancy intention and postpartum depression: secondary data analysis from a prospective cohort. BJOG 2013; 120:1116-22. [PMID: 23651010 DOI: 10.1111/1471-0528.12255] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the relationship between unintended pregnancy and postpartum depression. DESIGN Secondary analysis of data from a prospective pregnancy cohort. SETTING The study was performed at the University of North Carolina prenatal care clinics. POPULATION/SAMPLE Pregnant women enrolled for prenatal care at the University of North Carolina Hospital Center. METHODS Participants were questioned about pregnancy intention at 15-19 weeks of gestation, and classified as having an intended, mistimed or unwanted pregnancy. They were evaluated for postpartum depression at 3 and 12 months postpartum. Log binomial regression was used to assess the relationship between unintended pregnancy and depression, controlling for confounding by demographic factors and reproductive history. MAIN OUTCOME MEASURES Depression at 3 and 12 months postpartum, defined as Edinburgh Postpartum Depression Scale score >13. RESULTS Data were analysed for 688 women at 3 months and 550 women at 12 months. Depression was more likely in women with unintended pregnancies at both 3 months (risk ratio [RR] 2.1, 95% confidence interval [95% CI] 1.2-3.6) and 12 months (RR 3.6, 95% CI 1.8-7.1). Using multivariable analysis adjusting for confounding by age, poverty and education level, women with unintended pregnancies were twice as likely to have postpartum depression at 12 months (RR 2.0, 95% CI 0.96-4.0). CONCLUSION While many elements may contribute to postpartum depression, unintended pregnancy could also be a contributing factor. Women with unintended pregnancy may have an increased risk of depression up to 1 year postpartum.
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Affiliation(s)
- R J Mercier
- Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, NC 27599, USA.
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Bartley J, Garrett J, Grant CC, Camargo CA. Could vitamin d have a potential anti-inflammatory and anti-infective role in bronchiectasis? Curr Infect Dis Rep 2013; 15:148-57. [PMID: 23371406 DOI: 10.1007/s11908-013-0321-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Bronchiectasis is a chronic infective and inflammatory respiratory disease that causes significant morbidity and mortality. Patients with non-cystic-fibrosis bronchiectasis are frequently vitamin D deficient, and vitamin D levels correlate with disease severity. Infection-specific actions of vitamin D include the enhancement of innate immunity and the moderation of inflammation caused by the adaptive immune response. Potentially, vitamin D could influence the processes that lead to bronchiectasis and the frequency and severity of acute exacerbations. Randomized trials of vitamin D supplementation have shown effects that are likely to be protective against the development of bronchiectasis. Several issues need to be clarified before the development of clinical trials to investigate the role of vitamin D in bronchiectasis. These include an optimal vitamin D supplementation dose and appropriate and sensitive outcome measures that include assessment of exacerbation frequency and severity, lung function, and health-related quality of life.
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Affiliation(s)
- Jim Bartley
- Department of Surgery, University of Auckland, 10 Owens Road, Auckland, 1023, New Zealand,
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O'Neill E, Tang J, Garrett J, Hubacher D. Characteristics of Kenyan women who continue subdermal contraceptive implants at 18 months. Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.114] [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: 10/28/2022]
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Garrett J, Tang J, Zhang Y, Ruth C, Jing Z, Chen GH. TU-E-217BCD-10: Dose Reduction in Digital Breast Tomosynthesis with the Dose Reduction Prior Image Constrained Compressed Sensing (DR-PICCS) Algorithm. Med Phys 2012; 39:3916. [DOI: 10.1118/1.4735982] [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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Paregallo R, Prabhakaran S, Garrett J. Haitian women with unmet contraceptive need without intention to use contraceptives: should we address this unmet need? Contraception 2011. [DOI: 10.1016/j.contraception.2011.05.106] [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: 11/29/2022]
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Dieterich S, Chuang C, Cohen A, Taylor D, Wu X, Garrett J, Lowenstein J, Lee C, Cavedon C, Yu C, DˈSouza M. WE-B-BRA-03: TG135 - QA for Robotic Radiosurgery. Med Phys 2011. [DOI: 10.1118/1.3613302] [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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Cook RS, Rinehart C, Garrett J, Chakravarti A, Arteaga CL. Abstract P5-06-10: ErbB Signaling Is Required for Activation of Phosphatidylinositol-3 Kinase and Transformation of Mammary Epithelial Cells by Polyomavirus Middle T Antigen. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-06-10] [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: 11/16/2022]
Abstract
Abstract
Summary
Polyomavirus middle T (PyVmT) transforms cells through phosphatidylinositol 3-kinase (PI3K). Overexpression of ErbB2/ErbB3 heterodimers, potent activators of PI3K, occurs in PyVmT-driven mouse mammary tumors, but without known cause and consequence. Inhibition of ErbB2 with lapatinib, or genetically engineered loss of ErbB3, decreased PI3K signaling and tumor growth in mice, suggesting ErbB2/ErbB3 is required by PyVmT. ErbB2/ErbB3 formed signaling complexes containing PyVmT, p85 and Src. EZN-3920, a novel high-affinity oligonucleotide targeting ErbB3 transcripts, impaired ErbB3 expression in vivo, decreased PI3K signaling, cell survival, and growth of tumors, and improved response to lapatinib. Therefore, PyVmT utilizes ErbB2/ErbB3 overexpression to drive PI3K signaling. Furthermore, the challenge of ErbB3 as a kinase-inactive therapeutic target can be overcome by targeting ErbB3 mRNA transcripts in vivo. Significance
Given the widespread use of, and knowledge gained from the MMTV-PyVmT transgenic mouse breast cancer model, understanding how PyVmT utilizes existing cell signaling programs is necessary to interpret how results impact our understanding/treatment of human breast cancers. We found that ErbB2/ErbB3 heterodimers were a necessary part of PyVmT signaling complexes involving Src and PI3K, and that PyVmT depends on ErbB3 in the breast epithelium for PI3K activity and tumor growth. Because ErbB3 harbors a weak/inactive tyrosine kinase, therapeutic anti-ErbB3 interventions present with challenges. Further, anti-ErbB3 antibodies that block ligand interaction with ErbB3 do not alter ligand-independent ErbB3 signaling. However. these challenges were overcome using high-affinity oligonucleotides targeting ErbB3 mRNA. Use of the oligonucleotide EZN-3920 effectively reduced ErbB3 expression, inhibited PyVmT tumor growth, and improved the response of tumors to lapatinib. These results support oligonucleotide knock-down of targets as potential therapeutic strategy.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-06-10.
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Affiliation(s)
- RS Cook
- Vanderbilt University and the Vanderbilt-Ingram Cancer Center
| | - C Rinehart
- Vanderbilt University and the Vanderbilt-Ingram Cancer Center
| | - J Garrett
- Vanderbilt University and the Vanderbilt-Ingram Cancer Center
| | - A Chakravarti
- Vanderbilt University and the Vanderbilt-Ingram Cancer Center
| | - CL. Arteaga
- Vanderbilt University and the Vanderbilt-Ingram Cancer Center
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Dieterich S, Cavedon C, Chuang C, Cohen A, Garrett J, Lee C, Lowenstein J, D'Souza M, Taylor D, Wu X, Yu C. TU-B-203-03: QA of Radiation Delivery Systems - TG-135 QA for Robotic Radiosurgery. Med Phys 2010. [DOI: 10.1118/1.3469184] [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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32
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Garrett J, Naimi D, Le T. Predictive Value Of Combining Food-specific IgE Level With Skin Prick Test And Oral Food Challenge Outcome. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.347] [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: 11/29/2022]
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Garrett J, Olivares M, Rinehart C, Dave B, Cook R, Chang J, Arteaga C. Transcriptional and Post-Translational Upregulation of HER3 (ErbB3) Counteracts Antitumor Effect of HER2 Tyrosine Kinase Inhibitors. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
We hypothesized that sustained inhibition of HER3 and its output to PI3K/Akt is required for the optimal antitumor effect of HER2 inhibitors. Therefore, we examined the temporal effect of the HER2 tyrosine kinase inhibitor (TKI) lapatinib (lap) on feedback upregulation of active HER3 in HER2-overexpressing breast cancer cells. A time course with lap-treated cells showed 3 to 5-fold upregulation of HER3 RNA and protein, beginning at 4 h and increasing through 48 h. P-Tyr immunoblot of HER3 immunoprecipitates revealed recovery of HER3 phosphorylation at and beyond 13 h of treatment. Site-specific antibodies revealed HER3 phosphorylation at Y1197 and Y1289, two of the six p85 binding sites in HER3. Recovery of P-HER3 correlated temporally with recovery of T308 P-Akt. The upregulation of HER3 RNA upon treatment with lap suggested that inhibition of active HER2 and PI3K/Akt derepresses the transcription factor FoxO3a. Putative FoxO3a binding sites were identified within the 5' flanking region upstream of the HER3 transcription start site. Transfection with FoxO3a siRNA reduced basal and lap-induced HER3 RNA levels 2 to 5-fold compared to control cells. Conversely, overexpression of FoxO3a increased HER3 RNA 2.5-fold, which could be further enhanced by lap treatment. In addition to these transcriptional mechanisms, the recovery of P-HER3 upon lap-induced inhibition of HER2 suggested engagement of another tyrosine kinase transactivating HER3 and/or that HER2 had been incompletely inhibited by the TKI. However, IGF-IR, Src, and MET TKIs did not inhibit the recovery of P-HER3. On the other hand, the addition of trastuzumab (tz) to lap-treated cells prevented recovery of P-HER3, suggesting that disruption of a ligand-independent HER2-HER3 interaction was involved in partial maintenance of HER3 phosphorylation.The upregulation of HER3 RNA and partial maintenance of P-HER3 and P-Akt suggested that combined inhibition of HER2 and HER3 will synergistically inhibit tumor cell viability. Transfection with HER3 siRNA sensitized HER2+ breast cancer cells to each lap and tz as assessed by Apo-BrdU (apoptosis) and 3D-Matrigel growth assays. Further, treatment with AMG-888, a HER3 monoclonal antibody (AMGEN-U3), sensitized cells to each lap and tz. Ongoing studies include the treatment of BT474 xenografts in athymic mice with lap ± AMG-888 using [18F]-FDG-PET as a non-invasive imaging biomarker to predict treatment outcome. Finally, we examined HER3 levels by immunohistochemistry in sections from tumor blocks of patients enrolled in a neoadjuvant trial where lap was given alone during the first 6 weeks of therapy. The percent and intensity of tumor cell staining was calculated as a histoscore (Human Pathol. 26:291, 1995). On week 2 of therapy, HER3 levels increased 135% above pre-therapy levels (n=8; p=0.03, Mann-Whitney). These data suggest that upon inhibition of the HER2 tyrosine kinase, HER2+ breast cancers 1) upregulate HER3 by transcriptional mechanisms and partially maintain HER3 function by post-translational mechanisms; 2) this compensatory phosphorylation of HER3 partially maintains PI3K/Akt; and 3) inhibition of HER3 sensitizes HER2-dependent breast cancer cells to HER2 inhibitors.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 63.
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Affiliation(s)
| | | | | | - B. Dave
- 2Baylor College of Medicine, TX,
| | - R. Cook
- 1Vanderbilt-Ingram Cancer Center, TN,
| | - J. Chang
- 2Baylor College of Medicine, TX,
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Dieterich S, Cavedon C, Chuang C, Cohen A, Garrett J, Lee C, Lowenstein J, D'Souza M, Taylor D, Wu X, Yu C. TU-E-BRB-03: Performance-Based QA for Radiotherapy: TG-135 - QA for Robotic Radiosurgery. Med Phys 2009. [DOI: 10.1118/1.3182412] [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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35
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Garrett J, Chen B, Taylor DR. A survey of respiratory and sleep services in New Zealand undertaken by the Thoracic Society of Australia and New Zealand (TSANZ). N Z Med J 2009; 122:10-23. [PMID: 19305445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIMS In 2004, the NZ Branch of the TSANZ published "Standards for Adult Respiratory and Sleep Services" on the Ministry of Health's (MoH) website.1 The aim of this survey was to evaluate each of the 21 District Health Boards' (DHBs) performance against the published standards, concentrating particularly on staffing, infrastructure, clinical support services, implementation of guidelines, quality assurance activity, and basic services (sleep, lung function, and oxygen). METHODS Postal questionnaire survey of all DHBs in late 2006. RESULTS All 21 DHBs responded. Only 10 of 21 DHBs were complying with the minimum standards of care. Main deficiencies in care related to: inadequate medical staffing rates, lack of quality assurance measures and insufficient laboratory testing (sleep and lung function). The lack of monitoring of such basic activities as outpatient clinic attendances, oxygen and sleep services, and the non implementation of treatment guidelines were of particular concern. Seven-fold variations in prescription of assisted ventilation equipment and oxygen therapy exist across the country. CONCLUSIONS When evaluated against minimum standards of care published in 2004, major gaps in service provision exist in New Zealand. Access to services is variable. There is a lack of national leadership and insufficient regional organisation leading to large gaps in service provision of even basic respiratory services. Immediate changes to the current service provision structures are required.
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Affiliation(s)
- Jeff Garrett
- Middlemore Hospital, Otahuhu, Auckland, New Zealand.
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Jones A, Brown M, Trzeciak S, Shapiro N, Garrett J, Heffner A, Kline J. 207: The Effect of a Quantitative Resuscitation Strategy on Mortality in Patients With Sepsis: A Meta-Analysis. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.225] [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: 10/21/2022]
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Nowak E, Brousseau R, Garrett J, Masson L, Maynard C, Trevors J, Edge T. Characterization of formulated microbial products by denaturing gradient gel electrophoresis, total cellular fatty acid analysis, and DNA microarray analysis. Can J Microbiol 2008; 54:380-90. [DOI: 10.1139/w08-015] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Two commercial products, Biotize and Cycle, containing bacteria as an active ingredient were characterized for species identification and batch-to-batch variation by denaturing gradient gel electrophoresis (DGGE), total cellular fatty acid analysis (FAA), and a taxonomic DNA microarray. DGGE was useful at assessing the stability of consortia in different batches, and cluster analysis differentiated each batch even when only slight differences in species composition were observed. DGGE, FAA, and DNA microarray results indicated little batch-to-batch variation in Biotize and some batch variation in Cycle. The 3 methods agreed well with species identification in Biotize but generated conflicting results in the species composition of Cycle. This multi-method approach was useful in determining if the observed bacterial species present in the products matched the expected species composition.
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Affiliation(s)
- E. Nowak
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - R. Brousseau
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - J. Garrett
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - L. Masson
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - C. Maynard
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - J.T. Trevors
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - T.A. Edge
- National Water Research Institute, Environment Canada, 867 Lakeshore Road, Burlington, ON L7R 4A6, Canada
- Environmental Sector, Biotechnology Research Institute, National Research Council, 6100 Royalmount Avenue, Montréal, QC H4P 2R2, Canada
- Department of Environmental Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
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Park R, Nisbet M, Garrett J, Heaven D. Amiodarone Lung: Drug Induced Pulmonary Toxicity the Middlemore Experience. Heart Lung Circ 2007. [DOI: 10.1016/j.hlc.2007.06.182] [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: 10/23/2022]
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39
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Carlin EP, Bowman DD, Scarlett JM, Garrett J, Lorentzen L. Prevalence of Giardia in symptomatic dogs and cats throughout the United States as determined by the IDEXX SNAP Giardia test. Vet Ther 2006; 7:199-206. [PMID: 17039442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
National prevalence of Giardia infection in dogs and cats presenting to clinics with vomiting and/or diarrhea was examined using the IDEXX SNAP Giardia test kit. Veterinary practices across the United States were sent an invitation to participate in the survey and asked to use the test on fecal samples from the target population. The survey requested that the clinics report the results of 20 or more tests. A total of 21,092 results were reported, comprised of 16,114 dogs and 4,978 cats. Analysis of the data (excluding the handful of results reported from Puerto Rico) showed a Giardia prevalence of 15.6% among dogs tested, and 10.8% among cats. This difference was statistically significant (p < 0.001). Regional categorization into Northeast, Southeast, West, and Midwest drew out significant (p < 0.001) differences in prevalence in most cases for dogs; the differences were not significant for cats. These differences and other variables are currently being examined with this and additional data sets. We conclude on the basis of the SNAP test diagnostic that Giardia is a common enteric agent among dogs and cats with gastrointestinal signs.
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Affiliation(s)
- E P Carlin
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401, USA
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40
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Garrett J. Lung cancer management concerns in New Zealand. N Z Med J 2004; 117:U929. [PMID: 15280933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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41
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Casey P, Garrett J, Eaton T. Allergic bronchopulmonary aspergillosis in a lung transplant patient successfully treated with nebulized amphotericin. J Heart Lung Transplant 2002; 21:1237-41. [PMID: 12431500 DOI: 10.1016/s1053-2498(02)00425-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A case of allergic bronchopulmonary Aspergillosis (ABPA) complicating lung transplantation for cystic fibrosis is described. Control of ABPA was only achieved with 20 mg of prednisone and 600 mg of itraconazole per day. However, a prompt clinical and physiologic response was observed when nebulized amphotericin was introduced, which allowed prednisone to be reduced to 7.5 mg per day and, in time, all anti-fungal therapy to be withdrawn.
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Affiliation(s)
- Paul Casey
- Department of Respiratory Medicine, Green Lane Hospital, Auckland, New Zealand
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Baldwin DR, Eaton T, Kolbe J, Christmas T, Milne D, Mercer J, Steele E, Garrett J, Wilsher ML, Wells AU. Management of solitary pulmonary nodules: how do thoracic computed tomography and guided fine needle biopsy influence clinical decisions? Thorax 2002. [PMID: 12200528 DOI: 10.1136/thorax.57.9.817.pmid:12200528;pmcid:pmc1746431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Computed tomography (CT) and fine needle guided biopsy (FNB) are often used in the assessment of patients with lung nodules. The influence of these techniques on clinical decision making has not been quantified, especially for small solitary pulmonary nodules (SPN) where the probability of malignancy is lower. A study was undertaken to determine the effect of CT and FNB derived information on clinical decision making in patients with a solitary pulmonary nodule < or = 3 cm in diameter on initial chest radiography. METHODS Clinical, physiological, and outcome data on 114 patients with an SPN < or = 3 cm who had subsequent thoracic CT and FNB were extracted from the records of a specialist cardiorespiratory hospital in Auckland, New Zealand. Chest radiographs and CT scans were reported according to specified criteria by a thoracic radiologist. Computer generated summary sheets were used to present cases to each of six clinicians. Each case was presented three times: (1) with clinical data and chest radiograph only; (2) with the addition of the CT report; and (3) with all data including the result of the FNB. Clinicians were asked to specify their management on each occasion and to estimate the probability of the lesion being malignant. Reproducibility was assessed by re-evaluating 24 cases 1 month later. RESULTS 33 (29%) nodules were benign, 35 (31%) nodules (malignant) were resected with negative node sampling, and 46 (40%) had a non-curative outcome (radiotherapy, incomplete resection, refused therapy). Intra-clinician decision making was consistent for all three levels of clinical data (median kappa values 0.79-0.89). Agreement between clinicians on the need for surgery was lowest with chest radiography alone (kappa=0.33), rose with CT information (kappa=0.44), and increased further with the addition of the FNB data (kappa=0.57). The proportion of successful decisions on surgical intervention (against the known outcome) increased with the addition of CT reports and further with FNB reports (p=0.006, Friedman's test). The major benefit of the information added by CT and FNB reports was a reduction in unnecessary surgery, especially when the clinical perception of pre-test probability of malignancy was intermediate (31-70%). FNB data contributed most to the benefit (p<0.001). The addition of CT and FNB was cost efficient and can be applied specifically to patients with a low or intermediate probability of malignancy. CONCLUSION Both CT and FNB make cost effective contributions to the clinical management of SPN < or = 3 cm in diameter by reducing unnecessary operations and increasing agreement between physicians on the need for surgery.
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Affiliation(s)
- D R Baldwin
- Department of Respiratory Medicine, City Hospital, Nottingham NG5 1PB, UK.
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43
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Baldwin DR, Eaton T, Kolbe J, Christmas T, Milne D, Mercer J, Steele E, Garrett J, Wilsher ML, Wells AU. Management of solitary pulmonary nodules: how do thoracic computed tomography and guided fine needle biopsy influence clinical decisions? Thorax 2002; 57:817-22. [PMID: 12200528 PMCID: PMC1746431 DOI: 10.1136/thorax.57.9.817] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Computed tomography (CT) and fine needle guided biopsy (FNB) are often used in the assessment of patients with lung nodules. The influence of these techniques on clinical decision making has not been quantified, especially for small solitary pulmonary nodules (SPN) where the probability of malignancy is lower. A study was undertaken to determine the effect of CT and FNB derived information on clinical decision making in patients with a solitary pulmonary nodule < or = 3 cm in diameter on initial chest radiography. METHODS Clinical, physiological, and outcome data on 114 patients with an SPN < or = 3 cm who had subsequent thoracic CT and FNB were extracted from the records of a specialist cardiorespiratory hospital in Auckland, New Zealand. Chest radiographs and CT scans were reported according to specified criteria by a thoracic radiologist. Computer generated summary sheets were used to present cases to each of six clinicians. Each case was presented three times: (1) with clinical data and chest radiograph only; (2) with the addition of the CT report; and (3) with all data including the result of the FNB. Clinicians were asked to specify their management on each occasion and to estimate the probability of the lesion being malignant. Reproducibility was assessed by re-evaluating 24 cases 1 month later. RESULTS 33 (29%) nodules were benign, 35 (31%) nodules (malignant) were resected with negative node sampling, and 46 (40%) had a non-curative outcome (radiotherapy, incomplete resection, refused therapy). Intra-clinician decision making was consistent for all three levels of clinical data (median kappa values 0.79-0.89). Agreement between clinicians on the need for surgery was lowest with chest radiography alone (kappa=0.33), rose with CT information (kappa=0.44), and increased further with the addition of the FNB data (kappa=0.57). The proportion of successful decisions on surgical intervention (against the known outcome) increased with the addition of CT reports and further with FNB reports (p=0.006, Friedman's test). The major benefit of the information added by CT and FNB reports was a reduction in unnecessary surgery, especially when the clinical perception of pre-test probability of malignancy was intermediate (31-70%). FNB data contributed most to the benefit (p<0.001). The addition of CT and FNB was cost efficient and can be applied specifically to patients with a low or intermediate probability of malignancy. CONCLUSION Both CT and FNB make cost effective contributions to the clinical management of SPN < or = 3 cm in diameter by reducing unnecessary operations and increasing agreement between physicians on the need for surgery.
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Affiliation(s)
- D R Baldwin
- Department of Respiratory Medicine, City Hospital, Nottingham NG5 1PB, UK.
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Abstract
We describe the case of a six-year-old girl who presented with a 3-day history of diplopia and gait disturbance following a febrile flu-like illness. On examination she was found to have ataxia, areflexia and ophthalmoplegia, and a diagnosis of Miller Fisher syndrome was made after the exclusion of other conditions. This report outlines the frequency of Miller Fisher syndrome and lists the differential diagnoses that should be considered in Australia. In addition, the occurrence of pupillary dysfunction is discussed.
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Affiliation(s)
- J Garrett
- Department of Paediatrics, Townsville General Hospital, Townsville, Queensland, Australia.
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45
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Abstract
BACKGROUND Severe life threatening asthma (SLTA) is important in its own right and as a proxy for asthma death. In order to target hospital based intervention strategies to those most likely to benefit, risk factors for SLTA among those admitted to hospital need to be identified. Adverse psychological factors are purported risk factors for asthma death and SLTA /near fatal asthma. A study was undertaken to determine whether, in comparison with patients admitted to hospital with acute asthma, those with SLTA have specific adverse psychological factors. METHODS A case-control study was undertaken. Cases (n=77) were admitted to the intensive care unit with SLTA (mean (SD) pH 7.17 (0.15), PaCO(2) 10.7 (5.0) kPa). Controls (n=239) were admitted to general wards with acute asthma and were matched only by date of index attack. An interviewer administered questionnaire was undertaken 24-48 hours after admission. A random sample of community based asthmatics was recruited to provide normative data on asthmatics for comparison with cases and hospital controls. RESULTS The risk of SLTA increased with age (OR 1.04/year, 95% CI 1.01 to 1.07) and was less for women (OR 0.36, 95% CI 0.20 to 0.68). These variables were controlled for in all further analyses. There was a high prevalence of psychological disorder in both cases and matched controls, but there was no difference in prevalence of caseness for anxiety or depression, total (or individual) life events in last 12 months, availability of general or disease specific social support, nor in any of the domains of the Attitudes and Beliefs about Asthma Questionnaire (emotional (mal) adjustment, doctor-patient relationship, stigma, self-efficacy). Cases (SLTA) were less likely to have had previous emotional counselling (25% v. 35%, p<0.05). However, when comparison was made with a community based group of asthmatic patients, those admitted to hospital with acute asthma (SLTA and hospital controls) had a higher prevalence of anxiety and depression, higher total life events, and higher prevalence of certain specific life events. CONCLUSIONS There was considerable psychological morbidity generally (and anxiety specifically) in those admitted with acute asthma. Specific adverse psychological factors were not risk factors for SLTA, when comparison was made with those admitted to hospital with acute asthma, but adverse psychological factors were a risk factor for hospitalisation for acute asthma (including SLTA). Psychological risk factors for adverse events in asthma are dependent both on the type of event under study and the comparison group used.
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Affiliation(s)
- J Kolbe
- Respiratory Services, Green Lane Hospital, Auckland, New Zealand.
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46
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Davies WD, Jones FD, Garrett J, Hutchinson I, Walton G. Copolymerisable photoinitiators and water-based UV-curable systems. ACTA ACUST UNITED AC 2001. [DOI: 10.1007/bf02700400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pinette MG, Garrett J, Salvo A, Blackstone J, Pinette SG, Boutin N, Cartin A. Normal midtrimester (17-20 weeks) genetic sonogram decreases amniocentesis rate in a high-risk population. J Ultrasound Med 2001; 20:639-644. [PMID: 11400938 DOI: 10.7863/jum.2001.20.6.639] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To evaluate a screening protocol using advanced maternal age, triple-marker screening, and genetic sonography. METHODS We compared adverse chromosomal outcomes of pregnancy in 1556 women referred for increased risk of aneuploidy because of either advanced maternal age or triple-marker test results. Patients were counseled about the results of the triple-marker test and subsequent sonography, which led to a patient decision of whether to pursue amniocentesis. Fetal measurements and structural abnormalities were compared with chromosomal findings. When patients elected amniocentesis, karyotypes were obtained. RESULTS Genetic sonography reduced the rate of amniocentesis by 61% overall and by 40% when compared with an alpha-fetoprotein profile alone. The sensitivity of sonography combined with the triple-marker screen for the detection of trisomy 21 was 87% compared with 91% for the triple-marker screen alone. CONCLUSIONS This study confirmed that sonographic findings in a targeted population, in combination with other risk markers (advanced maternal age and triple-marker screening), can be used to assess the risk of aneuploidy. Biometry provides additional information for assessing the risk of aneuploidy. Combining advanced maternal age, serum triple-marker screening, and sonographic screening may provide better risk prediction for use in clinical counseling.
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Affiliation(s)
- M G Pinette
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland 04102, USA
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Learmonth DA, Benes J, Parada A, Hainzl D, Beliaev A, Bonifácio MJ, Matias PM, Carrondo MA, Garrett J, Soares-da-Silva P. Synthesis, anticonvulsant properties and pharmacokinetic profile of novel 10,11-dihydro-10-oxo-5H-dibenz/b,f/azepine-5-carboxamide derivatives. Eur J Med Chem 2001; 36:227-36. [PMID: 11337101 DOI: 10.1016/s0223-5234(01)01220-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A series of novel derivatives of oxcarbazepine (5), 10,11-dihydro-10-oxo-5H-dibenz/b,f/azepine-5-carboxamide was synthesised and evaluated for their anticonvulsant activity and sodium channel blocking properties. The oxime 8 was found to be the most active compound from this series, displaying greater potency than its geometric isomer 9 and exhibiting also the highest protective index value. Importantly, the metabolic profile of 8 differs from the already established dibenz/b,f/azepine-5-carboxamide drugs such as 1 and 5 which undergo rapid and complete conversion in vivo to several biologically active metabolites. In contrast 8 is metabolised to only a very minor extent leading to the conclusion that the observed anti-convulsant effect is solely attributable to 8. It is concluded that 8 may be as effective as 1 and 5 at controlling seizures and that the low toxicity and consequently high protective index should provide the compound with an improved side-effect profile.
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Affiliation(s)
- D A Learmonth
- Department of Research & Development, Laboratory of Chemistry, BIAL, 4785 S., Mamede do Coronado, Portugal
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Snell GI, Peacock M, Garrett J. Lung volume reduction surgery: the Thoracic Society of Australia and New Zealand. Intern Med J 2001; 31:112-5. [PMID: 11480473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Lung volume reduction surgery involves the removal of emphysematous lung tissue with the aim of palliating symptoms in selected patients with severe emphysema. This form of surgery is being practised in Australia with favourable short-term outcomes, similar to those reported in the literature. Large multicentre trials are currently underway in North America and the United Kingdom to clarify issues of safety and long-term efficacy. As a result, it is too early to apply an evidence-based approach to this procedure. In the meantime, local audits of practice need to be undertaken to define patient subgroups at higher risk of morbidity and mortality.
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Affiliation(s)
- G I Snell
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
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