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Sorensen J, Primdahl NL, Norredam M, Krasnik A. Challenges and Opportunities for Implementing Diversity Competence in a Medical Education Curriculum: A Qualitative Study of Perceptions Among Students and Teachers. J Med Educ Curric Dev 2024; 11:23821205241236593. [PMID: 38444784 PMCID: PMC10913502 DOI: 10.1177/23821205241236593] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES Medical education is under continuous pressure to introduce new curriculum content to ensure that physicians possess the competences that the population needs. Diversity competence (DC) is a relatively new area within medicine, challenging the existing curriculum. Frameworks and guidelines have been developed to provide support and assistance to educators in integrating DC into medical programs. However, integrating DC into curriculum has proven difficult and is therefore still not included in many European medical programs. The purpose of the study is therefore to identify the challenges and opportunities for implementing DC including a focus on migrant and ethnic minorities in a medical education program. METHODS From November 2-20, 2020, focus group discussions with medical students, junior physicians and course leaders were conducted. The participants were recruited via Facebook, newsletters, and emails. Two interview guides were developed and used as guidance for topics to be discussed. The focus group discussions were conducted partly physically and partly digitally. The interviews were transcribed and were analyzed using thematic analysis. RESULTS Three main challenges and opportunities were identified across the focus groups. Challenges: (i) a disparaging discourse about humanistic and social disciplines within the curriculum, (ii) limited levels of DC among teachers, and (iii) need for institutional support. Opportunities: (i) a clear interest in strengthening teachers' DC levels, (ii) incentives for improving the image of humanistic and social medicine, and (iii) relevant courses for implementing DC. CONCLUSION Our results showed that action in this area is needed. The themes identified indicated that there are within the curriculum many opportunities to implement DC, but they also illuminated the challenges. The results suggested both a need for focusing on individual competences for medical teachers and students, and also for organizational change and support in favor of DC training.
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Affiliation(s)
- J Sorensen
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health,
University of Copenhagen, Copenhagen, Denmark
| | - NL Primdahl
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health,
University of Copenhagen, Copenhagen, Denmark
| | - M Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health,
University of Copenhagen, Copenhagen, Denmark
| | - A Krasnik
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health,
University of Copenhagen, Copenhagen, Denmark
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Bhujwalla S, Sorensen J, Carey JJ, Dockery F. 300 ESTABLISHING THE PREVALENCE OF OSTEOPOROTIC FRACTURES IN IRELAND. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.263] [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
Fragility/low-trauma fractures are a major burden on health care, yet many could be prevented through Fracture Liaison Services (FLS). An Irish national FLS database (FLSDB) has recently been established and a reliable estimate of fracture numbers per locality is needed to measure FLS efficiency. Currently the Irish FLSDB uses the UK estimate of 1:4 hip vs. non-hip fracture numbers. We wanted to explore its accuracy in an Irish population.
Methods
We looked at all plain x-ray reports from six individual weeks across two years in our hospital. We selected those aged >50yrs with a reported new fracture. We determined the ratio of hip:non-hip fractures and of those admitted vs. discharged. We cross checked these against admitted fracture numbers from NQAIS (National Quality Assurance Information System) for the same 6 weeks. We then looked at all admissions Irish Emergency Departments during 2018-2019 with a new fracture aged >50yrs. We compared hip:non-hip fracture ratio of these vs. our local data.
Results
From 7,654 x-ray reports, 222 new fracture patients were identified. An additional 29 patients sustained fractures during this time period, either CT/MRI diagnoses or managed as fractures despite negative radiology report. NQAIS missed 21 admitted fractures (uncoded). The ratio admitted:discharged fractures in our audit was 2:3. Ratio of patients with hip:non-hip fractures was 1:9.5. Nationally there were 33,627 fracture patients aged >50y admitted to Irish hospitals in 2018-9, and of these, the hip:non-hip fracture ratio was 1:3. Adding estimated numbers of fracture patients not admitted (based on our local data) gives at least a 1:9 hip:non-hip ratio nationally.
Conclusion
Fracture numbers in Ireland are markedly underestimated if extrapolating from UK estimates. This has implications for service planning for Irish FLS, if rising fracture numbers are to be addressed.
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Affiliation(s)
- S Bhujwalla
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - J Sorensen
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - JJ Carey
- University Hospital Galway , Galway, Ireland
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Sorensen J, Michaëlis C, Møller Olsen JM, Krasnik A, Bozorgmehr K, Ziegler S. Diversity competence: what should be prioritised in an online course? An adapted delphi study. Eur J Public Health 2022. [PMCID: PMC9594172 DOI: 10.1093/eurpub/ckac129.731] [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: 12/03/2022] Open
Abstract
Background Population diversity is a reality in our societies and requires health systems and health professionals to adapt to the needs of diverse patient groups, including migrants and ethnic minorities. This study aims to investigate topics and methods that should be prioritised in an online course on diversity competence in healthcare delivery to improve health care encounters and provide health services that meet the unique needs of all patients in order to reduce health disparities. Methods The study uses an adapted Delphi method including two rounds, combining some open-ended questions with pre-defined items, asking 31 European academic experts and health professionals within the field of migrant health to rate training content and teaching methods. Consensus for training topics was set to 80% and for teaching methods 70%. Results The only item reaching 100% consensus as being important or very important to include was ‘health effects of migration (pre-, mid- and post-migration risk factors)’. Other high-scoring items were ‘social determinants of health’ (97%) and ‘discrimination within the healthcare sector’ (also 97%). A general trend was to focus more on reflective practice since almost all items in the reflection section reached consensus. ‘Reflection on own stereotypes and prejudices’ reached the highest consensus in this section (97%). Conclusions Experts’ prioritisations of teaching content and methods for diversity training can help the design of short online trainings for health professionals and reduce extensive course content, thereby fostering professional development and enabling diversity competence trainings to be implemented in cases of scarce resources. Key messages • Trend toward more focus on ‘diversity’ and less focus on ‘culture, and the inclusion of social determinants of health and awareness of stereotypes and bias in training of health professionals. • Diversity competence training should use reflective exercises and activities as teaching methods in online training.
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Affiliation(s)
- J Sorensen
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen , Copenhagen, Denmark
| | - C Michaëlis
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen , Copenhagen, Denmark
| | - JM Møller Olsen
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen , Copenhagen, Denmark
| | - A Krasnik
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen , Copenhagen, Denmark
| | - K Bozorgmehr
- Department of General Practice and Health Services Research, Heidelberg University Hospital , Heidelberg, Germany
- School of Public Health, University of Bielefeld , Bielefeld, Germany
| | - S Ziegler
- School of Public Health, University of Bielefeld , Bielefeld, Germany
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Abstract
UNLABELLED The authors utilised the Irish Hip Fracture Database (IHFD) to quantify the impact of hip fracture on the health service in terms of incidence, bed days and financial costs. The absolute number of hip fracture cases recorded by the IHFD has increased, as has the associated costs of hospitalisation. INTRODUCTION Hip fracture places a considerable clinical and financial burden on the healthcare system, with acute hospitalisation accounting for a substantial proportion of the costs incurred. This paper aimed to quantify the cost of hospitalisation for hip fracture in Ireland in terms of bed days and direct hospital costs. METHODS The authors analysed 23,494 cases in the Irish Hip Fracture Database (IHFD) from 2014 to 2020. Case numbers and length of stay were analysed annually. Hospital costs for hip fracture were described using the 2020 Activity-Based Funding Price List, which outlines the fees paid to public hospitals for inpatient activity. RESULTS For the time period 2014-2020, the total cost of hospitalisation for hip fracture was approximately €296 million, equating to approximately €11,700 per episode of care. The annual cost of hospitalisation increased from approximately €34 million in 2014 to €44 million in 2020. In 2020, the mean length of stay for hip fracture was 17 days accounting for > 62,600 acute hospital bed days. CONCLUSION The absolute number of hip fracture cases recorded by the IHFD has increased, as has the cost of hospitalisation. Given the current capacity issues and economic constraints, there is a growing need to prioritise time spent in the most expensive acute hospital setting to the immediate perioperative period and maximise the use of community services and early supportive discharge for the rehabilitation phase.
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Affiliation(s)
- H Ferris
- Department of Public Health, Health Service Executive-South, Cork, Ireland.
| | - L Brent
- National Office of Clinical Audit, Dublin, Ireland
| | - J Sorensen
- Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Hoegh S, Thellesen L, Bergholt T, Rom A, Johansen M, Sorensen J. 425 How often will midwives and obstetricians experience obstetric emergencies or high-risk deliveries: A national cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Galvin R, Burton E, Cummins V, O'Sullivan M, Swan L, Doyle F, Sorensen J, Skelton DA, Townley B, Rooney D, Jackson G, Warters A, Horgan NF. 255 A QUALITATIVE STUDY OF OLDER ADULTS’ EXPERIENCES OF EMBEDDING PHYSICAL ACTIVITY WITHIN THEIR HOME CARE SERVICES. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.255] [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: 02/25/2023] Open
Abstract
Abstract
Background
Physical activity programmes have been shown to improve older adults’ functional capacity, independence and quality of life. Research around structured exercise programmes has been completed in different groups of community-dwelling older people, however few studies have focused on the older population receiving formal home care. In a feasibility study, we embedded physical activity within older adults existing home care services through the ‘Care to Move’ (CTM) programme. The aim of this qualitative study is to explore older adults’ experiences of the CTM programme.
Methods
We conducted semi-structured telephone interviews with 13 older adults and one carer. Topics covered included participants overall experiences of the CTM programme, changes to their overall activity and participation, aspects of the programme that they liked or found valuable and issues that they found challenging. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery.
Results
Four themes emerged: i) ‘I’m feeling good about it’, ii) ‘safety and security is the name of the game’, iii) ‘we’re a team as it stands’, iv) ‘it’s [COVID] depressing for everybody at the moment’. Older adults identified benefits of CTM participation including improvements in physical and psychological wellbeing. However, frailty and multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of programme delivery and competing healthcare assistant (HCA) interests. The broader role of HCA’s in supporting the CTM programme was highlighted as well as the emotional support that HCAs provided to older adults. HCA continuity was identified as a barrier to ongoing programme engagement. The impact of COVID on older adults physical and mental health negatively impacted programme delivery.
Conclusion
Our findings suggest that embedding the CTM programme within home support services is feasible. Restructuring of services, addressing HCA continuity, and adopting individual approaches to programme delivery may enhance the implementation of services.
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Affiliation(s)
- R Galvin
- School of Allied Health , Ageing Research Centre, , Limerick, Ireland
- University of Limerick , Ageing Research Centre, , Limerick, Ireland
| | - E Burton
- School of Physiotherapy and Exercise Science, Curtin University , Perth, Australia
| | - V Cummins
- Primary Care Physiotherapy Services CHO9, Health Service Executive , Dublin, Ireland
| | - M O'Sullivan
- Department of Clinical Medicine, Trinity College Dublin , Dublin, Ireland
| | - L Swan
- Department of Clinical Medicine, Trinity College Dublin , Dublin, Ireland
| | - F Doyle
- Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland , Dublin, Ireland
| | - J Sorensen
- 7Health Outcomes Research Centre (HORC), Royal College of Surgeons in Ireland , Dublin, Ireland
| | - D A Skelton
- School of Health and Life Sciences, Galsgow Caledonian University , Glasgow, United Kingdom
- Later Life Training , Northumberland, United Kingdom
| | - B Townley
- Later Life Training , Northumberland, United Kingdom
| | - D Rooney
- North Dublin Home Care (NDHC) , Dublin, Ireland
| | - G Jackson
- North Dublin Home Care (NDHC) , Dublin, Ireland
| | - A Warters
- Older Person Services CHO9, Health Service Executive , Dublin, Ireland
| | - N F Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland , Dublin, Ireland
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Swan L, Horgan F, Cummins V, Doyle F, Galvin R, Burton E, Sorensen J, Jabakhanji SB, Skelton D, Townley B, Rooney D, Jackson G, Murphy L, Warters A, O'Sullivan M. 199 EMBEDDING PHYSICAL ACTIVITY WITHIN HOME CARE SERVICES FOR OLDER ADULTS IN IRELAND—A QUALITATIVE STUDY OF BARRIERS AND FACILITATORS. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.199] [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: 02/25/2023] Open
Abstract
Abstract
Background
In Ireland, over 53,000 older adults are supported in their community by formal home support, amounting to an estimated 19 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the ‘Care to Move’ (CTM) programme through existing home support services. The aim of the present qualitative study was to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in, and delivered the CTM programme.
Methods
We conducted semi-structured telephone interviews with 22 HCAs involved in the delivery of the programme among older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery.
Results
Barriers and facilitators were identified under three main themes i) the programme ii) the care setting, iii) the clients. Overall, there was a positive perception of the programme’s focus on ‘movement prompts and motivators’, the ‘fit’ within home support services, and the training provided. Practical challenges of limited time and the task-orientation nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the programme for their clients. Though negative perceptions of older adult’s motivation or ability to engage with physical activity also emerged. Risk, such as injury or pain, was identified but was not a dominant theme.
Conclusion
Our preliminary findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional ‘task-oriented' care models to more personalised proactive approaches may facilitate this initiative and support ageing in place.
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Affiliation(s)
- L Swan
- Trinity College Dublin , Dublin, Ireland
| | - F Horgan
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - V Cummins
- Health Service Executive , Dublin, Ireland
| | - F Doyle
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - R Galvin
- University of Limerick , Limerick, Ireland
| | - E Burton
- Curtin University , Curtin, Australia
| | - J Sorensen
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | | | - D Skelton
- Glasgow Caledonian University , Glasglow, United Kingdom
- Later Life Training, Northumberland , United Kingdom
| | - B Townley
- Later Life Training, Northumberland , United Kingdom
| | - D Rooney
- North Dublin Home Care , Dublin, Ireland
| | - G Jackson
- North Dublin Home Care , Dublin, Ireland
| | - L Murphy
- North Dublin Home Care , Dublin, Ireland
| | - A Warters
- Health Service Executive , Dublin, Ireland
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Sorensen J, Langer Primdahl N, Nørredam M, Krasnik A. Implementing a diversity sensitive curriculum in medical education – challenges and potentials. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Migrant and ethnic minority populations in Europe are growing, consequently increasing the need for the health systems and health educations to adapt to an increasingly diverse population with diverse needs. Improving health professionals' diversity competences has been proposed as one of the solutions to tackle inequalities in health between different ethnic groups and ensure that all patients receive the care that they need. The objective of this study was therefore to investigate potentials and challenges for implementing diversity competences in medical teaching programmes.
Methods
Four focus groups interviews and one individual interview was conducted with three groups of stakeholders: medical students, course leaders and newly graduated medical physicians. The focus group and individual interviews were conducted physically and digital and one focus group used both. The interviews had a duration between 30-90 minutes and informed consent was obtained from all participants. The data was transcribed and were coded using content analysis.
Results
6 main themes and 14 sub-themes were identified in the analyses. One theme indicated that there was a general wish for more focus on diversity competences in the curriculum. Other themes pointed to challenges regarding competing priorities in the context of medical education, a condescending discourse about social and humanistic medicine and lack of support to medical students regarding challenges in relation to migrant and ethnic minority patients in the clinical settings. Another major theme focused on medical teachers' challenges when teaching a diverse classroom.
Conclusions
Our results showed that action in this area is needed. The themes indicated that many opportunities to implement diversity competence in curriculum exist, but also illuminated the challenges. The results suggested a need for focusing on individual competences for medical teachers and students, but also for organisational change.
Key messages
A widespread interest for implementing diversity competence in curriculum, but competence development for teachers is also needed. Important to focus on individual competences, but also on organisational change.
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Affiliation(s)
- J Sorensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - N Langer Primdahl
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Nørredam
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Krasnik
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Sorensen J, Bergsten J, Baron T, Orndahl LH, Kero T, Bjerner T, Hedin E, Harms HJ, Flacshkampf FA. Myocardial efficiency in severe asymptomatic primary mitral regurgitation: relation to quantitative measures of regurgitation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To study the association of myocardial external efficiency (MEE) in mitral regurgitation (MR) towards routinely used quantitative indicators of disease severity and progression.
Background
Quantitative assessment of LV function and regurgitation in asymptomatic severe primary MR is crucial for management. MEE is a load-independent indicator of mechano-energetic coupling and can be measured non-invasively using 11C-acetate positron emission tomography (PET). The role of MEE in this setting has not been studied.
Methods
48 asymptomatic patients with severe primary mitral regurgitation underwent PET, echo, and CMR on the same day. MEE was automatically derived from PET as the ratio of cardiac work (cardiac output * mean arterial pressure) and total left ventricular (LV) oxygen consumption (mean MVO2 * LV mass). LV function and mitral regurgitant volumes (RegVol) were measured by echo and CMR. MEE in MR was compared to healthy volunteers (n=9). MEE and parameters of regurgitation severity and of LV volumes and function were studied as predictors of outcome (valve surgery or death).
Results
MEE was reduced in MR (21.5±4.2%) vs healthy volunteers (32.0±5.6%, p<0.001) and showed weak but significant correlations (r2<0.25) with regurgitation severity and LV volumes. There were 23 cardiac events (valve surgery: 22; cardiovascular death: 1) during follow-up (median 2.7 years, IQR 1.9–3.2). Univariate Cox models showed that MEE, echocardiographic left atrial volume as well as RegVol and LV ventricular volumes from both echo and CMR were significant outcome predictors (all p<0.05), while LVEF and NT-pro-BNP were not (p>0.05). Prediction by MEE was not affected by age, sex or BMI. When categorically divided by the median MEE was a strong predictor in Kaplan-Meier analysis (log-rank p=0.0004, figure 1) and remained independently significant, compared to all other univariate predictors in bivariate Cox models.
Conclusions
This study suggests an important role of energetic insufficiency in progression of asymptomatic severe primary MR. Reduced MEE was linked to outcome independently of standard functional measures of regurgitation severity or left ventricular size and function. Strategies for improvement of myocardial energetics in MR are warranted.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Heart-Lung Foundation Figure 1
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Affiliation(s)
- J Sorensen
- Uppsala University, Surgical Sciences, Nuclear Medicine, Uppsala, Sweden
| | - J Bergsten
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - T Baron
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - L H Orndahl
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - T Kero
- Uppsala University, Surgical Sciences, Nuclear Medicine, Uppsala, Sweden
| | | | - E Hedin
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - H J Harms
- Uppsala University, Surgical Sciences, Nuclear Medicine, Uppsala, Sweden
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Hansen KB, Sorensen J, Hansson NH, Nielsen R, Larsen AH, Frokiaer J, Tolbod LP, Gormsen LC, Harms HJ, Wiggers H. Mechanoenergetic coupling in heart failure with preserved, mid-range and reduced left ventricular ejection fraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0271] [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
Heart failure (HF) classification based on left ventricular ejection fraction (LVEF) can vary because of changes in filling pressures, afterload, and contractile function. 11C-acetate positron emission tomography (PET) provides a load-independent measure of myocardial external efficiency (MEE) by simultaneous assessment of myocardial oxygen consumption (MVO2), cardiac work, left ventricular mass (LVM), end-systolic wall stress (ESWS), and myocardial blood flow (MBF).
Purpose
We aimed to characterize mechanoenergetic derangements in patients with HF and to study its interrelation with age, sex and obesity.
Methods
MEE was measured in 121 participants with 11C-acetate PET, and LVEF was acquired with echocardiography. We investigated healthy controls (n=20) and patients with HF and reduced LVEF <40% (HFrEF; n=25), mid-range LVEF 40–49% (HFmrEF; n=23), as well as patients with asymptomatic aortic valve stenosis (AS) and LVEF ≥50% (AS-asymp; n=38), and symptomatic AS and LVEF ≥50% (defined as HF with preserved LVEF (HFpEF); n=15).
Results
MEE declined in tandem with reduced LVEF from HFpEF and HFmrEF to HFrEF (p=0.041, p<0.001, and p<0.001 versus control, respectively; Figure 1). Impaired MEE was aggravated with increasing LVM (p=0.001) due to a disproportionate increase in overall left ventricular MVO2. In a multivariate analysis, female sex (p<0.001), a lower body mass index (p<0.001), and advanced age (p=0.01) were associated with a lower MEE (Figure 2). HFpEF, HFmrEF, and HFrEF patients had distinct energetic profiles involving MEE, MVO2, MBF, ESWS, and LVM (Figure 2).
Conclusions
Mechanoenergetic uncoupling was evident in every clinical state within the HF syndrome and associated with left ventricular hypertrophy and progressive systolic dysfunction. Sex, age, and obesity impacted myocardial energetics. To date, the present study is the largest investigation of mechanoenergetic coupling across several categories of patients with heart failure. 11C-acetate PET extends our pathophysiological comprehension of the HF syndrome beyond LVEF.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart FoundationThe Lundbeck Foundation Relationship between LVEF and MEEMyocardial energetics in heart failure
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Affiliation(s)
- K B Hansen
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - J Sorensen
- Uppsala University, Department of Surgical Sciences, Nuclear Medicine, Uppsala, Sweden
| | - N H Hansson
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - R Nielsen
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - A H Larsen
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - J Frokiaer
- Aarhus University, Department of Clinical Medicine, Faculty of Health, Aarhus, Denmark
| | - L P Tolbod
- Aarhus University Hospital, Department of Nuclear Medicine & PET Centre, Aarhus, Denmark
| | - L C Gormsen
- Aarhus University Hospital, Department of Nuclear Medicine & PET Centre, Aarhus, Denmark
| | - H J Harms
- Aarhus University Hospital, Department of Nuclear Medicine & PET Centre, Aarhus, Denmark
| | - H Wiggers
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
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Lavretsky P, Duenez E, Sorensen J. Population genetics and conservation of recently discovered springsnails in Arizona. J Molluscan Stud 2021; 87:eyab020. [PMID: 34276251 PMCID: PMC8275448 DOI: 10.1093/mollus/eyab020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Indexed: 06/13/2023]
Abstract
Establishing baseline geographical distributions of extant genetic diversity is increasingly important for future conservation efforts of freshwater species. We analyse the mitochondrial cytochrome c oxidase subunit I (COI) gene to taxonomically characterize 233 samples from recently discovered springsnail populations throughout 17 sites in Arizona, USA. A total of 28 unique COI haplotypes were recovered, with the number of haplotypes ranging from 1 to 4 by population in Arizona. Phylogenetic analyses resulted in haplotypes from 13 of 17 locations in Arizona being successfully identified to species, with five described and three undescribed species in the genus Pyrgulopsis (Hydrobiidae). Future work will require in-depth morphological work to clarify the taxonomic status of these putatively novel species. Importantly, among recovered species, we identified haplotype diversity of the critically endangered Three Forks springsnail, Pyrgulopsis trivialis, in the eastern Gila watershed, which will inform wildlife managers in deciding which source populations to use in reintroduction efforts. We discuss possible causes for observed population structure of Arizona's springsnail populations, with suggestions for the future sampling schemes necessary for the conservation of this uniquely important freshwater mollusc.
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Affiliation(s)
| | - Esmeralda Duenez
- Department of Biological Sciences, University of Texas at El Paso, El Paso, TX 79668, USA
| | - Jeffrey Sorensen
- Arizona Game and Fish Department, 5000 West Carefree Highway, Phoenix, AZ 85086, USA
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Ferris H, Brent L, Sorensen J, Ahern E, Coughlan T. Discharge destination after hip fracture: findings from the Irish hip fracture database. Eur Geriatr Med 2021; 13:415-424. [PMID: 34420192 DOI: 10.1007/s41999-021-00556-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Although home continues to be the place from which the majority of patients are admitted, less than one third of patients are Discharged Directly Home (DDH) following hip fracture. Once ready for discharge, DDH as opposed to Discharge to an Alternative Location (DAL), i.e., community care, rehabilitation facility or long-term care, is a high priority for patients and clinicians alike. Not only is DDH integral to the quality of life of patients, it is also an essential driver of the socioeconomic cost of hip fracture care. METHODS We analysed 21,819 cases in the Irish Hip Fracture Database from 2013 to 2019. Descriptive and analytical statistics were conducted. RESULTS 29% (n = 6476) of patients were DDH during the study period. On multivariate analysis, the odds of DDH decreased as age increased (OR 0.28, p < 0.01, 95% CI 0.24-0.34). Patients who were independently mobile prior to fracture were 47% more likely to be DDH (OR 1.47, p < 0.01, 95% CI 1.29-1.68). Those mobilised early post operatively were 24% more likely to be DDH (OR 1.24, p < 0.01, 95% CI 1.06-1.45). Patients who waited > 72 h prior to surgery were 30% less likely to be DDH (OR 0.70, p < 0.01, 95% CI 0.56-0.88). CONCLUSION The authors identified patient characteristics that increased the likelihood of DDH, i.e., younger patients independently mobile prior to fracture, who received timely surgery and early post-operative mobilisation. The Irish Hip Fracture Standards (IHFS) incorporate 2 out the 3 modifiable factors identified, which reinforces the importance of the IHFS in improving patient outcomes.
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Affiliation(s)
- H Ferris
- Department of Public Health, Health Service Executive - South, Cork, Ireland.
| | - L Brent
- National Office of Clinical Audit, Dublin, Ireland
| | - J Sorensen
- Healthcare Outcomes Centre, Royal College of Surgeons, Dublin, Ireland
| | - E Ahern
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - T Coughlan
- Department of Age Related Health Care, Tallaght University Hospital, Dublin, Ireland
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Lindstrom E, Dahlgren D, Mehic A, Sigfridsson J, Kero T, Sorensen J, Harms HJ, Lubberink M. Myocardial blood flow values based on 15O-water PET are insensitive to image reconstruction settings. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
For 15O-water PET, a cutoff hyperemic myocardial blood flow (MBF) value of 2.3 mL/g/min for significant ischemia has been established (1). For other tracers, different studies show a wide range of proposed cutoff values. The use of uniform absolute cutoff values for pathological hyperemic MBF or flow reserve in clinical decision making requires robust quantification of MBF, with comparable values across scanners, centres, and reconstruction methods.
Purpose
The aim of the present work was to assess the effect of different reconstruction methods on quantitative MBF values based on 15O-water PET.
Methods 20 patients referred for assessment of ischemia underwent 4 min dynamic stress PET scans starting simultaneously with automated bolus injection of 400 MBq 15O-water on a digital PET/CT scanner. Images were reconstructed using 17 different reconstruction methods, with the clinical reconstruction used as reference: time-of-flight (TOF) ordered subsets expectation maximization (OSEM) with 3 iterations and 16 subsets, including point spread function recovery (PSF) and a 5 mm gaussian post-filter. Parameters that were varied were number of iterations (1-6), filter (3, 5 or 8 mm), exclusion of TOF and PSF, and using regularized reconstruction with 7 different values of the regularization parameter beta. Images were analyzed fully automatically using aQuant software, resulting in parametric MBF images and polar maps as well as regional MBF values. Correlation and agreement of MBF values based on each reconstruction were compared using regression and Bland-Altman analysis as well as Wilcoxon tests.
Results
Whole left ventricle MBF values ranged from 1.1 to 3.9 mL/g/min. Visually, there were only small differences in MBF images or polar maps between methods (Figure 1). Correlation between whole left ventricle MBF values based on the various reconstruction algorithms was high (r > 0.99). At the regional level, correlation coefficients were always > 0.94 (Figure 2). No significant bias was found between any of the reconstruction methods and the standard method (p > 0.65). Regression slopes relative to the standard method ranged from 0.993 to 1.080. Changes in reconstruction settings did not alter diagnosis in any patient.
Conclusion
Changes in reconstruction settings such as filter size, number of iterations, inclusion of time-of-flight or resolution recovery, and regularization, have negligible impact on MBF values based on 15O-water PET analyzed using the automated software. This is likely due to the fact that MBF is determined by the clearance rate of 15O-water rather than its uptake rate such as for other PET tracers, in addition to the used segmentation routines. These results also indicate that quantitative MBF measurements using 15O-water are likely to be robust across different types of PET scanners and hospitals, which is highly important for reliable clinical use of cut-off values for ischemia.
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Affiliation(s)
| | | | - A Mehic
- Uppsala University, Uppsala, Sweden
| | | | - T Kero
- Uppsala University, Uppsala, Sweden
| | | | - HJ Harms
- Aarhus University, Aarhus, Denmark
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Doyle F, Freedland KE, Carney RM, De Jonge P, Dickens C, Pedersen S, Sorensen J, Dempster M. Systematic review and network meta-analysis of randomised controlled trials of interventions for depressive symptoms in patients with coronary artery disease. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.184] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Objective
Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy.
Methods
We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8-weeks post-treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random effects network meta-analysis synthesized the evidence. GRADE was used to assess evidence quality.
Results
Thirty-three RCTs (7240 participants) provided analysable data. All treatments were equally acceptable. At 8-weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26-weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. GRADE ratings ranged from very low to low.
Conclusions
All treatments were equally acceptable, while antidepressants appeared to have the most robust evidence base for post-CAD depression. The evidence base was limited and biased; conclusions based on this literature should be drawn cautiously and considered to be tentative. Rigorous, multi-arm intervention trials, including trials of combination therapies and exercise, are urgently needed.
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Affiliation(s)
- F Doyle
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - KE Freedland
- Washington University School of Medicine, St Louis, United States of America
| | - RM Carney
- Washington University School of Medicine, St Louis, United States of America
| | - P De Jonge
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - C Dickens
- University of Exeter, Exeter, United Kingdom of Great Britain & Northern Ireland
| | - S Pedersen
- University of Southern Denmark, Odense, Denmark
| | - J Sorensen
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Dempster
- Queen"s University of Belfast, Belfast, United Kingdom of Great Britain & Northern Ireland
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Keelan S, Sorensen J, Downey E, Hegarty A, Nelson T, Duke D, Power C, Hill A. O30: EVALUATION OF AXILLARY LYMPH NODE METASTATIC BURDEN BY PREOPERATIVE ULTRASOUND. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.030] [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
Introduction
Sentinel lymph node biopsy (SLNB) is the gold standard for determining axillary nodal status. There is growing interest in using preoperative axillary ultrasound (AUS) as a non-invasive means of assessing the axilla. However, AUS has limited sensitivity and is subject to operator dependency. This study aimed to quantify axillary nodal burden in preoperative AUS.
Method
This retrospective study used an institutional database of all primary invasive breast carcinomas from 2006–2019. Those with pathologically proven axillary metastatic disease were included. Patients were considered in two groups, low nodal burden/LNB(1-2LN) and high nodal burden/HNB(≥3LN) based on total positive lymph node count(SLNB+ALND). Preoperative AUS reports were assessed to determine those suspicious for axillary metastasis.
Result
Of the 347 patients (n=349 axillae), 77.9% had LNB and 22.1% had HNB. In patients with LNB, 228(83.8%) had a normal AUS versus 44(16.2%) suspicious AUS. In those with HNB 60(77.9%) had normal AUS findings versus 17(22.1%) suspicious findings. On multivariate analysis Nottingham Grade-3 was associated with suspicious AUS findings (p=0.02). However, receptor status, SLN macro-metastasis and extra-nodal extension were not associated with abnormal AUS.
Conclusion
As the surgical approach to the axilla becomes increasingly conservative, detection of axillary involvement by non-invasive means is an area of increasing research. In this cohort, AUS did not reliably identify patients with axillary metastasis. These results highlight the challenges in accurately assessing the axilla using preoperative AUS, which may result in axillary undertreatment if used as an alternative to surgical staging.
Take-home message
As the surgical approach to the axilla becomes increasingly conservative, detection of axillary involvement by non-invasive means is an area of increasing research. This study highlights the challenges in accurately assessing the axilla using preoperative AUS, which may result in axillary undertreatment if used as an alternative to surgical staging.
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Affiliation(s)
- S Keelan
- Department of Surgery, Royal College of Surgeons in Ireland, Department of Surgery, 123 St Stephen's Green, Dublin, D02 YN77
| | - J Sorensen
- Royal College of Surgeons in Ireland, Department of Surgery, Healthcare Outcomes Research Centre (HORC), Beaux Lane House, Mercer Street Lower, Dublin 2
| | - E Downey
- Department of Surgery, Royal College of Surgeons in Ireland, Department of Surgery, 123 St Stephen's Green, Dublin, D02 YN77
| | - A Hegarty
- Department of Surgery, Royal College of Surgeons in Ireland, Department of Surgery, 123 St Stephen's Green, Dublin, D02 YN77
| | - T Nelson
- Department of Surgery, Royal College of Surgeons in Ireland, Department of Surgery, 123 St Stephen's Green, Dublin, D02 YN77
| | - D Duke
- Beaumont Hospital P.O. Box 1297, Beaumont Road, Dublin 9, Ireland
| | - C Power
- Beaumont Hospital P.O. Box 1297, Beaumont Road, Dublin 9, Ireland
| | - A Hill
- Department of Surgery, Royal College of Surgeons in Ireland, Department of Surgery, 123 St Stephen's Green, Dublin, D02 YN77
- Beaumont Hospital P.O. Box 1297, Beaumont Road, Dublin 9, Ireland
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Walsh ME, Ferris H, Coughlan T, Hurson C, Ahern E, Sorensen J, Brent L. Trends in hip fracture care in the Republic of Ireland from 2013 to 2018: results from the Irish Hip Fracture Database. Osteoporos Int 2021; 32:727-736. [PMID: 32997154 DOI: 10.1007/s00198-020-05636-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/09/2020] [Indexed: 01/08/2023]
Abstract
UNLABELLED Hip fractures continue to be one of the most serious and costly injuries suffered by older people globally. This paper describes the development of a national hip fracture audit and summarises the first 6 years of data from the Republic of Ireland. This can help inform care, standards and outcomes of hip fracture patients. INTRODUCTION Ireland has one of the highest standardised rates of hip fracture in the world behind northern European countries. The Irish Hip Fracture Database (IHFD) was established in 2012 to drive clinical and organisational improvements in quality and effectiveness of hip fracture care. This paper describes the progression of the IHFD between 2013 and 2018 and identifies trends and areas for improvement. METHODS The IHFD is a clinically led, web-based audit, with data collected through the national Hospital Inpatient Enquiry (HIPE) electronic system, the principal source of information from publicly funded acute hospitals in Ireland. Eligible cases are aged ≥ 60 years with hip fracture as defined by IHFD or with other specified hip fracture excluding periprosthetic fractures. As of 2015, all 16 trauma-receiving hospitals within Ireland submitted data. Demographics and adherence to six national quality standards are described. RESULTS A total of 17,983 cases were included in the analysis. National coverage has increased from 63% in 2013 to 99% in 2018. Demographic characteristics are unchanged, but higher levels of comorbidity are seen. Internal fixation and hemiarthroplasty are the most common modes of surgical repair with two-thirds of cases receiving spinal rather than general anaesthesia. Increasingly patients are being assessed by a geriatrician (11% in 2013 to 69% in 2018) and receive a bone health assessment (65% in 2013 to 84% in 2018). CONCLUSION While some hip fracture standards have improved, further improvements are required to compare favourably internationally. Reduction of surgical delay and ensuring early mobilisation post-operatively are immediate priorities for the IHFD.
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Affiliation(s)
- M E Walsh
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - H Ferris
- Department of Public Health, HSE South, St. Finbarr's Hospital, Cork, Ireland
- Strategic Planning and Transformation, Department of Public Health, Mount Kennett House, Henry St, Limerick, Ireland
| | - T Coughlan
- Department of Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Dublin 2, Ireland
| | - C Hurson
- Department of Trauma and Orthopaedics, St Vincent's University Hospital, Dublin, Dublin 4, Ireland
| | - E Ahern
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - J Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - L Brent
- National Office of Clinical Audit, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Olson J, Hersh AL, Sorensen J, Zobell J, Anderson C, Thorell EA. Intravenous Vancomycin Therapeutic Drug Monitoring in Children: Evaluation of a Pharmacy-Driven Protocol and Collaborative Practice Agreement. J Pediatric Infect Dis Soc 2020; 9:334-341. [PMID: 31344233 DOI: 10.1093/jpids/piz036] [Citation(s) in RCA: 11] [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] [Received: 01/21/2019] [Accepted: 05/03/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vancomycin optimization is challenging, requiring careful therapeutic drug monitoring (TDM) to avoid toxicity and ensure an efficacious concentration. Most prescriptions are empiric and often discontinued within 72 hours, which makes early TDM unnecessary. Although TDM using trough levels is common, the area under the concentration-time curve (AUC) is the preferred pharmacodynamic target. We studied the effect of a pharmacy-driven vancomycin collaborative practice agreement (CPA) at a children's hospital that delayed TDM up to 72 hours and targeted a 2-point 24-hour AUC of ≥400 mg × h/L. METHODS We retrospectively reviewed vancomycin courses in patients aged ≥30 days who received vancomycin between April 1, 2011, and August 30, 2017. We implemented the CPA on June 1, 2014. Outcomes included CPA use, use of TDM, dosage adjustments, and development of acute kidney injury; we compared courses given while monitoring only trough levels (TO-TDM) with those given while using the CPA (AUC-TDM). We performed interrupted time series analyses to account for preintervention trends. RESULTS We included 2379 courses in the TO-TDM period and 2155 in the AUC-TDM period. During AUC-TDM, 87% of the courses were managed by the CPA. In adjusted interrupted time series analyses, CPA implementation was associated with an initial change in level of -0.265 (95% confidence interval [CI], -0.336 to -0.189) TDM and an initial change in level of -0.332 (95% CI, -0.506 to -0.163) dosage adjustments. The 1-year risk of acute kidney injury decreased after CPA implementation (odds ratio, 0.695 [95% CI, 0.539-0.91]). CONCLUSION The pharmacy-driven vancomycin CPA resulted in less monitoring and fewer dose adjustments without increasing AKI.
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Affiliation(s)
- Jared Olson
- Department of Pharmacy, Primary Children's Hospital, Salt Lake City, Utah.,Division of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City
| | - Adam L Hersh
- Division of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City
| | - Jeffrey Sorensen
- Division of Pulmonary and Critical Care, Intermountain Medical Center, Murray, Utah
| | - Jeffrey Zobell
- Department of Pharmacy, Primary Children's Hospital, Salt Lake City, Utah
| | - Collin Anderson
- Department of Pharmacy, Primary Children's Hospital, Salt Lake City, Utah
| | - Emily A Thorell
- Division of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City
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18
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Mealy A, Sorensen J. Effects of an aging population on hospital costs related to elective hip replacements. Public Health 2019; 180:10-16. [PMID: 31835140 DOI: 10.1016/j.puhe.2019.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/17/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Elective hip replacement is a common procedure for elderly people with osteoarthrosis. With more elderly people in the future, the demand for hip replacements will increase and put additional constraints on hospital services. The objective was to explore the future need for hip replacements and related costs and to investigate if anticipated future efficiency gains might alleviate the strain of increased demand. STUDY DESIGN Registry-based modelling study. METHODS Data were obtained from the Irish Central Statistics Office and the national Hospital Inpatient Enquiry system for 2011-2017. We estimated the future demand for hip replacements each year until 2051 and analysed changes in hip replacement rates and the average length of stay. These assumptions were used in our projections. RESULTS Assuming no change in procedure rates, the annual cost of providing elective hip replacements is expected to increase by 1060 (30%) episodes in 2026 which implies a cost increment of €16M (33%) (vs 2017-level). If the historical increase in the procedure rate is assumed, the cost will increase by €33M (67%). If the observed reduction in length of stay can be maintained, costs will reduce by €14M (29.0%). Such a cost saving may alleviate the effect of the demographic changes and observed increases in procedure rates. CONCLUSIONS Steady-state assumptions are unrealistic and efficiency gains can alleviate future pressure from population growth. However, this analysis has not addressed the present insufficient capacity of public hospitals to meet population needs, as judged by waiting lists and transfers to private hospitals.
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Affiliation(s)
- A Mealy
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, 2, Ireland
| | - J Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, 2, Ireland.
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Baron T, Holm Orndahl L, Kero T, Sorensen J, Bjerner T, Hedin EM, Harms HJ, Stahle E, Astudillo R, Flachskampf FA. P1779Quantitation of severe degenerative mitral regurgitation by echocardiography and CMR with acetate PET for external reference for left ventricular volumes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0531] [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
Quantitative echocardiographic assessment of severity of primary mitral regurgitation (MR) is challenging. CMR is recommended if MR severity cannot be clearly determined, since quantitation of regurgitation as well as of left ventricular (LV) volumes and function is crucial for the indication for surgery especially in asymptomatic patients.
Purpose
We aimed to compare volumetric measurements obtained from transthoracic echo (TTE) and cardiovascular magnetic resonance (CMR) using ECG-gated [(11)C]acetate PET as reference for assessment of LV volumes.
Methods
A total of 51 asymptomatic patients with severe primary mitral regurgitation underwent TTE, CMR and PET on the same day. Mitral regurgitant volumes (RVol) were measured by TTE using proximal convergence (PISA) method and by CMR, subtracting aortic forward flow volume from LV stroke volume. LV volumes were measured by TTE, CMR and PET.
Results
Despite a fair correlation between regurgitant volumes measured by TTE and CMR (r=0.53, p<0.001), PISA method heavily overestimated regurgitant volumes on TTE as compared to CMR (103±60ml vs. 78±35ml, p<0.001). TTE systematically underestimated LV volumes as compared to CMR (see table) despite a good correlation (r=0.81, 0.67 and 0.76 respective for LV EDV, ESV and SV, p<0.001 for all). There was no difference in LV EF between the methods. LV volumes obtained by CMR and PET showed a strong correlation (r=0.92, 0.79 and 0.89 respective for LV EDV, ESV and SV, p<0.001 for all) and agreement (see table).
Comparison of TTE, CMR and PET TTE CMR PET PET TTEvs.CMR PET CMRvs.PET F-test LV EDV, ml 145±34 241±57 234±51 <0.001 0.004 <0.001 LV ESV, ml 47±11 76±22 81±23 <0.001 0.067 <0.001L LV SV, ml 99±26 164±38 152±34 <0.001 <0.001 <0.001 LV EF, % 68±5 69±5 65±6 0.236 <0.001 <0.001
Conclusions
As compared to CMR, PISA method used by TTE substantially overestimates regurgitant volumes in patients with asymptomatic primary mitral regurgitation. Conversely, LV volumes in spite of good correlation are heavily underestimated by TTE in comparison with CMR. A strong correlation and agreement between LV volumes measured by CMR and PET confirms the accuracy of the former method which is considered as a golden standard for assessment of ventricular function and volumes. Thus, even so-called quantitative echo measures should be understoas essentially semi-quantitative indicators of severity.
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Affiliation(s)
- T Baron
- Uppsala University, Dept. of Medical Sciences, Cardiology and Clinical Physiology, Uppsala, Sweden
| | - L Holm Orndahl
- Uppsala University, Dept. of Medical Sciences, Cardiology and Clinical Physiology, Uppsala, Sweden
| | - T Kero
- Uppsala University, Dept. of Surgical Sciences, Radiology, Uppsala, Sweden
| | - J Sorensen
- Uppsala University, Dept. of Surgical Sciences, Radiology, Uppsala, Sweden
| | - T Bjerner
- Uppsala University, Dept. of Surgical Sciences, Radiology, Uppsala, Sweden
| | - E.-M Hedin
- Uppsala University, Dept. of Medical Sciences, Cardiology and Clinical Physiology, Uppsala, Sweden
| | - H J Harms
- Aarhus University Hospital, Dept. of Nuclear Medicine & PET Centre, Aarhus, Denmark
| | - E Stahle
- Uppsala University, Dept. of Surgical Sciences, Thoracic surgery, Uppsala, Sweden
| | - R Astudillo
- Uppsala University, Dept. of Surgical Sciences, Thoracic surgery, Uppsala, Sweden
| | - F A Flachskampf
- Uppsala University, Dept. of Medical Sciences, Cardiology and Clinical Physiology, Uppsala, Sweden
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Nordstrom J, Magnusson P, Harms H, Lubberink M, Morner S, Sorensen J. P3361Pathophysiology measured with positron emission tomography is equally impaired in hypertrophic and non-hypertrophic regions in hypertrophic cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Hypertrophic cardiomyopathy (HCM) is a heterogeneous disease with regard to clinical manifestations. It is characterized by an asymmetric pattern of hypertrophy of the left ventricle. However, less is known about pathophysiological distribution of the abnormalities. Positron emission tomography (PET) provides quantitative assessment of myocardial blood flow (MBF), oxidative metabolism, and sympathetic innervation using the following tracers: 15O-water, 11C-acetate, and 11C-HED.
Purpose
The purpose of the present study was to investigate if physiological parameters measured with PET are more impaired in hypertrophic regions compared to non-hypertrophic regions.
Methods
We examined 25 HCM patients using a Discovery MI PET/CT with 15O-water, 11C-acetate, and 11C-HED. Wall thickness (WT) was calculated from the 11C-acetate scan for basal and mid segments (n=12) in the 17-segment model and hypertrophic regions were defined as segments >15 mm. 15O-water PET was performed during rest and adenosine induced stress. Quantification of MBF, oxygen consumption (MVO2) and retention index of 11C-HED (RIHED) was done in aQuant software. Comparison of parameters in hypertrophic regions to non-hypertrophic regions was done using Mann-Whitney U- test and Bland-Altman analysis with repeatability coefficient defined as 2 times the standard-deviation of differences.
Results
One patient had all segments >15mm and one patient had all segments <15mm and were therefore excluded from analysis. WT was 18.2±1.9 mm in hypertrophic regions and 12.2±1.5 mm in non-hypertrophic regions. None of the PET-parameters showed a significant difference between hypertrophic and non-hypertrophic regions, see table 1.
Table 1 MBFREST MBFSTRESS MVO2 RIHED Hypertrophic segments (mm) 0.70±0.20 1.74±0.92 0.092±0.026 0.12±0.037 Non-hypertrophic segments (mm) 0.68±0.18 1.71±0.87 0.094±0.025 0.12±0.036 p-value 0.767 0.851 0.956 0.684 Repeatability coefficient (%) 25.4 35.4 13.3 16.2 Mean ± standard deviation for PET-parameters in hypertrophic and non-hypertrophic segments. Relative repeatability coefficient (%) between regions and p-value for Mann-Whitney U-test.
Conclusion
Pathophysiology in terms of myocardial blood flow at rest and stress, oxygen consumption and sympathetic innervation are not significantly different in hypertrophic segments compared to non-hypertrophic segments in patients with HCM. Thus, the disease is not confined to hypertrophied areas but spread throughout the left ventricle.
Acknowledgement/Funding
Selanders stiftelse, Regionala forskningsrådet
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Affiliation(s)
| | - P Magnusson
- Karolinska Institute, Department of Medicine, Cardiology Research Unit, Stockholm, Sweden
| | - H Harms
- Århus University Hospital, Nuclear Medicine, Århus, Denmark
| | - M Lubberink
- Uppsala University, Nuclear Medicine and PET, Uppsala, Sweden
| | - S Morner
- Umea University, Dept of Public Health and Clinical Medicine, Umea, Sweden
| | - J Sorensen
- Århus University Hospital, Nuclear Medicine, Århus, Denmark
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Gailey R, Clemens S, Sorensen J, Kirk-Sanchez N, Gaunaurd I, Raya M, Klute G, Pasquina P. Variables that Influence Basic Prosthetic Mobility in People With Non-Vascular Lower Limb Amputation. PM R 2019; 12:130-139. [PMID: 31329356 DOI: 10.1002/pmrj.12223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 07/11/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND There exists a dearth of evidence on rehabilitation factors that influence prosthetic mobility in people with lower limb amputation (LLA). Examining variables that contribute to prosthetic mobility can inform rehabilitation interventions, providing guidance in developing more comprehensive care for these individuals. OBJECTIVE To determine the influence of modifiable and non-modifiable variables related to LLA and their impact on prosthetic mobility, using the International Classification of Functioning, Disability and Health (ICF) model. Secondarily, to determine if personal factors and self-reported balance and mobility are predictive of Component timed-up-and-go (cTUG) performance. DESIGN Cross-sectional study of a convenience sample. SETTING National conference. PARTICIPANTS People (N=68) with non-vascular causes of unilateral LLA. METHODS Assessment of anthropometrics, mobility, bilateral hip extensor strength, hip range of motion, single limb balance, and self report measures. Lasso linear regression and extreme gradient boosting analyses were used to determine influence of variables on prosthetic mobility. MAIN OUTCOME MEASURE Timed performance of the cTUG. RESULTS The following five variables were found to influence basic prosthetic mobility (P ≤ .05) in people with transtibial amputation: hip extensor strength, hip range of motion, single limb balance, waist circumference, and age. In the transfemoral cohort, number of comorbidities and waist circumference primarily influenced prosthetic mobility. Additionally, 66% of the variance in cTUG total time for the entire sample could be explained by simply regressing on level of amputation, number of comorbidities, age and Activities-specific Balance Confidence scale score, all variables easily collected in a waiting room. CONCLUSION Variables that are modifiable with physical therapy intervention including hip extensor strength, hip range of motion, single limb balance, and waist circumference significantly influenced basic prosthetic mobility. These variables can be affected by targeted rehabilitation interventions and lifestyle changes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Robert Gailey
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Sheila Clemens
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL.,Physical Therapy Department, Nicole Wertheim College of Nursing and Health Professions, Florida International University, FL Research Department, Miami Veterans Administration Healthcare System, Miami, FL.,Research Department, Miami Veterans Administration Healthcare System, Miami, FL
| | - Jeffrey Sorensen
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Neva Kirk-Sanchez
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Ignacio Gaunaurd
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL.,Research Department, Miami Veterans Administration Healthcare System, Miami, FL
| | - Michele Raya
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Glenn Klute
- Department of Mechanical Engineering, University of Washington, Seattle, WA.,Rehabilitation Research and Development, VA Puget Sound Health Care System, Seattle, WA
| | - Paul Pasquina
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.,Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
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Nally DM, Sorensen J, Kavanagh DO. Emergency laparotomy research methodology: A systematic review. Surgeon 2019; 18:80-90. [PMID: 31345681 DOI: 10.1016/j.surge.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/07/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Emergency abdominal surgery is associated with poorer clinical outcomes than similar procedures in the elective setting. Research into emergency laparotomy (EL) care is moving from observational studies which simply measure EL outcomes to interventional research evaluating the implementation of care strategies designed to improve the quality and outcomes from EL care. There is no consensus as to the optimal approach to conducting research in this sphere. The primary objective of this review was to examine how mortality and other outcome measures were reported in previous EL research and to identify what might be the most appropriate methods in future outcome research. METHODS A systematic review was performed in accordance with the PRISMA principles. Electronic databases were interrogated with a pre-specified search strategy to identify English language studies addressing outcomes from EL care. Retrieved papers were screened and assessed according to pre-defined eligibility criteria. The mortality and other outcomes reported in each paper were extracted and examined. RESULTS 16 studies were included. They demonstrated significant heterogeneity in case definition, outcome reporting and data processing. A wide range of mortality and other outcome measures were applied and reported. Only few studies included on patient-reported outcomes measures. CONCLUSION The heterogeneity in EL research, demonstrated by this review must be considered when EL outcomes are compared. A standardized approach with respect to case definition, outcome measurement, and data analysis would provide for more valid and comparable evaluation of EL outcomes. Future EL research should include more patient centred outcomes.
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Affiliation(s)
- D M Nally
- Department of Surgical Affairs, Royal College of Surgeons of Ireland, 121 St. Stephen's Green, Dublin 2, Ireland.
| | - J Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons of Ireland, Beaux Lane House, Mercer Street Lower, Dublin 2, Ireland.
| | - D O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons of Ireland, 121 St. Stephen's Green, Dublin 2, Ireland.
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23
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Nordstrom J, Harms H, Tolbod L, Sorensen J, Lubberink M. P156The influence of patient motion on the quantitative accuracy of dynamic cardiac 15O-water PET/CT. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez147.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Nordstrom
- Uppsala University Hospital, Nuclear Medicine and PET, Uppsala, Sweden
| | - H Harms
- Aarhus University Hospital, Aarhus, Denmark
| | - L Tolbod
- Aarhus University Hospital, Aarhus, Denmark
| | - J Sorensen
- Uppsala University Hospital, Nuclear Medicine and PET, Uppsala, Sweden
| | - M Lubberink
- Uppsala University Hospital, Nuclear Medicine and PET, Uppsala, Sweden
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24
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Rosengren S, Skibsted Clemmensen T, Tolbod L, Granstam SO, Eiskjaer H, Wikstrom G, Vedin O, Kero T, Lubberink M, Harms HJ, Flachskampf FA, Antoni G, Frost Andersen N, Hvitfeldt Poulsen S, Sorensen J. 37Diagnostic accuracy of [11C]PIB positron emission tomography for detection of cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez135.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Rosengren
- Uppsala University, Department of Medical Sciences, Haematology, Uppsala, Sweden
| | | | - L Tolbod
- Aarhus University Hospital, Department of Nuclear Medicine and PET, Aarhus, Denmark
| | - S O Granstam
- Uppsala University, Department of Medical Sciences, Clinical Physiology, Uppsala, Sweden
| | - H Eiskjaer
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - G Wikstrom
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - O Vedin
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - T Kero
- Uppsala University, Department of Surgical Sciences, Radiology, Uppsala, Sweden
| | - M Lubberink
- Uppsala University, Department of Surgical Sciences, Radiology, Uppsala, Sweden
| | - H J Harms
- Aarhus University Hospital, Department of Nuclear Medicine and PET, Aarhus, Denmark
| | - F A Flachskampf
- Uppsala University, Department of Medical Sciences, Clinical Physiology, Uppsala, Sweden
| | - G Antoni
- Uppsala University, Department of Medical Chemistry, Uppsala, Sweden
| | - N Frost Andersen
- Aarhus University Hospital, Department of Haematology, Aarhus, Denmark
| | | | - J Sorensen
- Uppsala University, Department of Surgical Sciences, Radiology, Uppsala, Sweden
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25
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Sorensen J, Harms HJ, Wikstrom G, Pilebro B, Vedin O, Granstam SO, Rosengren S. 240Symptomatic transthyretin cardiac amyloidosis is associated with chronic myocardial ischemia at rest and early death. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez145.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Affiliation(s)
- J Sorensen
- Uppsala University, Surgical Sciences, Nuclear Medicine, Uppsala, Sweden
| | - H J Harms
- Aarhus University, Clinical Institute, Aarhus, Denmark
| | - G Wikstrom
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - B Pilebro
- Umea University Hospital, Cardiology, Umea, Sweden
| | - O Vedin
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - S O Granstam
- Uppsala University, Medical sciences, Uppsala, Sweden
| | - S Rosengren
- Uppsala University, Medical sciences, Uppsala, Sweden
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26
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Peltan ID, Brown SM, Bledsoe JR, Sorensen J, Samore MH, Allen TL, Hough CL. ED Door-to-Antibiotic Time and Long-term Mortality in Sepsis. Chest 2019; 155:938-946. [PMID: 30779916 DOI: 10.1016/j.chest.2019.02.008] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [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: 11/10/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The impact of antibiotic timing on sepsis outcomes remains controversial due to conflicting results from previous studies. OBJECTIVES This study investigated the association of door-to-antibiotic time with long-term mortality in ED patients with sepsis. METHODS This retrospective cohort study included nontrauma adult ED patients with clinical sepsis admitted to four hospitals from 2013 to 2017. Only patients' first eligible encounter was included. Multivariable logistic regression was used to measure the adjusted association between door-to-antibiotic time and 1-year mortality. Secondary analyses used alternative antibiotic timing measures (antibiotic initiation within 1 or 3 h and separate comparison of antibiotic exposure at each hour up to hour 6), alternative outcomes (hospital, 30-day, and 90-day mortality), and alternative statistical methods to mitigate indication bias. RESULTS Among 10,811 eligible patients, median door-to-antibiotic time was 166 min (interquartile range, 115-230 min), and 1-year mortality was 19%. After adjustment, each additional hour from ED arrival to antibiotic initiation was associated with a 10% (95% CI, 5-14; P < .001) increased odds of 1-year mortality. The association remained linear when each 1-h interval of door-to-antibiotic time was independently compared with door-to-antibiotic time ≤ 1 h and was similar for hospital, 30-day, and 90-day mortality. Mortality at 1 year was higher when door-to-antibiotic times were > 3 h vs ≤ 3 h (adjusted OR, 1.27; 95% CI, 1.13-1.43) but not > 1 h vs ≤ 1 h (adjusted OR, 1.26; 95% CI, 0.98-1.62). CONCLUSIONS Delays in ED antibiotic initiation time are associated with clinically important increases in long-term, risk-adjusted sepsis mortality.
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Affiliation(s)
- Ithan D Peltan
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT.
| | - Samuel M Brown
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Joseph R Bledsoe
- Departments of Medicine and Emergency Medicine, Intermountain Medical Center, Murray, UT
| | - Jeffrey Sorensen
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT
| | - Matthew H Samore
- Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Todd L Allen
- Departments of Medicine and Emergency Medicine, Intermountain Medical Center, Murray, UT
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA
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27
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Webb BJ, Harrington R, Schwartz J, Kammerer J, Spalding J, Lee E, Dodds B, Kaufusi S, Goodman BE, Firth SD, Martin G, Sorensen J, Hoda D. The clinical and economic impact of cytomegalovirus infection in recipients of hematopoietic stem cell transplantation. Transpl Infect Dis 2018; 20:e12961. [PMID: 29975816 DOI: 10.1111/tid.12961] [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: 11/03/2017] [Revised: 05/12/2018] [Accepted: 06/19/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND CMV infection (CMV-I) remains an important complication of hematopoietic stem cell transplantation (HSCT). METHODS This was a retrospective, single-center cohort study in HSCT recipients. Primary outcomes were adjusted cost and all-cause mortality. Secondary analyses investigated CMV risk factors and the effect of serostatus. RESULTS Overall, 690 transplant episodes were included (allogeneic [n = 310]; autologous [n = 380]). All received preemptive CMV antiviral therapy at first detectable DNAemia. CMV-I occurred in 34.8% of allogeneic and 2.1% of autologous transplants; median time to onset was 45 days. In allogeneic HSCT recipients, the primary risk factor for CMV-I was CMV donor/recipient (D/R) serostatus. In a Markov multi-state model for allogeneic HSCT recipients, the hazard ratio for CMV-I and relapse was 1.5 (95% CI 0.8-2.8) and for CMV-I and mortality 2.4 (95% CI 0.9-6.5). In a multivariable model for all patients, CMV-I was associated with increased total cost (coefficient = 0.21, estimated incremental daily cost USD $500; P = 0.02). Cost was attenuated in allogeneic HSCT recipients (coefficient = 0.13, USD $699 vs $613, or $24 892 per transplant episode; P = 0.23). CMV disease (CMV-D) complicated 29.6% of CMV-I events in allogeneic HSCT recipients, but was not associated with an incrementally increased adjusted risk of mortality compared with CMV-I alone. CMV-I (56.4%) and CMV-D (19.8%) were significantly overrepresented in D-/R+ serostatus HSCT recipients, and mortality was higher in R+ HSCT recipients. CONCLUSIONS Despite early preemptive antiviral treatment, CMV-I impacts clinical outcomes and cost after HSCT, but the impact on cost is less pronounced in allogeneic HSCT recipients compared with autologous HSCT recipients.
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Affiliation(s)
- Brandon J Webb
- Division of Infectious Disease, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Jason Schwartz
- Astellas Pharma Global Development, Inc., Northbrook, Illinois
| | | | - James Spalding
- Astellas Pharma Global Development, Inc., Northbrook, Illinois
| | - Edward Lee
- Astellas Pharma Global Development, Inc., Northbrook, Illinois
| | - Bart Dodds
- Innovations and Business Development, Intermountain Healthcare, Salt Lake City, Utah
| | - Stephanie Kaufusi
- Innovations and Business Development, Intermountain Healthcare, Salt Lake City, Utah
| | - Bruce E Goodman
- Innovations and Business Development, Intermountain Healthcare, Salt Lake City, Utah
| | - Sean D Firth
- Innovations and Business Development, Intermountain Healthcare, Salt Lake City, Utah
| | - Greta Martin
- Innovations and Business Development, Intermountain Healthcare, Salt Lake City, Utah
| | - Jeffrey Sorensen
- Statistical Data Center, Office of Research, Intermountain Healthcare, Salt Lake City, Utah
| | - Daanish Hoda
- Intermountain Blood and Marrow Transplant/Acute Leukemia Program, Salt Lake City, Utah
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Kay AB, Majercik S, Sorensen J, Woller SC, Stevens SM, White TW, Morris DS, Baldwin M, Bledsoe JR. Weight-based enoxaparin dosing and deep vein thrombosis in hospitalized trauma patients: A double-blind, randomized, pilot study. Surgery 2018; 164:S0039-6060(18)30094-1. [PMID: 29699807 DOI: 10.1016/j.surg.2018.03.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/15/2018] [Accepted: 03/07/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Venous thromboembolism is a cause of morbidity and mortality in trauma patients. Chemoprophylaxis with low-molecular-weight heparin at a standardized dose is recommended. Conventional chemoprophylaxis may be inadequate. We hypothesized that a weight-adjusted enoxaparin prophylaxis regimen would reduce the frequency of venous thromboembolism in hospitalized trauma patients and at 90-day follow-up. METHODS This prospective, randomized pilot study enrolled adult patients admitted to a level 1 trauma center between July 2013 and January 2015. Subjects were randomized to receive either standard (30 mg subcutaneously every 12 hours) or weight-based (0.5mg/kg subcutaneously every 12 hours) enoxaparin. Surveillance duplex ultrasound for lower extremity deep vein thrombosis was performed on hospital days 1, 3, and 7, and weekly thereafter. The primary outcome was deep vein thrombosis during hospitalization. Secondary outcomes included venous thromboembolism at 90 days and significant bleeding events. RESULTS Two hundred thirty-four (124 standard, 110 weight-based) subjects were enrolled. There was no difference between standard and weight-based regarding age, body mass index, percentage female gender, injury severity score, or percentage that had surgery. There was a trend toward less in-hospital deep vein thrombosis in weight-based (12 [9.7%] standard vs 4 [3.6%] weight-based, P = .075). At 90 days, there was no difference in venous thromboembolism (12 [9.7%] standard vs 6 [5.5%] weight-based, P =.34). There was 1 bleeding event, which occurred in a standard subject. CONCLUSION Weight-based enoxaparin dosing for venous thromboembolism chemoprophylaxis in trauma patients may provide better protection against venous thromboembolism than standard. A definitive study is necessary to determine whether weight-based dosing is superior to standard.
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Affiliation(s)
- Annika Bickford Kay
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT
| | - Sarah Majercik
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT.
| | - Jeffrey Sorensen
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT
| | - Scott C Woller
- Department of Internal Medicine, Intermountain Medical Center, Murray, UT; Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Scott M Stevens
- Department of Internal Medicine, Intermountain Medical Center, Murray, UT; Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Thomas W White
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT
| | - David S Morris
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT
| | - Margaret Baldwin
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT
| | - Joseph R Bledsoe
- Department of Emergency Medicine, Intermountain Medical Center, Murray, UT
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Khemasuwan D, Sorensen J, Griffin DC. Predictive Variables for Failure in Administration of Intrapleural Tissue Plasminogen Activator/Deoxyribonuclease in Patients With Complicated Parapneumonic Effusions/Empyema. Chest 2018; 154:550-556. [PMID: 29425674 DOI: 10.1016/j.chest.2018.01.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 09/02/2017] [Revised: 12/20/2017] [Accepted: 01/24/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Combined intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) has been shown to reduce the need for surgical intervention for complicated pleural effusion/empyema (CPE/empyema). For patients in whom tPA/DNase is likely to fail, however, receipt of this therapy may simply delay the inevitable. The goal of this study was to identify risk factors for failure of combined intrapleural therapy. METHODS We performed a retrospective chart review of patients who received intrapleural tPA/DNase for the treatment of CPE/empyema. Clinical variables included demographic data, radiographic parameters at time of diagnosis, and results from pleural fluid analysis. We used gradient boosted trees-an ensemble machine learning technique, with hyperparameter tuning to mitigate overfitting-to rank the importance of 19 candidate clinical variables with respect to their ability to predict failure of tPA/DNase therapy. RESULTS We identified 84 patients who received intrapleural tPA/DNase for the treatment of complicated pleural effusions/empyema over a 5-year period. Resolution of CPE/empyema with intrapleural tPA/DNase was achieved in two-thirds of the patients (n = 57). Of the 19 candidate predictors of tPA/DNase failure, the presence of pleural thickening was found to be the most important (48% relative importance), followed by the presence of an abscess or necrotizing pneumonia (24%), the pleural protein level (6%), and the presence of loculated effusion (4%). CONCLUSIONS Our analysis found that the presence of pleural thickening and the presence of an abscess/necrotizing pneumonia helps to triage patients in whom combined intrapleural therapy is likely to fail. The results warrant further study and validation in a prospective multicenter study.
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Affiliation(s)
| | - Jeffrey Sorensen
- Pulmonary and Critical Care Medicine, Intermountain Healthcare, Murray, UT
| | - David C Griffin
- Department of Surgery, Intermountain Medical Center, Murray, UT
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Johansson H, Weinehall L, Sorensen J, Dalton J, Jenkins P, Jerdén L. Lifestyle counseling in primary care – the views of family physicians in United States and Sweden. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.078] [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: 11/15/2022] Open
Affiliation(s)
- H Johansson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - L Weinehall
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - J Sorensen
- Bassett Healthcare Network Research Institute, Cooperstown, NY, United States
| | - J Dalton
- Bassett Healthcare Network Research Institute, Cooperstown, NY, United States
| | - P Jenkins
- Bassett Healthcare Network Research Institute, Cooperstown, NY, United States
| | - L Jerdén
- Dalarna County Council, Unit of Research and Development, Falun, Sweden
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31
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Hansson N, Sorensen J, Harms H, Kim W, Nielsen R, Tolbod L, Frokiaer J, Bouchelouche K, Dodt K, Sihm I, Poulsen S, Wiggers H. P186Metoprolol treatment reduces hemodynamic and metabolic overload in patients with asymptomatic aortic valve stenosis - a randomized double-blind placebo controlled trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p186] [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: 11/13/2022] Open
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Brown SM, Sorensen J, Lanspa MJ, Rondina MT, Grissom CK, Shahul S, Mathews VJ. Multi-complexity measures of heart rate variability and the effect of vasopressor titration: a prospective cohort study of patients with septic shock. BMC Infect Dis 2016; 16:551. [PMID: 27724850 PMCID: PMC5057204 DOI: 10.1186/s12879-016-1896-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/08/2015] [Accepted: 10/04/2016] [Indexed: 12/20/2022] Open
Abstract
Background Septic shock is a common and often devastating syndrome marked by severe cardiovascular dysfunction commonly managed with vasopressors. Whether markers of heart rate complexity before vasopressor up-titration could be used to predict success of the up-titration is not known. Methods We studied patients with septic shock requiring vasopressor, newly admitted to the intensive care unit. We measured the complexity of heart rate variability (using the ratio of fractal exponents from detrended fluctuation analysis) in the 5 min before all vasopressor up-titrations in the first 24 h of an intensive care unit (ICU) admission. A successful up-titration was defined as one that did not require further up-titration (or decrease in mean arterial pressure) for 60 min. Results We studied 95 patients with septic shock, with a median APACHE II of 27 (IQR: 20–37). The median number of up-titrations, normalized to 24 h, was 12.2 (IQR: 8–17) with a maximum of 49. Of the up-titrations, the median proportion of successful interventions was 0.28 (IQR: 0.12–0.42). The median of mean arterial pressure (MAP) at the time of a vasopressor up-titration was 66 mmHg; the average infusion rate of norepinephrine at the time of an up-titration was 0.11 mcg/kg/min. The ratio of fractal exponents was not associated with successful up-titration on univariate or multivariate regression. On exploratory secondary analyses, however, the long-term fractal exponent was associated (p = 0.003) with success of up-titration. Independent of heart rate variability, MAP was associated (p < 0.001) with success of vasopressor up-titration, while neither Sequential Organ Failure Assessment (SOFA) nor Acute Physiology and Chronic Health Evaluation II (APACHE II) score was associated with vasopressor titration. Conclusions Only a third of vasopressor up-titrations were successful among patients with septic shock. MAP and the long-term fractal exponent were associated with success of up-titration. These two, complementary variables may be important to the development of rational vasopressor titration protocols. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1896-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samuel M Brown
- Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT, USA. .,Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jeffrey Sorensen
- Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT, USA
| | - Michael J Lanspa
- Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT, USA.,Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Matthew T Rondina
- Internal Medicine, University of Utah Medical Center and School of Medicine and George E. Wahlen VA Medical Center, Salt Lake City, UT, USA.,Molecular Medicine Program in the Eccles Institute of Human Genetics, Salt Lake City, UT, USA
| | - Colin K Grissom
- Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT, USA.,Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sajid Shahul
- Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA
| | - V J Mathews
- School of Electrical Engineering & Computer Science, Oregon State University, Corvallis, OR, USA
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Weil R, Pinto K, Lincoln J, Hall-Arber M, Sorensen J. The use of personal flotation devices in the Northeast lobster fishing industry: An examination of the decision-making process. Am J Ind Med 2016; 59:73-80. [PMID: 26443130 DOI: 10.1002/ajim.22537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 09/09/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study explored perspectives of Northeast commercial lobstermen regarding the use of personal flotation devices (PFDs). Researchers sought to identify factors contributing to low PFD use, and motivators that could lead to increased use of PFDs. METHODS This qualitative research (n = 72) included 25 commercial fishermen who participated in in-depth, semi-structured interviews, and 47 attendees of Lobstermen's meetings who engaged in focus groups. RESULTS The results showed substantial barriers to PFD use. Fishermen described themselves as being proactive about safety whenever possible, but described a longstanding tradition of not wearing PFDs. Key factors integrally linked with the lack of PFD use were workability, identity/social stigma, and risk diffusion. CONCLUSION Future safety interventions will need to address significant barriers to PFD use that include issues of comfort and ease of use, as well as social acceptability of PFDs and reorientation of risk perceptions related to falls overboard.
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Affiliation(s)
- R. Weil
- The Northeast Center for Occupational Health and Safety: Agriculture; Forestry and Fishing, Bassett Healthcare Network; Cooperstown New York
| | - K. Pinto
- Fishing Partnership Support Services; Burlington Massachusetts
| | - J. Lincoln
- Commercial Fishing Safety Research and Design Program, Alaska Pacific Office; National Institute for Occupational Safety and Health; Anchorage Alaska
| | - M. Hall-Arber
- MIT Sea Grant; Massachusetts Institute of Technology; Cambridge Massachusetts
| | - J. Sorensen
- The Northeast Center for Occupational Health and Safety: Agriculture; Forestry and Fishing, Bassett Healthcare Network; Cooperstown New York
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Hard DL, McKenzie EA, Cantis D, May J, Sorensen J, Bayes B, Madden E, Wyckoff S, Stone B, Maass J. A Demonstration Project in New York and Virginia: Retrofitting Cost-Effective Roll-over Protective Structures (CROPS) on Tractors. J Agric Saf Health 2015; 21:173-85. [PMID: 26373215 DOI: 10.13031/jash.21.11066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The NIOSH cost-effective roll-over protective structure (CROPS) demonstration project sought to determine whether three prototype roll-over protective structures (ROPS) designed to be retrofitted on Ford 8N, Ford 3000, Ford 4000, and Massey Ferguson 135 tractors could be installed in the field and whether they would be acceptable by the intended end users (farmers). There were a total of 50 CROPS. demonstrators (25 in New York and 25 in Virginia), with 45 observers attending the New York CROPS demonstrations and 36 observers attending the Virginia CROPS demonstrations, for a total of 70 participants in New York and 61 in Virginia. The oldest retrofitted tractors were 77 to 62 years old, while the newest retrofitted tractors were 40 to 37 years old. The most frequently retrofitted tractor in the CROPS demonstration project was a Ford 3000 series tractor (n = 19; 38%), followed by Ford 4000 (n = 11; 22%), Massey Ferguson 135 (n = 11; 22%), and Ford 8N (n = 9; 18%). A major issue of CROPS retrofitting was the rear wheel fenders. The effort involved in disassembling the fenders (removing the old bolts was often faster by cutting them with a torch), modifying the fender mounting brackets, and then reinstalling the fenders with the CROPS generally required the most time. In addition, various other semi-permanent equipment attachments, such as front-end loaders, required additional time and effort to fit with the CROPS. Demonstrators were asked to rank the reasons why they had not retrofitted their tractors with ROPS until they had enrolled in the CROPS demonstration program. ROPS "cost too much" was ranked as the primary reason for participants in both states (80% for New York and 88% for Virginia). The second highest ranked reasons were "ROPS wasn't available" for Virginia (80%) and "hassle to find ROPS" for New York (69%). The third highest ranked reasons were "not enough time to find ROPS" for New York (67%) and "hassle to find ROPS" for Virginia (79%). All demonstrators and observers indicated that they were glad to have participated in the CROPS project.
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Jerdén L, Jenkins P, Sorensen J, Johansson H, May J, Dalton J, Weinehall L. Patients’ experiences of lifestyle counseling: Large differences between US and Swedish primary care. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.029] [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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Sorensen J, Duran C, Stingo F, Wei W, Rao A, Zhang L, Court L, Erasmus J, Godoy M. SU-D-BRA-06: Dual-Energy Chest CT: The Effects of Virtual Monochromatic Reconstructions On Texture Analysis Features. Med Phys 2015. [DOI: 10.1118/1.4923886] [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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Pellegrino T, Petretta M, Boemio A, Piscopo V, Carotenuto R, Russo B, Pellegrino S, De Matteis G, Cuocolo A, Ryzhkova DV, Kostina I, Azevedo Coutinho M, Cortez-Dias N, Cantinho G, Guimaraes T, Silva G, Menezes M, Francisco A, Placido R, Conceicao I, Pinto F, Nakajima K, Nakata T, Matsuo S, Jacobson A, Paterson CA, Al Jabri AJ, Robinson J, Martin W, Reid S, Smith SA, Harms H, Tolbod L, Kero T, Bouchelouche K, Frokiaer J, Sorensen J, Matsuo S, Nakajima K, Kinuya S, Yamagishi M. Moderated Poster Session 3: Monday 4 May 2015, 10:00-11:00 * Room: Moderated Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bouyoucef SE, Uusitalo V, Kamperidis V, De Graaf M, Maaniitty T, Stenstrom I, Broersen A, Scholte A, Saraste A, Bax J, Knuuti J, Furuhashi T, Moroi M, Awaya T, Masai H, Minakawa M, Kunimasa T, Fukuda H, Sugi K, Berezin A, Kremzer A, Clerc O, Kaufmann B, Possner M, Liga R, Vontobel J, Mikulicic F, Graeni C, Benz D, Kaufmann P, Buechel R, Ferreira M, Cunha M, Albuquerque A, Ramos D, Costa G, Lima J, Pego M, Peix A, Cisneros L, Cabrera L, Padron K, Rodriguez L, Heres F, Carrillo R, Mena E, Fernandez Y, Huizing E, Van Dijk J, Van Dalen J, Timmer J, Ottervanger J, Slump C, Jager P, Venuraju S, Jeevarethinam A, Yerramasu A, Atwal S, Mehta V, Lahiri A, Arjonilla Lopez A, Calero Rueda MJ, Gallardo G, Fernandez-Cuadrado J, Hernandez Aceituno D, Sanchez Hernandez J, Yoshida H, Mizukami A, Matsumura A, Smettei O, Abazid R, Sayed S, Mlynarska A, Mlynarski R, Golba K, Sosnowski M, Winther S, Svensson M, Jorgensen H, Bouchelouche K, Gormsen L, Holm N, Botker H, Ivarsen P, Bottcher M, Cortes CM, Aramayo G E, Daicz M, Casuscelli J, Alaguibe E, Neira Sepulveda A, Cerda M, Ganum G, Embon M, Vigne J, Enilorac B, Lebasnier A, Valancogne L, Peyronnet D, Manrique A, Agostini D, Menendez D, Rajpal S, Kocherla C, Acharya M, Reddy P, Sazonova I, Ilushenkova Y, Batalov R, Rogovskaya Y, Lishmanov Y, Popov S, Varlamova N, Prado Diaz S, Jimenez Rubio C, Gemma D, Refoyo Salicio E, Valbuena Lopez S, Moreno Yanguela M, Torres M, Fernandez-Velilla M, Lopez-Sendon J, Guzman Martinez G, Puente A, Rosales S, Martinez C, Cabada M, Melendez G, Ferreira R, Gonzaga A, Santos J, Vijayan S, Smith S, Smith M, Muthusamy R, Takeishi Y, Oikawa M, Goral JL, Napoli J, Montana O, Damico A, Quiroz M, Damico A, Forcada P, Schmidberg J, Zucchiatti N, Olivieri D, Jeevarethinam A, Venuraju S, Dumo A, Ruano S, Rakhit R, Davar J, Nair D, Cohen M, Darko D, Lahiri A, Yokota S, Ottervanger J, Maas A, Mouden M, Timmer J, Knollema S, Jager P, Sanja Mazic S, Lazovic B, Marina Djelic M, Jelena Suzic Lazic J, Tijana Acimovic T, Milica Deleva M, Vesnina Z, Zafrir N, Bental T, Mats I, Solodky A, Gutstein A, Hasid Y, Belzer D, Kornowski R, Ben Said R, Ben Mansour N, Ibn Haj Amor H, Chourabi C, Hagui A, Fehri W, Hawala H, Shugushev Z, Patrikeev A, Maximkin D, Chepurnoy A, Kallianpur V, Mambetov A, Dokshokov G, Teresinska A, Wozniak O, Maciag A, Wnuk J, Dabrowski A, Czerwiec A, Jezierski J, Biernacka K, Robinson J, Prosser J, Cheung G, Allan S, Mcmaster G, Reid S, Tarbuck A, Martin W, Queiroz R, Falcao A, Giorgi M, Imada R, Nogueira S, Chalela W, Kalil Filho R, Meneghetti W, Matveev V, Bubyenov A, Podzolkov V, Shugushev Z, Maximkin D, Chepurnoy A, Baranovich V, Faibushevich A, Kolzhecova Y, Volkova O, Kallianpur V, Peix A, Cabrera L, Padron K, Rodriguez L, Fernandez J, Lopez G, Mena E, Fernandez Y, Dondi M, Paez D, Butcher C, Reyes E, Al-Housni M, Green R, Santiago H, Ghiotto F, Hinton-Taylor S, Pottle A, Mason M, Underwood S, Casans Tormo I, Diaz-Exposito R, Plancha-Burguera E, Elsaban K, Alsakhri H, Yoshinaga K, Ochi N, Tomiyama Y, Katoh C, Inoue M, Nishida M, Suzuki E, Manabe O, Ito Y, Tamaki N, Tahilyani A, Jafary F, Ho Hee Hwa H, Ozdemir S, Kirilmaz B, Barutcu A, Tan Y, Celik F, Sakgoz S, Cabada Gamboa M, Puente Barragan A, Morales Vitorino N, Medina Servin M, Hindorf C, Akil S, Hedeer F, Jogi J, Engblom H, Martire V, Pis Diez E, Martire M, Portillo D, Hoff C, Balche A, Majgaard J, Tolbod L, Harms H, Bouchelouche K, Soerensen J, Froekiaer J, Gormsen L, Nudi F, Neri G, Procaccini E, Pinto A, Vetere M, Biondi-Zoccai G, Falcao A, Chalela W, Giorgi M, Imada R, Soares J, Do Val R, Oliveira M, Kalil Filho R, Meneghetti J, Tekabe Y, Anthony T, Li Q, Schmidt A, Johnson L, Groenman M, Tarkia M, Kakela M, Halonen P, Kiviniemi T, Pietila M, Yla-Herttuala S, Knuuti J, Roivainen A, Saraste A, Nekolla S, Swirzek S, Higuchi T, Reder S, Schachoff S, Bschorner M, Laitinen I, Robinson S, Yousefi B, Schwaiger M, Kero T, Lindsjo L, Antoni G, Westermark P, Carlson K, Wikstrom G, Sorensen J, Lubberink M, Rouzet F, Cognet T, Guedj K, Morvan M, El Shoukr F, Louedec L, Choqueux C, Nicoletti A, Le Guludec D, Jimenez-Heffernan A, Munoz-Beamud F, Sanchez De Mora E, Borrachero C, Salgado C, Ramos-Font C, Lopez-Martin J, Hidalgo M, Lopez-Aguilar R, Soriano E, Okizaki A, Nakayama M, Ishitoya S, Sato J, Takahashi K, Burchert I, Caobelli F, Wollenweber T, Nierada M, Fulsche J, Dieckmann C, Bengel F, Shuaib S, Mahlum D, Port S, Gemma D, Refoyo E, Cuesta E, Guzman G, Lopez T, Valbuena S, Fernandez-Velilla M, Del Prado S, Moreno M, Lopez-Sendon J, Harbinson M, Donnelly L, Einstein AJ, Johnson LL, Deluca AJ, Kontak AC, Groves DW, Stant J, Pozniakoff T, Cheng B, Rabbani LE, Bokhari S, Caobelli F, Schuetze C, Nierada M, Fulsche J, Dieckmann C, Bengel F, Aguade-Bruix S, Pizzi M, Romero-Farina G, Terricabras M, Villasboas D, Castell-Conesa J, Candell-Riera J, Brunner S, Gross L, Todica A, Lehner S, Di Palo A, Niccoli Asabella A, Magarelli C, Notaristefano A, Ferrari C, Rubini G, Sellem A, Melki S, Elajmi W, Hammami H, Ziadi M, Montero J, Ameriso J, Villavicencio R, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Barinaga Martin C, Martin Fernandez J, Alonso Rodriguez D, Iglesias Garriz I, Gemma D, Refoyo E, Cuesta E, Guzman G, Valbuena S, Rosillo S, Del Prado S, Torres M, Moreno M, Lopez-Sendon J, Taleb S, Cherkaoui Salhi G, Regbaoui Y, Ait Idir M, Guensi A, Puente A, Rosales S, Martinez C, Cabada M, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Martin Lopez CE, Castano Ruiz M, Martin Fernandez J, Iglesias Garriz I. Poster Session 2: Monday 4 May 2015, 08:00-18:00 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ferreira M, Robalo M, Saraiva T, Cunha M, Goncalves L, Albuquerque A, Ramos D, Costa G, Lima J, Pego M, Peovska I, Davceva Pavlovska J, Pop Gorceva D, Zdravkovska M, Vavlukis M, Kostova N, Bulugahapitiya DS, Feben A, Avison M, Foley J, Martin J, De Graaf MA, Van Den Hoogen I, Leen A, Kharagjitsingh A, Kroft L, Jukema J, Bax J, Scholte A, Patel K, Mahan M, Ananthasubramaniam K, Durmus Altun G, Alpay M, Altun A, Andreini D, Pontone G, Mushtaq S, Bertella E, Conte E, Segurini C, Volpato V, Petulla M, Baggiano A, Pepi M, Van Dijk J, Huizing E, Jager P, Slump C, Ottervanger J, Van Dalen J, Yambao E, Calleja H, Sibulo A, Ramirez Moreno A, Siles Rubio J, Noureddine M, Munoz-Bellido J, Bravo R, Martinez F, Valle A, Milan A, Inigo-Garcia L, Velasco T, Ramaiah VL, Devanbu JS, Taywade SK, Hejjaji VS, Zafrir N, Bental T, Gutstein A, Solodky A, Mats I, Kornowski R, Lagan J, Hasleton J, Meah M, Mcshane J, Trent R, Massalha S, Israel O, Koskosi A, Kopelovich M, Marai I, Venuraju S, Jeevarethinam A, Dumo A, Ruano S, Darko D, Cohen M, Nair D, Rosenthal M, Rakhit R, Lahiri A, Pizzi MN, Roque A, Fernandez-Hidalgo N, Cuellar-Calabria H, Gonzalez-Alujas M, Oristrell G, Rodriguez-Palomares J, Tornos P, Aguade-Bruix S, Smettei O, Abazid R, Ahmed WMK, Samy W, Behairy N, Tayeh O, Hassan A, Berezin A, Kremzer A, Samura T, Berezina T, Scrima G, Bertuccio G, Canseco Nadia N, Cruz Raul C, Gonzalez Cristian G, Hernandez Salvador S, Alexanderson Erick E, Zerahn B, Shugushev Z, Maximkin D, Chepurnoy A, Volkova O, Tsedenova A, Faibushevich A, Baranovich V, Yoshida H, Mizukami A, Matsumura A, Keller M, Silber S, Falcao A, Imada R, Azouri L, Giorgi M, Santos R, Mello S, Kalil Filho R, Meneghetti J, Chalela W, Kanni L, Ohrman T, Nygren AT, Irabi R, Falcao A, Imada R, Azouri L, Parisotto T, Soares J, Kalil Filho R, Meneghetti J, Chalela W, Burrell S, Burrell S, Lo C, Zavadovskyi K, Gulya M, Lishmanov Y, Amin A, Kandeel A, Shaban M, Nawito Z, Caobelli F, Soffientini A, Thackeray J, Bengel F, Pizzocaro C, Guerra U, Hellberg S, Silvola J, Kiugel M, Liljenback H, Savisto N, Thiele A, Laine V, Knuuti J, Roivainen A, Saraste A, Ismail B, Hadizad T, Dekemp R, Beanlands R, Dasilva JN, Hyafil F, Sorbets E, Duchatelle V, Rouzet F, Le Guludec D, Feldman L, Martire V, De Pierris C, Martire M, Pis Diez E, Ramaiah V, Devanbu JS, Hejjaji VS, Lebasnier A, Legallois D, Peyronnet D, Desmonts C, Zalcman G, Bienvenu B, Agostini D, Manrique A, Solomyanyy V, Mintale I, Zabunova M, Narbute I, Ratniece M, Jakobsons E, Kaire K, Kamzola G, Briede I, Jegere S, Erglis A, Mostafa S, Abdelkader M, Abdelkader H, Abdelkhlek S, Khairy E, Huidu S, Popescu A, Lacau S, Huidu A, Dimulescu D, Abazid R, Smettei O, Sayed S, Al Harby F, Habeeb A, Saqqah H, Merganiab S, Selvanayagam J, Harms H, Tolbod L, Hansson N, Kero T, Orndahl L, Kim W, Bouchelouche K, Wiggers H, Frokiaer J, Sorensen J, Hansson N, Tolbod L, Harms H, Wiggers H, Kim W, Hansen E, Zaremba T, Frokiaer J, Sorensen J, Harms H, Tolbod L, Hansson N, Kero T, Orndahl L, Kim W, Bouchelouche K, Wiggers H, Frokiaer J, Sorensen J. Poster Session 3: Tuesday 5 May 2015, 08:30-12:30 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bertella E, Baggiano A, Petulla' M, Mushtaq S, Beltrama V, Gripari P, Conte E, Russo E, Andreini D, Pontone G, Soukka I, Maaniitty T, Saraste A, Uusitalo V, Ukkonen H, Kajander S, Maki M, Bax J, Knuuti J, De Graaf MA, Caselli C, Lorenzoni V, Rovai D, Marinelli M, Del Ry S, Giannessi D, Bax J, Scholte A, Neglia D, Thackeray J, Korf-Klingebiel M, Wang Y, Kustikova O, Bankstahl J, Wollert K, Bengel F, Harms H, Tolbod L, Hansson N, Kim W, Bouchelouche K, Wiggers H, Frokiaer J, Sorensen J, Maaniitty T, Stenstrom I, Saraste A, Uusitalo V, Ukkonen H, Kajander S, Maki M, Bax J, Knuuti J. Young Investigator Award Competition: Sunday 3 May 2015, 08:30-10:00 * Room: Milan. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Johansson S, Sorensen J, Lax MA, Owenius R. Initial imaging findings using [ 18f]GE-148 ([ 18F]FACBC) PET/CT in subjects with primary prostate cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15138] [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: 11/20/2022] Open
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Sorensen J, Hansen O, Vilmar A, Frank H. Prospective randomized phase III trial of triplet chemotherapy with paclitaxel + gemcitabine + cisplatin compared to standard doublet chemotherapy with vinorelbine + cisplatin in advanced non-small cell lung cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8034] [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: 11/20/2022] Open
Abstract
8034 Background: Paclitaxel + gemcitabine + cisplatin showed promising results in phase II with 59% response rate and 48 weeks median survival. Hence, it was compared to a standard doublet regimen to examine for superiority. Methods: Histologically verified inoperable NSCLC patients (pts) aged 18–75 years, performance status 0–2 and normal organ function were randomized to regimen A (paclitaxel 180 mg/m2 and cisplatin 100 mg/m2 day 1 with gemcitabine 1000 mg/m2 day 1 and 8 every 3 weeks) or regimen B (cisplatin 100 mg/m2 day 1 and weekly i.v. vinorelbine every 4 weeks) for maximum 6 cycles. Totally 428 pts were needed to detect a 30% median survival increase with 80% power and two-sided type 1-error of 5%. Results: 221 pts.received reg. A and 222 reg. B. Overall, median age was 62 years (range 38–75 yrs), 58% were males, 11% had performance status 2, 62% stage IV disease, 46% adenocarcinoma, and 28% squamous cell carcinoma (SCC), equally distributed between the regimens. Median no. of treatment courses were 4 in both regimens. Frequencies of CTC grade 4 leucocytopenia, thrombocytopenia, or grade 3+4 nausea, neurotoxicity, or nephrotoxicity were 15%, 17%, 19%, 8%, and 8% in reg. A, and 18%, 5% (p=0.001), 17%, 11%(p=0.014), and 7% in reg. B, respectively. Febrile leucopenia episodes were 14% and 10% in reg. A and B, while thrombocytopenic bleedings occurred in 12% and 4% of pts (p=0.008), respectively, with two toxic deaths due to bleeding in reg. A and none in reg. B. Response rates were 52% and 49% in reg. A and reg. B, median response durations were 263 and 217 days (not significant), median times to progressions (TTP) 6.7 and 5.8 months (p=0.453), and median survival times 11.4 and 10.8 months (p=0.415), respectively. In SCC subtype, TTP was higher in reg. A than reg. B (medians 7.0 mths vs. 4.1 mths, p=0.001) and survival was increased (medians 13.5 mths vs 9.7 mths, p=0.020). Conclusions: The triplet regimen A had significantly higher activity in SCC, both with respect to TTP and to survival with median survival in excess of one year and may be preferred in this histologic subtype. [Table: see text]
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Affiliation(s)
- J. Sorensen
- National University Hospital, Copenhagen, Denmark; Odense University Hospital, Odense, Denmark; Aalborg Hospital, Aalborg, Denmark
| | - O. Hansen
- National University Hospital, Copenhagen, Denmark; Odense University Hospital, Odense, Denmark; Aalborg Hospital, Aalborg, Denmark
| | - A. Vilmar
- National University Hospital, Copenhagen, Denmark; Odense University Hospital, Odense, Denmark; Aalborg Hospital, Aalborg, Denmark
| | - H. Frank
- National University Hospital, Copenhagen, Denmark; Odense University Hospital, Odense, Denmark; Aalborg Hospital, Aalborg, Denmark
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Schwartz J, Rohrwasser A, Hillas E, Sorensen J, Gayowski T, Hutson W, Lalouel J. QS194. Development of Portal Hypertension in the Setting of Acute Liver Injury. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.494] [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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Sorensen J, Skovsgaard T, Bork E, Damstrup L, Ingeberg S. Double blind, placebo-controlled randomized study of chlorhexidine prophylaxis for chemotherapy-induced oral mucositis with nonblinded randomized comparison to oral cooling (cryotherapy). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8508] [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: 11/20/2022] Open
Abstract
8508 Background: Oral mucositis is a frequent complication to many chemotherapy agents in conventional doses. Chlorhexidine prophylaxis has been beneficial in some studies and suggested detrimental in others, but never compared to cryotherapy. Methods: Previously untreatedpatients (pts) with colon or gastic cancer receiving the first course of bolus 5-FU 425 mg/m2 with leucovorine 20 mg/m2 daily in five days were randomized, pending informed consent, to either chlorhexidine 0.1% 15 ml mouthrinse one minut TID for 3 wks. (regimen A), or to doubble blind placebo (normal saline with same taste additive as in A) with same dose and frequency (reg. B), or to cryotherapy with crushed ice tips from 10 min. before to 35 min. after start of chemotherapy (reg. C). Pts self-reported on severity (CTC-grading, main end-point) and duration of oral mucositis and side effects on a questionnaire. 75 pts were planned in each arm to detect a 15% difference in grade 3–4 mucositis with a 5% type 1 error and a 20% power. Chi-square test and Mann-Whitney test were used. Results: Among 225 pts randomized, 206 answered the questionnaire (70, 64, and 63 pts in reg.A, reg.B, and reg.C) There were no differences between the regimens with respect to diagnoses, stage, age, gender, smoking habits, or performance status. Mucositis grade 3–4 (impaired oral nutrition/need of artificial nutrition) occurred in 13%, 33%, and 11% in regimens A, B, and C, respectively. Reg. B was significantly worse than A (p<0.01) and C (p<0.005). Median mucositis durations were A: 3 days (0–17), B: 5 (0–20), and C: 1 (0–20). Duration was significantly longer in B than in both A (p=0.035) and C (p=0.003). Pts <40 years had grade 3–4 mucositis in 36% compared to 18% among older pts (p=0.14). Conclusions: Oral mucositis is common with bolus 5-FU,but frequency and duration may be significantly improved by either prophylactic chlorhexidine or by cryotherapy, giving similar results. The latter is an easy and inexpensive treatment which however is drug- and schedule-dependent as it can not be used with infusional 5-FU or with chemotherapy with substantially longer half-lifes than 5-FU. No significant financial relationships to disclose.
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Affiliation(s)
- J. Sorensen
- National University Hospital, Copenhagen, Denmark; Herlev Hospital, Copenhagen County, Denmark; Hillerod Hospital, Hillerod, Denmark; Naestved Hospital, Naestved, Denmark
| | - T. Skovsgaard
- National University Hospital, Copenhagen, Denmark; Herlev Hospital, Copenhagen County, Denmark; Hillerod Hospital, Hillerod, Denmark; Naestved Hospital, Naestved, Denmark
| | - E. Bork
- National University Hospital, Copenhagen, Denmark; Herlev Hospital, Copenhagen County, Denmark; Hillerod Hospital, Hillerod, Denmark; Naestved Hospital, Naestved, Denmark
| | - L. Damstrup
- National University Hospital, Copenhagen, Denmark; Herlev Hospital, Copenhagen County, Denmark; Hillerod Hospital, Hillerod, Denmark; Naestved Hospital, Naestved, Denmark
| | - S. Ingeberg
- National University Hospital, Copenhagen, Denmark; Herlev Hospital, Copenhagen County, Denmark; Hillerod Hospital, Hillerod, Denmark; Naestved Hospital, Naestved, Denmark
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Sorensen J, Riska H, Ravn J, Hansen O, Palshof T, Rytter C, Mattson K, Ladegaard L, Pilegaard H, Aaseboe U. O-116 Scandinavian randomised trial of neoadjuvant chemotherapy in NSCLC stages IB-IIIA. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80250-8] [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: 10/25/2022]
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Sorensen J, Jacobsen A, Ravn J, Berthelsen A. P-427 Preoperative staging by FDG-PET-CT-scan in patients with resectable malignant pleural mesothelioma (MPM). Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80920-1] [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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Gao Y, Zhou B, Diao Z, Sorensen J, Picheny M. MARS: A Statistical Semantic Parsing and Generation-Based Multilingual Automatic tRanslation System. Machine Translation 2002. [DOI: 10.1023/b:coat.0000010802.38267.29] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sorensen J. The evolution of a registered nurse. Nurs BC 2001; 33:18-20. [PMID: 12152464] [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: 02/26/2023]
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Affiliation(s)
- H M Lazarus
- Department of Surgery, LDS Hospital, Salt Lake City, Utah 84103, USA
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