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Yates JL, Hunt DT, Kulas KE, Chave KJ, Styer L, Chakravarthi ST, Cai GY, Bermúdez-González MC, Kleiner G, Altman D, Srivastava K, Simon V, Feihel D, McGowan J, Hogrefe W, Noone P, Egan C, Slifka MK, Lee WT. Development of a novel serological assay for the detection of mpox infection in vaccinated populations. J Med Virol 2023; 95:e29134. [PMID: 37805977 PMCID: PMC10686281 DOI: 10.1002/jmv.29134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
In 2022 the World Health Organization declared a Public Health Emergency for an outbreak of mpox, the zoonotic Orthopoxvirus (OPV) affecting at least 104 nonendemic locations worldwide. Serologic detection of mpox infection is problematic, however, due to considerable antigenic and serologic cross-reactivity among OPVs and smallpox-vaccinated individuals. In this report, we developed a high-throughput multiplex microsphere immunoassay using a combination of mpox-specific peptides and cross-reactive OPV proteins that results in the specific serologic detection of mpox infection with 93% sensitivity and 98% specificity. The New York State Non-Vaccinia Orthopoxvirus Microsphere Immunoassay is an important tool to detect subclinical mpox infection and understand the extent of mpox spread in the community through retrospective analysis.
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Affiliation(s)
- Jennifer L Yates
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, The School of Public Heath, The University at Albany, Albany, New York, USA
| | - Danielle T Hunt
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Karen E Kulas
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Karen J Chave
- Scientific Cores, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Linda Styer
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, The School of Public Heath, The University at Albany, Albany, New York, USA
| | - Sandhya T Chakravarthi
- Scientific Cores, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Gianna Y Cai
- Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Maria C Bermúdez-González
- Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Giulio Kleiner
- Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Deena Altman
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Komal Srivastava
- Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Viviana Simon
- Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, USA
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
- The Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Dennis Feihel
- Department of Medicine, North Shore University Hospital, Manhasset, New York, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Joseph McGowan
- Department of Medicine, North Shore University Hospital, Manhasset, New York, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | | | | | - Christina Egan
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, The School of Public Heath, The University at Albany, Albany, New York, USA
| | - Mark K Slifka
- Najit Technologies, Inc., Beaverton, Oregon, USA
- Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Oregon, USA
| | - William T Lee
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, The School of Public Heath, The University at Albany, Albany, New York, USA
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Yates JL, Hunt DT, Kulas KE, Chave K, Styer L, Chakravarthi ST, Cai GY, Bermúdez-González MC, Kleiner G, Altman D, Srivastava K, Simon V, Feihel D, McGowan J, Hogrefe W, Noone P, Egan C, Slifka MK, Lee WT. Development of a Novel Serological Assay for the Detection of Mpox Infection in Vaccinated Populations. medRxiv 2023:2023.04.18.23288419. [PMID: 37162953 PMCID: PMC10168407 DOI: 10.1101/2023.04.18.23288419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In 2022 the World Health Organization declared a Public Health Emergency for an outbreak of mpox, the zoonotic Orthopoxvirus (OPV) affecting at least 103 non-endemic locations world-wide. Serologic detection of mpox infection is problematic, however, due to considerable antigenic and serologic cross-reactivity among OPVs and smallpox-vaccinated individuals. In this report, we developed a high-throughput multiplex microsphere immunoassay (MIA) using a combination of mpox-specific peptides and cross-reactive OPV proteins that results in the specific serologic detection of mpox infection with 93% sensitivity and 98% specificity. The New York State Non-Vaccinia Orthopoxvirus Microsphere Immunoassay is an important diagnostic tool to detect subclinical mpox infection and understand the extent of mpox spread in the community through retrospective analysis.
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Aladin B, Thompson M, Addison D, Havens J, McGowan J, Nash D, Smith C. The YGetIt? Program: A Mobile Application, PEEP, and Digital Comic Intervention to Improve HIV Care Outcomes for Young Adults. Health Promot Pract 2023:15248399221150789. [PMID: 36924286 DOI: 10.1177/15248399221150789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
INTRODUCTION In New York State (NYS), young adults account for the largest number of new human immunodeficiency virus (HIV) infections and struggle to seek and remain in HIV care. Digital interventions and access to peer support have demonstrated positive influences on the HIV care continuum and health outcomes. The New York State Department of Health (NYS DOH) developed YGetIt? (YGI) that combines a mobile application, GET!, peer navigation (PEEPs), and a compelling digital comic series, "Tested," to facilitate the timely entry of young people into HIV care, to prevent vulnerable youth from dropping out of care, and to achieve sustained viral load suppression among those in care. This article describes the development and early implementation of the YGI digital intervention. Intervention design. GET! provided a high level of confidentiality and security, ease of access, and Wi-Fi accessibility. YGI enrolled 113 HIV-positive participants from a clinical setting who were individually randomized at a 1:1 ratio to receive access to GET! plus PEEPs (n = 53) or the app alone (n = 60). LESSONS LEARNED For recruitment, staff and organization buy-in was essential to the success of the intervention, and building relationships was critical. GET! development was an iterative process. Peer Engagement Educator Professionals (PEEPs) who were tech savvy, representative of the priority population, and had shared life experience with participants were most impactful. Interest in apps declines over time and participants in the APP alone arm were less engaged. CONCLUSION GET! is a communication and engagement tool that supports HIV care and may serve as a model for like digital interventions.
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Affiliation(s)
| | - Mark Thompson
- NYS Department of Health AIDS Institute, New York, NY, USA
| | - Diane Addison
- CUNY Institute for Implementation Science in Population Health. New York, NY, USA
| | - Jessica Havens
- NYS Department of Health AIDS Institute, New York, NY, USA
| | - Joseph McGowan
- Northwell Health Center for AIDS Research and Treatment (CART), Manhasset, NY, USA
| | - Denis Nash
- CUNY Institute for Implementation Science in Population Health. New York, NY, USA.,City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Cheryl Smith
- NYS Department of Health AIDS Institute, New York, NY, USA
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Shah N, Shah S, McGowan J. Immune Reconstitution Inflammatory Syndrome (IRIS) Causing Large Bowel Obstruction. J Gastrointest Surg 2023; 27:452-453. [PMID: 36344798 DOI: 10.1007/s11605-022-05511-w] [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] [Received: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Nishit Shah
- Department of Surgery, PIH Health, 12462 Putnam Street, Suite 500, Whittier, CA, 90602, USA.
| | - Sanjiv Shah
- Gouverneur Health, NYC Health and Hospitals, New York, NY, USA
| | - Joseph McGowan
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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Schwartz RM, Charlton J, Gorlin M, Weinberg A, Wallach F, McGowan J. 1287. Understanding Factors Associated with Polypharmacy and Differential Medication Adherence in People with HIV. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
For people with HIV (PWH), number of chronic medications (meds) used to treat comorbidities may impact quality of life (QoL), illness perception, medication beliefs, and clinical outcomes. Factors associated with adherence to antiretrovirals (ARVs) may differ from adherence to other chronic meds. This study aims to assess these factors to promote better med management and adherence among PWH taking chronic meds and ARVs.
Methods
174 participants (pts) were enrolled from an HIV program in a large health system. Inclusion criteria were age > 18 years, English speaking, prescribed ARVs, and having > 1 comorbidity requiring a chronic med (non-ARV). Measures included validated scales of QoL, illness perceptions, med beliefs, and adherence barriers (e.g., forgot, too many pills, avoiding side effects); and past 6-month emergency department (ED) use and hospitalization. Generalized linear models, ANOVA, and Wilcoxon sum rank tests assessed associations between number of chronic meds (< 4 vs > 5) and outcomes. Multivariable logistic regression models using backwards elimination were used to assess factors associated with adherence (overall, HIV-meds, non-HIV meds).
Results
Complete data from 160 pts were analyzed: 50% male; 84% US-born; 46% taking > 5 chronic meds. Pts taking > 5 meds were older, less likely to be employed, had significantly lower QoL (mean difference=5.23, 95%CI=0.19-10.27. p< .05), significantly higher med side effects (mean ranks=88.51 vs 73.77, p< .05), and 3-fold greater ED visits (mean estimate=2.99, 95%CI=1.52-5.89, p< .05). Regression models indicated that number of adherence barriers (but not other predictors) was consistently associated with lower adherence after controlling for demographics: (overall adherence: OR=0.85, 95%CI=0.79=0.91; HIV med adherence: OR=0.88, 95%CI=0.81-0.94; non-HIV med adherence: OR=0.86, 95%CI=0.80-0.92).
Conclusion
Adverse events (i.e., ED use, poor QoL, med side effects) are associated with number of chronic meds. Number of adherence barriers is associated with poor adherence across med type, highlighting the importance of interventions to address polypharmacy and the complexities of managing HIV and comorbidities. Assessment of barriers can contribute to the promotion of adherence for both HIV and non-HIV meds.
Disclosures
Amy Weinberg, DNP, MS, Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds.
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Affiliation(s)
| | | | - Margaret Gorlin
- Feinstein Institutes for Medical Research , Manhasset, New York
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Shah N, McGowan J. Comparative Effectiveness and Harms of Antibiotics for Outpatient Diverticulitis. Ann Intern Med 2022; 175:W25-W26. [PMID: 35286832 DOI: 10.7326/l22-0007] [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: 11/22/2022] Open
Affiliation(s)
- Nishit Shah
- Department of Surgery, PIH Health, Whittier, California
| | - Joseph McGowan
- Professor of Medicine, Zucker School of Medicine at Hofstra/Northwell, and Division of Infectious Diseases, Department of Medicine, North Shore University Hospital, Manhasset, New York
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McGowan J. Reconstruction of Post-Mohs Surgical Wounds Using a Novel Nanofiber Matrix. Wounds 2022. [DOI: 10.25270/wnds/20150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introduction. Surgical wound healing after Mohs micrographic surgery can be challenging. Achieving an optimal aesthetic outcome is another important consideration, especially for facial lesions. Objective. This case series evaluates the use of a novel synthetic nanofiber matrix after Mohs surgery to achieve desired results. Materials and Methods. Four patients with NMSCs on the auricular helix underwent Mohs micrographic surgery at a single cancer center. The synthetic nanofiber matrix was applied to the prepared Mohs surgical defect and covered with a dressing. The wounds were evaluated regularly for healing progress, and an additional synthetic nanofiber matrix was applied as needed. Results. Wounds were treated with an average of 1.25 applications ± 0.50 standard deviation of synthetic nanofiber matrix. The initial average wound size was 11.8 cm2. All wounds healed in 7.9 weeks ± 4.2 with excellent aesthetic results, minimal scar formation, and no skin deformity. In cases with exposed structures (cartilage and perichondrium), the synthetic nanofiber material promoted complete closure and healing. No complications were reported. Treatment using a synthetic nanofiber matrix resulted in complete wound healing in all patients. Conclusions. This study shows the synthetic nanofiber matrix is a viable option for the reconstruction of post-Mohs surgical defects.
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Bevilacqua KG, Brinkley C, McGowan J, Wallach F, Schwartz RM. "We are Getting Those Old People Things." Polypharmacy Management and Medication Adherence Among Adult HIV Patients with Multiple Comorbidities: A Qualitative Study. Patient Prefer Adherence 2022; 16:2773-2780. [PMID: 36311288 PMCID: PMC9604404 DOI: 10.2147/ppa.s382005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Improvements in treatment have led to a growing population of older adults living with HIV. As this population ages, polypharmacy, or the use of more than five medications, may become more common among people living with HIV (PLWH). METHODS Two qualitative focus groups (N=7, N=8) were conducted among a sample of patients who participated in a larger study regarding differential medication adherence. Open-ended questions and probes focused on barriers and facilitators to multiple medication management as well as differential adherence. RESULTS Overall, patients were able to manage their polypharmacy. Social support facilitated adherence while long-term antiretroviral (ARV) use, medication-specific requirements and emotional fatigue were barriers to management. A small number of participants reported differential adherence that prioritized non-HIV medications over ARVs due to more immediate effects of non-adherence. DISCUSSION Findings suggest that PLWH have learned to manage their polypharmacy, but still face significant challenges adhering to multiple medications in the long-term. Future research may focus on the emotional toll of long-term ARV use and how patients' own management strategies may be leveraged to promote adherence.
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Affiliation(s)
- Kristin G Bevilacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Correspondence: Kristin G Bevilacqua, Johns Hopkins University Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 N Wolfe St, Baltimore, MD, 21205, USA, Email
| | - Charell Brinkley
- Department of Medicine, Division of Infectious Disease, Northwell Health, Manhasset, NY, USA
| | - Joseph McGowan
- Department of Medicine, Division of Infectious Disease, Northwell Health, Manhasset, NY, USA
| | - Frances Wallach
- Department of Medicine, Division of Infectious Disease, Northwell Health, Manhasset, NY, USA
| | - Rebecca M Schwartz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Occupational Medicine, Epidemiology and Prevention, Great Neck, NY, USA
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
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Thondapu V, Ranganath P, Zhang E, Takigami A, Kohanski M, McGowan J, Harris G, Tower-Rader A, Meyersohn N, Lu M, Hoffmann U, Hedgire S, Ghoshhajra B. Integration Of Fractional Flow Reserve Derived From Coronary Ct Angiography (FFRCT) Into Clinical Practice: Initial Experience From A Tertiary Care Center. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
COVID-19 in-hospital morbidity and mortality in people living with HIV (PLWH) were compared to HIV-negative COVID-19 patients within a New York City metropolitan health system, the hardest hit region in the United States early in the pandemic. A total of 10,202 inpatients were diagnosed with COVID-19, of which 99 were PLWH. PLWH were younger (58.3 years (SD = 12.42) versus 64.32 years (SD = 16.77), p < 0.001) and had a higher prevalence of men (73.7% versus 57.9%, p = 0.002) and Blacks (43.4% versus 21.7%, p < 0.001) than the HIV-negative population. PLWH had a higher prevalence of malignancies (18% versus 7%, p = < 0.001), chronic liver disease (12% versus 3%, p < 0.001), and end-stage renal disease (11% versus 4%, p = 0.007). Use of a ventilator, admission to the ICU, and in-hospital mortality were not different. Of the 99 PLWH, 12 were virally unsuppressed and 9 had CD4% < 14. Two of the 12 virally unsuppressed patients and 4/9 patients with CD4% < 14 died. Ninety-one of the 99 PLWH were on treatment for HIV, and 5 of the 8 not on treatment died. Among PLWH with prior values, absolute CD4 count decreased an average of 192 cells/mm3 at the time of COVID-19 diagnosis (p < 0.001). Hospitalized patients with HIV and COVID-19 coinfection did not have worse outcomes than the general population. Among PLWH, those with CD4%<14 or not on treatment for HIV had higher mortality rates. Those PLWH who received IL-6 inhibitors had lower mortality rates. PLWH given antifungal medications, hydroxychloroquine, antibiotics (including azithromycin), steroids, and vasopressors had higher mortality rates.
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Affiliation(s)
- Sarah Flannery
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Rebecca Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Rehana Rasul
- Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - David A Hirschwerk
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Frances Wallach
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Bruce Hirsch
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Joseph McGowan
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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Evans R, Taylor S, Kalasthry J, Sakai N, Miles A, Aboagye A, Agoramoorthy L, Ahmed S, Amadi A, Anand G, Atkin G, Austria A, Ball S, Bazari F, Beable R, Beare S, Beedham H, Beeston T, Bharwani N, Bhatnagar G, Bhowmik A, Blakeway L, Blunt D, Boavida P, Boisfer D, Breen D, Bridgewater J, Burke S, Butawan R, Campbell Y, Chang E, Chao D, Chukundah S, Clarke C, Collins B, Collins C, Conteh V, Couture J, Crosbie J, Curtis H, Daniel A, Davis L, Desai K, Duggan M, Ellis S, Elton C, Engledow A, Everitt C, Ferdous S, Frow A, Furneaux M, Gibbons N, Glynne-Jones R, Gogbashian A, Goh V, Gourtsoyianni S, Green A, Green L, Green L, Groves A, Guthrie A, Hadley E, Halligan S, Hameeduddin A, Hanid G, Hans S, Hans B, Higginson A, Honeyfield L, Hughes H, Hughes J, Hurl L, Isaac E, Jackson M, Jalloh A, Janes S, Jannapureddy R, Jayme A, Johnson A, Johnson E, Julka P, Kalasthry J, Karapanagiotou E, Karp S, Kay C, Kellaway J, Khan S, Koh D, Light T, Limbu P, Lock S, Locke I, Loke T, Lowe A, Lucas N, Maheswaran S, Mallett S, Marwood E, McGowan J, Mckirdy F, Mills-Baldock T, Moon T, Morgan V, Morris S, Morton A, Nasseri S, Navani N, Nichols P, Norman C, Ntala E, Nunes A, Obichere A, O'Donohue J, Olaleye I, Oliver A, Onajobi A, O'Shaughnessy T, Padhani A, Pardoe H, Partridge W, Patel U, Perry K, Piga W, Prezzi D, Prior K, Punwani S, Pyers J, Rafiee H, Rahman F, Rajanpandian I, Ramesh S, Raouf S, Reczko K, Reinhardt A, Robinson D, Rockall A, Russell P, Sargus K, Scurr E, Shahabuddin K, Sharp A, Shepherd B, Shiu K, Sidhu H, Simcock I, Simeon C, Smith A, Smith D, Snell D, Spence J, Srirajaskanthan R, Stachini V, Stegner S, Stirling J, Strickland N, Tarver K, Teague J, Thaha M, Train M, Tulmuntaha S, Tunariu N, van Ree K, Verjee A, Wanstall C, Weir S, Wijeyekoon S, Wilson J, Wilson S, Win T, Woodrow L, Yu D. Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI. Clin Radiol 2020; 75:308-315. [PMID: 31836179 DOI: 10.1016/j.crad.2019.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/30/2019] [Indexed: 01/26/2023]
Abstract
AIM To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.
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Lathouwers E, Wong EY, Brown K, Baugh B, Ghys A, Jezorwski J, Mohsine EG, Van Landuyt E, Opsomer M, De Meyer S, De Wit S, Florence E, Vandekerckhove L, Vandercam B, Brunetta J, Klein M, Murphy D, Rachlis A, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Arastéh K, Bickel M, Bogner J, Esser S, Faetkenheuer G, Jessen H, Kern W, Rockstroh J, Spinner C, Stellbrink HJ, Stoehr A, Antinori A, Castelli F, Chirianni A, De Luca A, Di Biagio A, Galli M, Lazzarin A, Maggiolo F, Maserati R, Mussini C, Garlicki A, Gasiorowski J, Halota W, Horban A, Parczewski M, Piekarska A, Belonosova E, Chernova O, Dushkina N, Kulagin V, Ryamova E, Shuldyakov A, Sizova N, Tsybakova O, Voronin E, Yakovlev A, Antela A, Arribas JR, Berenguer J, Casado J, Estrada V, Galindo MJ, Garcia Del Toro M, Gatell JM, Gorgolas M, Gutierrez F, Gutierrez MDM, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Rivero A, Rubio R, Viciana P, De Los Santos I, Clarke A, Gazzard BG, Johnson MA, Orkin C, Reeves I, Waters L, Benson P, Bhatti L, Bredeek F, Crofoot G, Cunningham D, DeJesus E, Eron J, Felizarta F, Franco R, Gallant J, Hagins D, Henry K, Jayaweera D, Lucasti C, Martorell C, McDonald C, McGowan J, Mills A, Morales-Ramirez J, Prelutsky D, Ramgopal M, Rashbaum B, Ruane P, Slim J, Wilkin A, deVente J, De Wit S, Florence E, Moutschen M, Van Wijngaerden E, Vandekerckhove L, Vandercam B, Brunetta J, Conway B, Klein M, Murphy D, Rachlis A, Shafran S, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Gasiorowski J, Halota W, Horban A, Piekarska A, Witor A, Arribas JR, Perez-Valero I, Berenguer J, Casado J, Gatell JM, Gutierrez F, Galindo MJ, Gutierrez MDM, Iribarren JA, Knobel H, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Pulido F, Ricart C, Rivero A, Santos Gil I, Blaxhult A, Flamholc L, Gisslèn M, Thalme A, Fehr J, Rauch A, Stoeckle M, Clarke A, Gazzard BG, Johnson MA, Orkin C, Post F, Ustianowski A, Waters L, Bailey J, Benson P, Bhatti L, Brar I, Bredeek UF, Brinson C, Crofoot G, Cunningham D, DeJesus E, Dietz C, Dretler R, Eron J, Felizarta F, Fichtenbaum C, Gallant J, Gathe J, Hagins D, Henn S, Henry KW, Huhn G, Jain M, Lucasti C, Martorell C, McDonald C, Mills A, Morales-Ramirez J, Mounzer K, Nahass R, Olivet H, Osiyemi O, Prelutsky D, Ramgopal M, Rashbaum B, Richmond G, Ruane P, Scarsella A, Scribner A, Shalit P, Shamblaw D, Slim J, Tashima K, Voskuhl G, Ward D, Wilkin A, de Vente J. Week 48 Resistance Analyses of the Once-Daily, Single-Tablet Regimen Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) in Adults Living with HIV-1 from the Phase III Randomized AMBER and EMERALD Trials. AIDS Res Hum Retroviruses 2020; 36:48-57. [PMID: 31516033 PMCID: PMC6944133 DOI: 10.1089/aid.2019.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is being investigated in two Phase III trials, AMBER (NCT02431247; treatment-naive adults) and EMERALD (NCT02269917; treatment-experienced, virologically suppressed adults). Week 48 AMBER and EMERALD resistance analyses are presented. Postbaseline samples for genotyping/phenotyping were analyzed from protocol-defined virologic failures (PDVFs) with viral load (VL) ≥400 copies/mL at failure/later time points. Post hoc analyses were deep sequencing in AMBER, and HIV-1 proviral DNA from baseline samples (VL <50 copies/mL) in EMERALD. Through week 48 across both studies, no darunavir, primary PI, or tenofovir resistance-associated mutations (RAMs) were observed in HIV-1 viruses of 1,125 participants receiving D/C/F/TAF or 629 receiving boosted darunavir plus emtricitabine/tenofovir-disoproxil-fumarate. In AMBER, the nucleos(t)ide analog reverse transcriptase inhibitor (N(t)RTI) RAM M184I/V was identified in HIV-1 of one participant during D/C/F/TAF treatment. M184V was detected pretreatment as a minority variant (9%). In EMERALD, in participants with prior VF and genoarchive data (N = 140; 98 D/C/F/TAF and 42 control), 4% had viruses with darunavir RAMs, 38% with emtricitabine RAMs, mainly at position 184 (41% not fully susceptible to emtricitabine), 4% with tenofovir RAMs, and 21% ≥ 3 thymidine analog-associated mutations (24% not fully susceptible to tenofovir) detected at screening. All achieved VL <50 copies/mL at week 48 or prior discontinuation. D/C/F/TAF has a high genetic barrier to resistance; no darunavir, primary PI, or tenofovir RAMs were observed through 48 weeks in AMBER and EMERALD. Only one postbaseline M184I/V RAM was observed in HIV-1 of an AMBER participant. In EMERALD, baseline archived RAMs to darunavir, emtricitabine, and tenofovir in participants with prior VF did not preclude virologic response.
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Affiliation(s)
| | - Eric Y Wong
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | - Bryan Baugh
- Janssen Research & Development LLC, Raritan, New Jersey
| | - Anne Ghys
- Janssen Pharmaceutica NV, Beerse, Belgium
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Jull J, Whitehead M, Petticrew M, Kristjansson E, Gough D, Petkovic J, Volmink J, Weijer C, Taljaard M, Edwards S, Mbuagbaw L, Cookson R, McGowan J, Lyddiatt A, Boyer Y, Cuervo LG, Armstrong R, White H, Yoganathan M, Pantoja T, Shea B, Pottie K, Norheim O, Baird S, Robberstad B, Sommerfelt H, Asada Y, Wells G, Tugwell P, Welch V. When is a randomised controlled trial health equity relevant? Development and validation of a conceptual framework. BMJ Open 2017; 7:e015815. [PMID: 28951402 PMCID: PMC5623521 DOI: 10.1136/bmjopen-2016-015815] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Randomised controlled trials can provide evidence relevant to assessing the equity impact of an intervention, but such information is often poorly reported. We describe a conceptual framework to identify health equity-relevant randomised trials with the aim of improving the design and reporting of such trials. METHODS An interdisciplinary and international research team engaged in an iterative consensus building process to develop and refine the conceptual framework via face-to-face meetings, teleconferences and email correspondence, including findings from a validation exercise whereby two independent reviewers used the emerging framework to classify a sample of randomised trials. RESULTS A randomised trial can usefully be classified as 'health equity relevant' if it assesses the effects of an intervention on the health or its determinants of either individuals or a population who experience ill health due to disadvantage defined across one or more social determinants of health. Health equity-relevant randomised trials can either exclusively focus on a single population or collect data potentially useful for assessing differential effects of the intervention across multiple populations experiencing different levels or types of social disadvantage. Trials that are not classified as 'health equity relevant' may nevertheless provide information that is indirectly relevant to assessing equity impact, including information about individual level variation unrelated to social disadvantage and potentially useful in secondary modelling studies. CONCLUSION The conceptual framework may be used to design and report randomised trials. The framework could also be used for other study designs to contribute to the evidence base for improved health equity.
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Affiliation(s)
- J Jull
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - M Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - M Petticrew
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - E Kristjansson
- Centre for Research on Educational and Community Services, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - D Gough
- Department of Social Science, Evidence for Policy and Practice Information and Co-ordinating Centre, Social Science Research Unit, University College London, London, UK
| | - J Petkovic
- Bruyère Continuing Care, Bruyère Research Institute, Elisabeth Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - J Volmink
- The South African Cochrane Center, South African Medical Research Council, Cape Town, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - C Weijer
- Rotman Institute of Philosophy, University of Western Ontario, Ontario, Canada
| | - M Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - S Edwards
- Research Ethics and Governance, University College London, London, UK
| | - L Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - R Cookson
- Centre for Health Economics, University of York, York, UK
| | - J McGowan
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - A Lyddiatt
- Cochrane Musculoskeletal Group, Ontario, Canada
| | - Y Boyer
- Brandon University, Brandon, Manitoba, Canada
| | - L G Cuervo
- Office of Knowledge Management, Bioethics and Research, Pan American Health Organization/World Health Organization, Washington, District of Columbia, USA
| | - R Armstrong
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - H White
- Campbell Collaboration, New Delhi, India
| | - M Yoganathan
- Bruyère Continuing Care, Bruyère Research Institute, Elisabeth Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - T Pantoja
- Department of Family Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - B Shea
- Bruyère Continuing Care, Bruyère Research Institute, Elisabeth Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - O Norheim
- Centre for Intervention Science in Matnernal and Child Health (CISMAC), University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - S Baird
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - B Robberstad
- Centre for Intervention Science in Matnernal and Child Health (CISMAC), University of Bergen, Bergen, Norway
- Centre for International Health, University of Bergen, Bergen, Norway
| | - H Sommerfelt
- Centre for Intervention Science in Matnernal and Child Health (CISMAC), University of Bergen, Bergen, Norway
- Centre for International Health, University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Y Asada
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - G Wells
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - P Tugwell
- Bruyère Continuing Care, Bruyère Research Institute, Elisabeth Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - V Welch
- Bruyère Continuing Care, Bruyère Research Institute, Elisabeth Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Elfekey M, McGowan J. Analysis of a New Algorithm for the Diagnosis of Syphilis Among Patients With Human Immunodeficiency Virus (HIV) Infection. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohammed Elfekey
- Infectious Diseases, Hofstra North Shore - LIJ School of Medicine, Manhasset, New York
| | - Joseph McGowan
- North Shore University Hospital, Manhasset, New York and Rebecca Schwartz, PhD, Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Hofstra Northwell School of Medicine, Manhasset, New York
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Brown JP, McGowan J, Chouial H, Capocci S, Smith C, Ivens D, Lampe F, Johnson M, Sathia L, Rodger A, Lipman M. P226 Impaired respiratory health status in the UK HIV infected population despite the use of antiretroviral therapy: Abstract P226 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Welch V, Jull J, Petkovic J, Armstrong R, Boyer Y, Cuervo LG, Edwards S, Lydiatt A, Gough D, Grimshaw J, Kristjansson E, Mbuagbaw L, McGowan J, Moher D, Pantoja T, Petticrew M, Pottie K, Rader T, Shea B, Taljaard M, Waters E, Weijer C, Wells GA, White H, Whitehead M, Tugwell P. Protocol for the development of a CONSORT-equity guideline to improve reporting of health equity in randomized trials. Implement Sci 2015; 10:146. [PMID: 26490367 PMCID: PMC4618136 DOI: 10.1186/s13012-015-0332-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health equity concerns the absence of avoidable and unfair differences in health. Randomized controlled trials (RCTs) can provide evidence about the impact of an intervention on health equity for specific disadvantaged populations or in general populations; this is important for equity-focused decision-making. Previous work has identified a lack of adequate reporting guidelines for assessing health equity in RCTs. The objective of this study is to develop guidelines to improve the reporting of health equity considerations in RCTs, as an extension of the Consolidated Standards of Reporting Trials (CONSORT). METHODS/DESIGN A six-phase study using integrated knowledge translation governed by a study executive and advisory board will assemble empirical evidence to inform the CONSORT-equity extension. To create the guideline, the following steps are proposed: (1) develop a conceptual framework for identifying "equity-relevant trials," (2) assess empirical evidence regarding reporting of equity-relevant trials, (3) consult with global methods and content experts on how to improve reporting of health equity in RCTs, (4) collect broad feedback and prioritize items needed to improve reporting of health equity in RCTs, (5) establish consensus on the CONSORT-equity extension: the guideline for equity-relevant trials, and (6) broadly disseminate and implement the CONSORT-equity extension. DISCUSSION This work will be relevant to a broad range of RCTs addressing questions of effectiveness for strategies to improve practice and policy in the areas of social determinants of health, clinical care, health systems, public health, and international development, where health and/or access to health care is a primary outcome. The outcomes include a reporting guideline (CONSORT-equity extension) for equity-relevant RCTs and a knowledge translation strategy to broadly encourage its uptake and use by journal editors, authors, and funding agencies.
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Affiliation(s)
- Vivian Welch
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - J Jull
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - J Petkovic
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - R Armstrong
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, 5/207 Bouverie St Carlton 3010, Victoria, Australia.
| | - Y Boyer
- Canada Research Chair in Aboriginal Health and Wellness, Brandon University, Manitoba, Canada.
| | - L G Cuervo
- Research Promotion and Development Office of Knowledge Management, Bioethics and Research Pan American Health Organization, World Health Organization, Washington, DC, USA.
| | - Sjl Edwards
- Research Ethics and Governance, University College London, London, England.
| | - A Lydiatt
- Cochrane Musculoskeletal Group, London, Ontario, Canada.
| | - D Gough
- Department of Social Science, University College London, London, UK.
| | - J Grimshaw
- Ottawa Hospital Research Institute, Medicine University of Ottawa, Ottawa, Canada.
| | - E Kristjansson
- School of Psychology, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - L Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. .,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada. .,Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Avenue Henri Dunant, Messa, Yaoundé, Cameroon.
| | - J McGowan
- Department of Medicine, University of Ottawa, Ontario, Canada.
| | - D Moher
- Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - T Pantoja
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Centro Médico San Joaquín Vicuña Mackenna 4686, Macul, Santiago, Chile.
| | - M Petticrew
- Department of Social and Environmental Health Research, Public Health Evaluation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England.
| | - K Pottie
- Departments of Family Medicine and Epidemiology and Community Medicine Primary Care Research Group and Equity Methods Group, Bruyere Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
| | - T Rader
- Canadian Agency for Drugs and Technology in Health, 865 Carling Ave Ottawa, Ontario, Canada.
| | - B Shea
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - M Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada.
| | - E Waters
- Public Health Insight, Melbourne School of Population and Global Health, University of Melbourne, 5/207 Bouverie St Carlton 3010, Victoria, Australia.
| | - C Weijer
- Rotman Institute of Philosophy, Western University, 1151 Richmond Street, London, Ontario, Canada.
| | - G A Wells
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - H White
- Alfred Deakin University, Geelong, Victoria, Australia.
| | - M Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - P Tugwell
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
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Griffin DO, Metzger M, Poeth K, Deng K, Dharsee A, Rico JC, McGowan J. Malignancies, Particularly B-Cell Lymphomas, Are a Frequent Cause of Mortality in Human Immunodeficiency Virus-1 Patients Despite Highly Active Antiretroviral Therapy. Open Forum Infect Dis 2015; 2:ofv147. [PMID: 26566539 PMCID: PMC4630453 DOI: 10.1093/ofid/ofv147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022] Open
Abstract
Human immunodeficiency virus (HIV)-1-infected individuals are affected by diseases at rates above those of their HIV-negative peers despite the increased life expectancy of the highly active antiretroviral therapy era. We followed a cohort of approximately 2000 HIV-1-infected patients for 5 years. The most frequent cause of death in this HIV-1-infected cohort was malignancy, with 39% of all classified deaths due to cancer. Among the cancer deaths, B-cell lymphomas were the most commonly seen malignancy, representing 34% of all cancer deaths. These lymphomas were very aggressive with a median survival of <2 months from time of diagnosis.
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Affiliation(s)
- Daniel O Griffin
- Department of Biochemistry and Molecular Biophysics ; Department of Medicine, Division of Infectious Diseases , Columbia University Medical Center ; Department of Medicine-Division of Infectious Disease , Hofstra North Shore-LIJ School of Medicine , Manhasset
| | - Michael Metzger
- Department of Biochemistry and Molecular Biophysics , Howard Hughes Medical Institute, Columbia University Medical Center , New York, New York
| | - Kaitlin Poeth
- Department of Medicine-Division of Infectious Disease , Hofstra North Shore-LIJ School of Medicine , Manhasset
| | - Kathy Deng
- Department of Medicine-Division of Infectious Disease , Hofstra North Shore-LIJ School of Medicine , Manhasset
| | - Arif Dharsee
- Department of Medicine-Division of Infectious Disease , Hofstra North Shore-LIJ School of Medicine , Manhasset
| | - Juan Carlos Rico
- Department of Medicine-Division of Infectious Disease , Hofstra North Shore-LIJ School of Medicine , Manhasset
| | - Joseph McGowan
- Department of Biochemistry and Molecular Biophysics , Howard Hughes Medical Institute, Columbia University Medical Center , New York, New York
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McCrum C, Stenner P, Defever E, Cross V, McGowan J, Moore A. Q-Methodology as a valuable research approach in physiotherapy: an illustration using a study of self-management in chronic low back pain. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1830] [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: 11/28/2022]
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Akbar H, Grala T, Vailati Riboni M, Cardoso F, Verkerk G, McGowan J, Macdonald K, Webster J, Schutz K, Meier S, Matthews L, Roche J, Loor J. Body condition score at calving affects systemic and hepatic transcriptome indicators of inflammation and nutrient metabolism in grazing dairy cows. J Dairy Sci 2015; 98:1019-32. [DOI: 10.3168/jds.2014-8584] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/03/2014] [Indexed: 12/15/2022]
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Kay JK, Loor JJ, Heiser A, McGowan J, Roche JR. Managing the grazing dairy cow through the transition period: a review. Anim Prod Sci 2015. [DOI: 10.1071/an14870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The transition period of the dairy cow generally refers to the last three weeks of gestation and the first three weeks of lactation. During this period, the dairy cow faces numerous physiological challenges, requiring both homeostatic and homeorhetic changes to support the demands of lactation. Management strategies to achieve a successful transition have developed over many decades. Historically, these strategies focussed on achieving high energy intakes pre-calving in an attempt to improve post-calving metabolism; however, more recent research has indicated that this approach may not be appropriate. Physiological and molecular data have indicated that imposing a slight negative energy balance (EBAL) pre-calving can improve post-calving EBAL, metabolic health indices and milk production. It was hypothesised that the challenges of the transition period would be less in a grazing system than in an intensive confinement system, due to the lower milk production and the difference in population density and, therefore, pathogen exposure. However, the molecular and immunological responses to the change of state are similar in magnitude in a moderate-yielding pasture-fed cow and in a high-yielding cow fed a total mixed ration. The collective data point to a peripartum immunosuppression, which is affected by body condition score and feeding level. This review will outline the literature and provide an assessment of the most recent transition cow management for grazing dairy cows.
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Dransfield A, Hines E, McGowan J, Holzman B, Nur N, Elliott M, Howar J, Jahncke J. Where the whales are: using habitat modeling to support changes in shipping regulations within National Marine Sanctuaries in Central California. ENDANGER SPECIES RES 2014. [DOI: 10.3354/esr00627] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
HIV is known to subvert cellular machinery to enhance its replication. Recently, HIV has been reported to enhance TC renin expression. We hypothesized that HIV induces and maintains high renin expression to promote its own replication in TCs. Renin enhanced HIV replication in TCs in a dose-dependent manner. (P)RR-deficient TCs, as well as those lacking renin, displayed attenuated NF-κB activity and HIV replication. TCs treated with renin and Hpr displayed activation of the (P)RR-PLZF protein signaling cascade. Renin, HIV, and Hpr activated the PI3K pathway. Both renin and Hpr cleaved Agt (a renin substrate) to Ang I and also cleaved Gag polyproteins (protease substrate) to p24. Furthermore, aliskiren, a renin inhibitor, reduced renin- and Hpr-induced cleavage of Agt and Gag polyproteins. These findings indicate that renin contributes to HIV replication in TCs via the (P)RR-PLZF signaling cascade and through cleavage of the Gag polyproteins.
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Affiliation(s)
- Nirupama Chandel
- Center of Immunology and Inflammation, Feinstein Institute for Medical Research, North Shore LIJ Hofstra Medical School, Manhasset, New York, USA; and
| | - Kamesh Ayasolla
- Center of Immunology and Inflammation, Feinstein Institute for Medical Research, North Shore LIJ Hofstra Medical School, Manhasset, New York, USA; and
| | - Xiqian Lan
- Center of Immunology and Inflammation, Feinstein Institute for Medical Research, North Shore LIJ Hofstra Medical School, Manhasset, New York, USA; and
| | - Partab Rai
- Center of Immunology and Inflammation, Feinstein Institute for Medical Research, North Shore LIJ Hofstra Medical School, Manhasset, New York, USA; and
| | - Joanna Mikulak
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Mohammad Husain
- Center of Immunology and Inflammation, Feinstein Institute for Medical Research, North Shore LIJ Hofstra Medical School, Manhasset, New York, USA; and
| | - Ashwani Malhotra
- Center of Immunology and Inflammation, Feinstein Institute for Medical Research, North Shore LIJ Hofstra Medical School, Manhasset, New York, USA; and
| | - Joseph McGowan
- Center of Immunology and Inflammation, Feinstein Institute for Medical Research, North Shore LIJ Hofstra Medical School, Manhasset, New York, USA; and
| | - Pravin C Singhal
- Center of Immunology and Inflammation, Feinstein Institute for Medical Research, North Shore LIJ Hofstra Medical School, Manhasset, New York, USA; and
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Roche J, Macdonald K, Schütz K, Matthews L, Verkerk G, Meier S, Loor J, Rogers A, McGowan J, Morgan S, Taukiri S, Webster J. Calving body condition score affects indicators of health in grazing dairy cows. J Dairy Sci 2013; 96:5811-25. [DOI: 10.3168/jds.2013-6600] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 05/25/2013] [Indexed: 11/19/2022]
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Chandel N, Husain M, Goel H, Salhan D, Lan X, Malhotra A, McGowan J, Singhal PC. VDR hypermethylation and HIV-induced T cell loss. J Leukoc Biol 2013; 93:623-31. [PMID: 23390308 PMCID: PMC3597838 DOI: 10.1189/jlb.0812383] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/02/2013] [Accepted: 01/18/2013] [Indexed: 12/16/2022] Open
Abstract
Epigenetics contributes to the development of variety of diseases by modulation of gene expression. We evaluated the effect of HIV-induced VDR methylation on loss of TCs. HIV/TC displayed enhanced VDR-CpG methylation and increased expression of Dnmt3b but attenuated expression of VDR. A demethylating agent, AZA, inhibited this effect of HIV. HIV/TC also displayed the activation of the RAS, which was reversed by EB (a VDA). Further, HIV/TCs displayed enhanced generation of ROS and induction of DSBs but attenuated DNA repair response. However, in the presence of AZA, EB, LOS (a RAS blocker), Cat, and tempol (free radical scavengers), HIV-induced TC ROS generation and induction of DSBs were attenuated but associated with enhanced DNA repair. Additionally, AZA, EB, and LOS provided protection against HIV-induced TC apoptosis. These findings suggested that HIV-induced TC apoptosis was mediated through ROS generation in response to HIV-induced VDR methylation and associated activation of the RAS.
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Affiliation(s)
- Nirupama Chandel
- Immunology Center, Feinstein Institute for Medical Research, Hofstra North Shore-Long Island Jewish Health System School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Mohammad Husain
- Immunology Center, Feinstein Institute for Medical Research, Hofstra North Shore-Long Island Jewish Health System School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Hersh Goel
- Immunology Center, Feinstein Institute for Medical Research, Hofstra North Shore-Long Island Jewish Health System School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Divya Salhan
- Immunology Center, Feinstein Institute for Medical Research, Hofstra North Shore-Long Island Jewish Health System School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Xiqian Lan
- Immunology Center, Feinstein Institute for Medical Research, Hofstra North Shore-Long Island Jewish Health System School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Ashwani Malhotra
- Immunology Center, Feinstein Institute for Medical Research, Hofstra North Shore-Long Island Jewish Health System School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Joseph McGowan
- Immunology Center, Feinstein Institute for Medical Research, Hofstra North Shore-Long Island Jewish Health System School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Pravin C. Singhal
- Immunology Center, Feinstein Institute for Medical Research, Hofstra North Shore-Long Island Jewish Health System School of Medicine at Hofstra University, Hempstead, New York, USA
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McGowan J, Smith CD, Maize J, Cook J. Giant fibrous hamartoma of infancy: A report of two cases and review of the literature. J Am Acad Dermatol 2011; 64:579-86. [DOI: 10.1016/j.jaad.2009.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 09/05/2009] [Accepted: 09/17/2009] [Indexed: 10/19/2022]
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McGowan J. Developing desirable behaviour in an emergency. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.137] [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: 11/28/2022]
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Barton P, McGowan J. A survey of undergraduate resuscitation training in UK medical schools. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Poterjoy BS, Vibert Y, Sola-Visner M, McGowan J, Visner G, Nogee LM. Neonatal respiratory failure due to a novel mutation in the surfactant protein C gene. J Perinatol 2010; 30:151-3. [PMID: 20118944 DOI: 10.1038/jp.2009.97] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 11/09/2022]
Abstract
A full-term infant developed respiratory distress immediately after birth, requiring a prolonged course of extra-corporeal membrane oxygenation, followed by high-frequency ventilation. She was unable to wean off mechanical ventilation, required tracheostomy, and ultimately lung transplantation. A novel mutation in the surfactant C protein gene was identified as the cause of her lung disease.
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Affiliation(s)
- B S Poterjoy
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA 19134, USA.
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Looker AC, Melton LJ, Harris T, Borrud L, Shepherd J, McGowan J. Age, gender, and race/ethnic differences in total body and subregional bone density. Osteoporos Int 2009; 20:1141-9. [PMID: 19048179 PMCID: PMC3057045 DOI: 10.1007/s00198-008-0809-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
Abstract
SUMMARY Total body bone density of adults from National Health and Nutrition Examination Survey (NHANES) 1999-2004 differed as expected for some groups (men>women and blacks>whites) but not others (whites>Mexican Americans). Cross-sectional age patterns in bone mineral density (BMD) of older adults differed at skeletal sites that varied by degree of weight-bearing. INTRODUCTION Total body dual-energy X-ray absorptiometry (DXA) data offer the opportunity to compare bone density of demographic groups across the entire skeleton. METHODS The present study uses total body DXA data (Hologic QDR 4500A, Hologic, Bedford MA, USA) from the NHANES 1999-2004 to examine BMD of the total body and selected skeletal subregions in a wide age range of adult men and women from three race/ethnic groups. Total body, lumbar spine, pelvis, right leg, and left arm BMD and lean mass from 13,091 adults aged 20 years and older were used. The subregions were chosen to represent sites with different degrees of weight-bearing. RESULTS Mean BMD varied in expected ways for some demographic characteristics (men>women and non-Hispanic blacks>non-Hispanic whites) but not others (non-Hispanic whites>Mexican Americans). Differences in age patterns in BMD also emerged for some characteristics (sex) but not others (race/ethnicity). Differences in cross-sectional age patterns in BMD and lean mass by degree of weight-bearing in older adults were observed for the pelvis, leg, and arm. CONCLUSION This information may be useful for generating hypotheses about age, race, and sex differences in fracture risk in the population.
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Affiliation(s)
- A C Looker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA.
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Papaioannou A, Kennedy CC, Cranney A, Hawker G, Brown JP, Kaiser SM, Leslie WD, O'Brien CJM, Sawka AM, Khan A, Siminoski K, Tarulli G, Webster D, McGowan J, Adachi JD. Risk factors for low BMD in healthy men age 50 years or older: a systematic review. Osteoporos Int 2009; 20:507-18. [PMID: 18758880 PMCID: PMC5104557 DOI: 10.1007/s00198-008-0720-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 06/12/2008] [Indexed: 10/21/2022]
Abstract
SUMMARY In this systematic review, we summarize risk factors for low bone mineral density and bone loss in healthy men age 50 years or older. Consistent risk factors were: age, smoking, low weight, physical/functional limitations, and previous fracture. Data specific to men has clinical and policy implications. INTRODUCTION Osteoporosis is a significant health care problem in men as well as women, yet the majority of evidence on diagnosis and management of osteoporosis is focused on postmenopausal women. The objective of this systematic review is to examine risk factors for low bone mineral density (BMD) and bone loss in healthy men age 50 years or older. MATERIALS AND METHODS A systematic search for observational studies was conducted in MEDLINE, Cochrane Database of Systematic Reviews, DARE, CENTRAL, CINAHL and Embase, Health STAR. The three main search concepts were bone density, densitometry, and risk factors. Trained reviewers assessed articles using a priori criteria. RESULTS Of 642 screened abstracts, 299 articles required a full review, and 25 remained in the final assessment. Consistent risk factors for low BMD/bone loss were: advancing age, smoking, and low weight/weight loss. Although less evidence was available, physical/functional limitations and prevalent fracture (after age 50) were also associated with low BMD/bone loss. The evidence was inconsistent or weak for physical activity, alcohol consumption, calcium intake, muscle strength, family history of fracture/osteoporosis, and height/height loss. CONCLUSION In this systematic review, we identified several risk factors for low BMD/bone loss in men that are measurable in primary practice.
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Affiliation(s)
- A Papaioannou
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Ontario, Canada.
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Waugh EJ, Lam MA, Hawker GA, McGowan J, Papaioannou A, Cheung AM, Hodsman AB, Leslie WD, Siminoski K, Jamal SA. Risk factors for low bone mass in healthy 40-60 year old women: a systematic review of the literature. Osteoporos Int 2009; 20:1-21. [PMID: 18523710 PMCID: PMC5110317 DOI: 10.1007/s00198-008-0643-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Accepted: 04/07/2008] [Indexed: 11/24/2022]
Abstract
UNLABELLED Based on a systematic review of the literature, only low body weight and menopausal status can be considered with confidence, as important risk factors for low BMD in healthy 40-60 year old women. The use of body weight to identify high risk women may reduce unnecessary BMD testing in this age group. INTRODUCTION BMD testing of perimenopausal women is increasing but may be unnecessary as fracture risk is low. Appropriate assessment among younger women requires identification of risk factors for low BMD specific to this population. METHODS We conducted a systematic literature review of risk factors for low BMD in healthy women aged 40-60 years. Articles were retrieved from six databases and reviewed for eligibility and methodological quality. A grade for overall strength of evidence for each risk factor was assigned. RESULTS There was good evidence that low body weight and post-menopausal status are risk factors for low BMD. There was good or fair evidence that alcohol and caffeine intake, and reproductive history are not risk factors. There was inconsistent or insufficient evidence for the effect of calcium intake, physical activity, smoking, age at menarche, history of amenorrhea, family history of OP, race and current age on BMD. CONCLUSIONS Based on current evidence in Caucasians, we suggest that, in healthy women aged 40-60 years, only those with a low body weight (< 70 kg) be selected for BMD testing. Further research is necessary to determine optimal race-specific discriminatory weight cut-offs and to evaluate the risk factors for which there was inconclusive evidence.
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Affiliation(s)
- E J Waugh
- Osteoporosis Research Program, Women's College Hospital, Toronto, ON, Canada.
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Abstract
Nausea and vomiting are two of the most common symptoms experienced by those with HIV. While the causes are most commonly attributed to medication side effects, infectious causes, gastroparesis and psychosomatic, therapy aimed at controlling symptoms has not been well studied. Since nausea and vomiting have been identified as the most common cause of discontinuation of highly active antiretroviral therapy (HAART) therapy, and due to the extensive morbidity associated with these symptoms, we sought to review and discuss causes and management of these symptoms in HIV-infected patients and demonstrate the need for further research in this area. Such studies could include investigation into the prophylactic use of antiemetics with initiation or modification of HAART therapy to monitor patient compliance. In addition, anticipatory nausea and vomiting should be further studied, as it could prove to be quite prevalent, as in cancer patients.
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Affiliation(s)
- S Chubineh
- Department of Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
| | - J McGowan
- Department of Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
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Abstract
INTRODUCTION Public health initiatives to immunize children and adults have effectively reduced the number of tetanus cases in the USA. However, in the Third National Health and Nutrition Examination Survey (NHANES III), immigrants from Mexico had a 67% nonprotective anti-tetanus antibody (ATA) level. Less work has been conducted among other vulnerable populations such as human immunodeficiency virus (HIV)-infected patients. The objective of this study was to measure ATA levels among the HIV immigrant population compared with US-born HIV-infected patients. METHODS A convenience sample of 158 HIV-infected individuals was recruited to determine the levels of ATA. A nonprotective level of ATA was defined as below 0.15 IU/ml. RESULTS Among the HIV-infected patients, 72% (114/158) were born in the USA. A total of 17% (27/158) lacked protective levels of ATA. A total of 6.1% (7/114) of those born in the USA lacked protection, compared to 45% (20/44) born outside the USA (p < 0.0001). CONCLUSION The results illustrate that the country of birth is an important predictor of ATA protection, even among HIV-infected patients.
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Affiliation(s)
- K Alagappan
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
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Vyas A, Harding C, McGowan J, Snare R, Bogdan D. Noradrenergic neurotoxin, N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine hydrochloride (DSP-4), treatment eliminates estrogenic effects on song responsiveness in female zebra finches (Taeniopygia guttata). Behav Neurosci 2008; 122:1148-57. [DOI: 10.1037/0735-7044.122.5.1148] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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DiPalma JA, McGowan J, Cleveland MV. Clinical trial: an efficacy evaluation of reduced bisacodyl given as part of a polyethylene glycol electrolyte solution preparation prior to colonoscopy. Aliment Pharmacol Ther 2007; 26:1113-9. [PMID: 17894653 DOI: 10.1111/j.1365-2036.2007.03459.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND In an attempt to further improve patient preparation experience with reduced volume gut lavage solutions using 2-L sulphate-free electrolyte lavage solution plus 20-mg bisacodyl (HalfLytely with Bisacodyl Tablets Bowel Prep Kit, Braintree Laboratories, Inc., Braintree, MA, USA), a low bisacodyl dose preparation was developed using 10 mg bisacodyl. AIM To compare preparation methods using the 10- or 20-mg bisacodyl with 2-L sulphate-free electrolyte lavage method. METHODS At 10 US centres, 455 patients undergoing colonoscopy for routine clinical indications were equally randomized to receive 10- or 20-mg bisacodyl with 2-L sulphate-free electrolyte lavage method. Colonoscopists rated the efficacy of colon cleansing, blinded to the preparation assignment. RESULTS Physician assessment of colon cleansing showed no difference between those randomized to receive the 10- or 20-mg bisacodyl preparations (P = 0.52). The 10-mg preparation had lower symptom scores for cramping (P < 0.001) and overall discomfort (P = 0.001). Other reported adverse experiences were few, mild and not different between groups. CONCLUSION Two-litre sulphate-free electrolyte lavage method solution with 10-mg bisacodyl is as effective as the 20-mg bisacodyl preparation for cleansing the colon prior to colonoscopy. The 10-mg bisacodyl regimen has an improved safety profile, with significantly reduced cramping, nausea and overall discomfort.
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Affiliation(s)
- J A DiPalma
- Division of Gastroenterology, College of Medicine, University of South Alabama, Mobile, AL 36693, USA
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Abstract
It has been realized for some time that the visual system performs at least two general sorts of motion processing. First-order motion processing applies some variant of standard motion analysis (i.e. spatiotemporal Fourier energy analysis) directly to stimulus luminance, whereas second-order motion processing applies standard motion analysis to one or another grossly non-linear transformation of stimulus luminance. We have developed a method for disentangling the different sorts of mechanisms that may operate in human vision to detect second-order motion. This method hinges on an empirical condition called transition invariance that may or may not be satisfied by a family psi of textures. Any failure of this condition indicates that more than one mechanism is involved in detecting the motion of stimuli composed of the textures in psi. We have shown that the family of sinusoidal gratings oriented orthogonally to the direction of motion and varying in contrast and spatial frequency is transition invariant. We modelled the results in terms of a single-channel motion computation. We have new results indicating that a specific class of textures differing in texture element density and texture element contrast decisively fails the test of transition invariance. These findings suggest that in addition to the single second-order motion channel required by our earlier results there exists at least one other second-order motion channel. We argue that the preprocessing transformation used by this channel is a pointwise non-linearity that maps stimulus contrasts of absolute value less than some relatively high threshold tau onto 0, but increases with magnitude of c-tau for contrasts. c of absolute value greater than tau.
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Affiliation(s)
- C Chubb
- Department of Psychology, Rutgers University, New Brunswick, NJ 08903
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Reaume MN, Nurbhai M, McGowan J, O'Rourke K, Moja PL, Evans WK, Graham ID, Grimshaw JM. Determining knowledge transfer gaps in the life cycle of evidence for chemotherapy in non-small cell lung cancer (NSCLC) through cumulative meta-analysis. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.6555] [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: 11/20/2022] Open
Abstract
6555 Background: The uptake of research findings into practice is often delayed (Antman et al. JAMA 1992). We investigated the relative role of evidence in determining clinical recommendations and practice for NSCLC. Novel chemotherapy agents (NCA) approved for use in Canada between 1992 and 2002 were eligible. Methods: We conducted a systematic review of evidence for vinorelbine (V), paclitaxel (P) and gemcitabine (G) in combination with a platinum agent for the treatment of advanced NSCLC. Primary endpoint of efficacy was median survival. For each included randomized controlled trial (RCT), the publications dates of abstracts and journal articles were considered. At each time point when new data was available, a new meta-analysis using the Follman methodology was performed. Bibliometric analyses were performed to identify key milestones for each drug (e.g. Health Canada Notice of Compliance, provincial drug funding, and clinical recommendations). Results: 3,399 references were obtained for NCA in advanced NSCLC. Eligibility review identified 20 references for V representing 6 RCTs (1994–2002), 16 for P representing 4 RCTs (1997–2000), and 10 for G representing 7 RCTs (1998–2003). All drugs trended towards median survival benefit throughout the time of analysis. However, over time the estimated effect for V became weaker, remained stable for P and became stronger for G. The 1997 ASCO guideline recommended V and P as standard therapy; G was only cited as a promising investigational agent. By 2003, the ASCO guideline recommended G as a standard. Only V received Ontario provincial funding in 1997, while G and P received funding in 2002 and 2003 respectively. Conclusions: This study demonstrates the relatively small pool of RCT evidence for NCAs. These three commonly used NCAs demonstrate different patterns of evolution of evidence. For advanced NSCLC, the time gap between evidence and clinical recommendations is short. Caution should be used for generating recommendations using early results, when the evidence base is not stable, which may either over or underestimate true effectiveness. No significant financial relationships to disclose.
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Affiliation(s)
- M. N. Reaume
- The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Istituto di Igiene Università degli Studi di Milan, Milan, Italy; Juravinski Cancer Centre, Hamilton, ON, Canada; Canadian Institute for Health Research, Ottawa, ON, Canada
| | - M. Nurbhai
- The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Istituto di Igiene Università degli Studi di Milan, Milan, Italy; Juravinski Cancer Centre, Hamilton, ON, Canada; Canadian Institute for Health Research, Ottawa, ON, Canada
| | - J. McGowan
- The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Istituto di Igiene Università degli Studi di Milan, Milan, Italy; Juravinski Cancer Centre, Hamilton, ON, Canada; Canadian Institute for Health Research, Ottawa, ON, Canada
| | - K. O'Rourke
- The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Istituto di Igiene Università degli Studi di Milan, Milan, Italy; Juravinski Cancer Centre, Hamilton, ON, Canada; Canadian Institute for Health Research, Ottawa, ON, Canada
| | - P. L. Moja
- The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Istituto di Igiene Università degli Studi di Milan, Milan, Italy; Juravinski Cancer Centre, Hamilton, ON, Canada; Canadian Institute for Health Research, Ottawa, ON, Canada
| | - W. K. Evans
- The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Istituto di Igiene Università degli Studi di Milan, Milan, Italy; Juravinski Cancer Centre, Hamilton, ON, Canada; Canadian Institute for Health Research, Ottawa, ON, Canada
| | - I. D. Graham
- The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Istituto di Igiene Università degli Studi di Milan, Milan, Italy; Juravinski Cancer Centre, Hamilton, ON, Canada; Canadian Institute for Health Research, Ottawa, ON, Canada
| | - J. M. Grimshaw
- The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Health Research Institute, Ottawa, ON, Canada; Istituto di Igiene Università degli Studi di Milan, Milan, Italy; Juravinski Cancer Centre, Hamilton, ON, Canada; Canadian Institute for Health Research, Ottawa, ON, Canada
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Abstract
BACKGROUND Polyethylene glycol 3350 (MiraLAX, Braintree Laboratories Inc., Braintree, MA, USA) is approved for the short-term treatment of occasional constipation. AIM To extend the safety data of polyethylene glycol used for chronic treatment of chronic constipation. METHODS Study subjects who met defined criteria for chronic constipation were enrolled in this open-labelled, single-treatment multi-centre study to receive polyethylene glycol laxative as a single daily dose of 17 g for 12 months. Subjects returned to their study centres after 2, 4, 6, 9 and 12 months of treatment where blood and urine samples were collected and adverse events were reviewed. At each visit, subjects were queried for ROME constipation criteria and they rated their overall improvement using a global efficacy scale. RESULTS 311 patients including 117, age 65 and older, were enrolled and received treatment at one of 50 centres. One hundred and eighty-four completed all 12 months of treatment. With respect to the 'Global Efficacy Assessment', depending on the month of observation, 80-88% of enrolled patients, and 84-94% of the elderly, were treated successfully. Similar results were obtained from secondary efficacy measures that assessed individual ROME constipation criteria at each visit. The response to treatment was durable over time. Over the 1-year course of study representing 218 patient-years at the labelled dose, medication-associated adverse effects were gastrointestinal complaints of diarrhoea, loose stool, flatulence and nausea. These effects were generally mild or moderate in severity. There were no clinically significant changes in haematology or blood chemistry, particularly electrolytes, for the study population as a whole or the elderly group. CONCLUSIONS Polyethylene glycol laxative is safe and effective for treating constipation in adult and elderly patients for periods up to 12 months, with no evidence of tachyphylaxis.
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Affiliation(s)
- J A Di Palma
- Division of Gastroenterology, University of South Alabama College of Medicine, Mobile, Alabama, USA.
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Nichol G, Huszti E, Rokosh J, Dumbrell A, McGowan J, Becker L. Impact of informed consent requirements on cardiac arrest research in the United States: exception from consent or from research? Resuscitation 2004; 62:3-23. [PMID: 15246579 DOI: 10.1016/j.resuscitation.2004.02.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Revised: 02/11/2004] [Accepted: 02/11/2004] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Research in patients with life-threatening illness such as cardiac arrest is challenging since they can not consent. The Food and Drug Administration addressed research under emergency conditions by publishing new criteria for exception from informed consent in 1996. We systematically reviewed randomized trials over a 10-year period to assess the impact of these regulations. METHODS Case-control study of published trials for cardiac arrest (cases) and atrial fibrillation (controls.) Studies were identified by using structured searches of MEDLINE and EMBASE from 1992 to 2002. Included were studies using random allocation in humans with cardiac arrest or atrial fibrillation prior to enrollment. Excluded were duplicate publications. Number of American trials, foreign trials and proportion of trials of American origin were compared by using regression analysis. Changes in cardiac arrest versus atrial fibrillation trials were calculated as risk differences. RESULTS Of 4982 identified cardiac arrest studies, 57 (1.1%) were randomized trials. The number of American cardiac arrest trials decreased by 15% (95% CI: 8, 22%) annually (P = 0.05). The proportion of cardiac arrest trials of American origin decreased by 16% (95% CI: 10, 22%) annually (P = 0.006). Of 5596 identified atrial fibrillation studies, 197 trials (3.5%) were randomized trials. The risk difference between cardiac arrest versus atrial fibrillation trials being of American origin decreased significantly (annual difference -5.8% (95% CI: -10, -0.1%), P = 0.03). INTERPRETATION Fewer American cardiac arrest trials were published during the last decade, when federal consent requirements changed. Regulatory requirements for clinical trials may inhibit improvements in care and threaten public health.
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Affiliation(s)
- G Nichol
- Clinical Epidemiology Program and Department of Medicine, University of Ottawa, ON, Canada.
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Kristjansson E, Robinson VA, Greenhalgh T, McGowan J, Francis D, Tugwell P, Petticrew M, Shea B, Wells G. School feeding for improving the physical and psychosocial health of disadvantaged elementary school children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2003. [DOI: 10.1002/14651858.cd004676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Farmer AP, Légaré F, McAuley LM, Thomas R, Harvey EL, McGowan J, Grimshaw JM, Wolf FM. Printed educational materials: effects on professional practice and health care outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2003. [DOI: 10.1002/14651858.cd004398] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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McGowan J. For expert literature searching, call a librarian. CMAJ 2001; 165:1301-2. [PMID: 11760973 PMCID: PMC81618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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Tugwell P, Wells G, Peterson J, Welch V, Page J, Davison C, McGowan J, Ramroth D, Shea B. Do silicone breast implants cause rheumatologic disorders? A systematic review for a court-appointed national science panel. Arthritis Rheum 2001; 44:2477-84. [PMID: 11710703 DOI: 10.1002/1529-0131(200111)44:11<2477::aid-art427>3.0.co;2-q] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assist in evaluating expert testimony and scientific evidence presented in law suits brought against silicone breast implant manufacturers, a US District Court Order established a National Science Panel to assess whether existing studies provide scientific evidence of an association between silicone breast implants and systemic classic/accepted connective disease, atypical connective disease, and certain signs and symptoms identified by plaintiffs in the law suits. Local disorders potentially associated with these implants were not addressed in this review. Therefore, we performed a systematic review of published studies on the association between silicone breast implants and systemic connective tissue disorders. METHODS Data from relevant studies (human cohort, case-control, or cross-sectional studies with > or = 10 participants and appropriate controls) were identified through literature searches of Medline, Current Contents, HealthStar, Biological Abstracts, EMBase, Toxline, and Dissertation Abstracts. Two independent reviewers, using standard collection forms, extracted data from the included studies. Adjusted relative risks (RRs) in cohort studies and odds ratios (ORs) in case-control and cross-sectional studies were reported if provided; otherwise, unadjusted RRs and ORs were calculated. RESULTS Twenty-four studies meeting inclusion criteria were identified. No association was evident between breast implants and any established or atypical connective tissue disorder. There was discordance among studies in reports of arthralgias, lymphadenopathy, myalgias, sicca symptoms, skin changes, and stiffness. CONCLUSION The panel found no evidence to support expert testimony suggesting an association between silicone breast implants and connective diseases. Discordance for symptoms may reflect differences in symptoms included in various categories, the small number of cases, and the effect of having single subjects with > 1 symptom represented in analyses of each symptom reported. The process presented here is an early example of the use of independent scientific panels to help courts clarify scientific evidence in legal proceedings.
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Affiliation(s)
- P Tugwell
- Centre for Global Health, University of Ottawa, Institute of Population Health, Ontario, Canada
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Rostom A, Wells G, Tugwell P, Welch V, Dubé C, McGowan J. The prevention of chronic NSAID induced upper gastrointestinal toxicity: a Cochrane collaboration metaanalysis of randomized controlled trials. J Rheumatol 2000; 27:2203-14. [PMID: 10990235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To review the effectiveness of common interventions for the prevention of nonsteroidal antiinflammatory drug (NSAID) induced upper gastrointestinal (GI) toxicity. METHODS Randomized controlled clinical trials (RCT) of prostaglandin analogs, H2-receptor antagonists (H2RA), or proton pump inhibitors (PPI) for the prevention of chronic NSAID induced upper GI toxicity were identified through electronic databases, the Cochrane control trials register, conference proceedings, and by contacting content experts and companies. Outcome measures investigated were endoscopic ulcers, ulcer complications, symptoms, overall dropouts, dropouts due to symptoms, and study quality. RESULTS Thirty-four RCT met the inclusion criteria. All doses of misoprostol significantly reduced the risk of endoscopic ulcers. Misoprostol 800 microg/day was superior to 400 microg/day for the prevention of endoscopic gastric ulcers (RR 0.18, RR 0.38, respectively; p = 0.0055). A dose-response relationship was not seen with duodenal ulcers. Misoprostol caused diarrhea at all doses, although significantly more at 800 than 400 microg/day (p = 0.0012). Misoprostol was the only prophylactic agent documented to reduce ulcer complications. Standard doses of H2RA were effective at reducing the risk of endoscopic duodenal (RR 0.24, 95% CI 0.10-0.57) but not gastric ulcers (RR 0.73, 95% CI 0.50-1.09). Both double dose H2RA and PPI were effective at reducing the risk of endoscopic duodenal and gastric ulcers (RR 0.44, 95% CI 0.26-0.74 and RR 0.37, 95% CI 0.27-0.51, respectively, for gastric ulcer) and were better tolerated than misoprostol. CONCLUSION Misoprostol, PPI, and double dose H2RA are effective in preventing chronic NSAID related endoscopic gastric and duodenal ulcers. Lower doses of misoprostol are less effective and are still associated with diarrhea. Only misoprostol 800 microg/day has been directly shown to reduce the risk of ulcer complications.
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Affiliation(s)
- A Rostom
- Department of Medicine, University of Ottawa, Ontario, Canada.
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Markey DW, McGowan J, Hanks JB. The effect of clinical pathway implementation on total hospital costs for thyroidectomy and parathyroidectomy patients. Am Surg 2000; 66:533-8; discussion 538-9. [PMID: 10888128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Clinical pathways have long been used to guide the delivery of patient care in varied practice settings. There is little information in the literature to document the effectiveness of pathway implementation in general surgical populations. This study reports the effect of clinical pathway implementation in two general surgical patient groups, thyroidectomy and parathyroidectomy. Clinical pathways were implemented to serve patients undergoing thyroidectomy and parathyroidectomy surgery. The effects of both clinical pathways on total hospital costs, length of hospitalization, variances, and outcomes were collected and evaluated from July 1998 through July 1999. These data were compared to data from the previous year. The average length of stay for parathyroidectomy patients decreased from 2.4 to 1.5 days (P = 0.26) for pathway patients as compared to prepathway patients. The average cost per case decreased from $5071 to $4291 (P = 0.50) for parathyroidectomy pathway versus prepathway patients. The average length of stay decrease for thyroidectomy patients was 1.4 to 1.2 (P = 0.16) for the pathway to prepathway comparison. The average cost per case decrease was minor at $4117 to $4111. Pharmacy costs and laboratory utilization were effectively reduced. Perioperative costs rose dramatically during this period, operating room/central sterile supply cost per case rose 12 per cent, anesthesia supply cost per case rose 15 per cent, and surgical pathology costs increased 110 per cent overall for both patient groups. Clinical pathway implementation has allowed us to reduce or maintain total hospital costs in the face of rising perioperative costs. We conclude that implementation of these clinical pathways has allowed us to improve consistency with which we deliver care while maintaining the quality of patient outcomes and reducing the costs of care and length of hospital stay.
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Affiliation(s)
- D W Markey
- Department of Surgery, University of Virginia Health System, Charlottesville 22908, USA
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Abstract
OBJECTIVE To determine whether the recommended method of locating finger position for chest compression in infant cardiac arrest can cause pressure on the abdomen or xiphisternum. DESIGN The length from the inter-nipple line to the xiphisternum was calculated in 30 infants. These lengths were compared with the finger position achieved by 30 adults, using the recommended method, on templates of infant chests. RESULTS The mean infant lower sternal length was 2.3 cm (95% CI 1.6). The mean distance covered by the adults fingers was 4.4 cm (95% CI 0.9). CONCLUSION If any infant in this study had chest compressions performed by any of the adults, using the recommended method, pressure would be exerted on the xiphisternum or abdomen. We suggest changing the method of locating finger position, to one using sternal anatomy.
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Affiliation(s)
- F Clements
- Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
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Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are important agents in the management of arthritic and inflammatory conditions, and are among the most frequently prescribed medications in North America and Europe. However, there is overwhelming evidence linking these agents to a variety of gastrointestinal (GI) toxicities. OBJECTIVES To review the effectiveness of common interventions for the prevention of NSAID induced upper GI toxicity. SEARCH STRATEGY A literature search was conducted, according to the Cochrane methodology for identification of randomized controlled trials in electronic databases, including MEDLINE from 1966 to January 2000, Current Contents for 6 months prior to January 2000, Embase to Febuary 1999, and a search of the Cochrane Controlled Trials Register from 1973 to 1999. Recent conference proceedings were reviewed and content experts and companies were contacted. SELECTION CRITERIA Randomized controlled clinical trials (RCTs) of prostaglandin analogues (PA), H2-receptor antagonists (H2RA) or proton pump inhibitors (PPI) for the prevention of chronic NSAID induced upper GI toxicity were included. DATA COLLECTION AND ANALYSIS Two independent reviewers extracted data regarding population characteristics, study design, methodological quality and number of patients with endoscopic ulcers, ulcer complications, symptoms, overall drop-outs, drop outs due to symptoms. Dichotomous data was pooled using Revman V3.1. Heterogeneity was evaluated using a chi square test. MAIN RESULTS Thirty-three RCTs met the inclusion criteria. All doses of misoprostol significantly reduced the risk of endoscopic ulcers. Misoprostol 800 ug/day was superior to 400 ug/day for the prevention of endoscopic gastric ulcers (RR=0.18, and RR=0. 38 respectively, p=0.0055). A dose response relationship was not seen with duodenal ulcers. Misoprostol caused diarrhea at all doses, although significantly more at 800ug/day than 400ug/day (p=0.0012). Misoprostol was the only prophylactic agent documented to reduce ulcer complications. Standard doses of H2RAs were effective at reducing the risk of endoscopic duodenal (RR=0.24; 95% CI: 0.10-0. 57) but not gastric ulcers(RR=0.73; 95% CI:0.50-1.09). Both double dose H2RAs and PPIs were effective at reducing the risk of endoscopic duodenal and gastric ulcers (RR=0.44; 95% CI:0.26-0.74 and RR=0.37;95% CI;0.27-0.51 respectively for gastric ulcer), and were better tolerated than misoprostol. REVIEWER'S CONCLUSIONS Misoprostol, PPIs, and double dose H2RAs are effective at preventing chronic NSAID related endoscopic gastric and duodenal ulcers. Lower doses of misoprostol are less effective and are still associated with diarrhea. Only Misoprostol 800ug/day has been directly shown to reduce the risk of ulcer complications.
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Affiliation(s)
- A Rostom
- University of Ottawa Department of Medicine, A1 - Endoscopy Unit, Ottawa Hospital - Civic Campus, 1053 Carling Ave., Ottawa, Ontario, Canada, K1Y-4E9.
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Abstract
BACKGROUND Osteoarthritis (OA) is a disease that affects synovial joints, which mainly causes degeneration and destruction of hyaline cartilage. To date, no curative treatment for OA exists. The primary goals for OA therapy are to relieve pain, maintain or improve functional status, and minimize deformity. Transcutaneous electrical nerve stimulation (TENS) is a noninvasive modality in physiotherapy that is commonly used to control both acute and chronic pain arising from several conditions. A number of trials evaluating the efficacy of TENS in OA have been published. OBJECTIVES To assess the effectiveness of TENS in the treatment of knee OA. The primary outcomes of interest were those described by the Outcome Measures in Rheumatology Clinical Trials (OMERACT) 3, which included pain relief, functional status, patient global assessment, and change in joint imaging for studies of one year or longer. The secondary objective was to determine the most effective mode of TENS application in pain control. SEARCH STRATEGY We searched MEDLINE, EMBASE, CINAHL, HEALTHSTAR, PEDro, Current Contents and the Cochrane Controlled Trial Register using the Cochrane Musculoskeletal Group search strategy for trials up to and including December 1999. We also hand-searched reference lists and consulted content experts. SELECTION CRITERIA Two independent reviewers selected the trials that met predetermined inclusion criteria. DATA COLLECTION AND ANALYSIS Two independent reviewers extracted the data using standardized forms and assessed the quality of randomization, blinding and dropouts. A third reviewer was consulted to resolve any differences. For dichotomous outcomes, relative risks (RR) were calculated. For continuous data, weighted mean differences (WMD) or standardized mean difference (SMD) of the change from baseline were calculated. A fixed effects model was used unless heterogeneity of the populations existed. In this case, a random effects model was used. MAIN RESULTS Seven trials were eligible to be included in this review. Six used TENS as the active treatment while one study used acupuncture-like TENS (AL-TENS). A number of 148 and 146 patients were involved in the active TENS treatment and placebo, respectively. Three studies were cross-over studies and the others were parallel group, randomized controlled trials (RCTs). Median methodological quality of these studies was two. Pain relief from active TENS and AL-TENS treatment was significantly better than placebo treatment. Knee stiffness also improved significantly in active treatment group compared to placebo. Different modes of TENS setting (High Rate and Strong Burst Mode TENS) demonstrated a significant benefit in pain relief of the knee OA over placebo. Subgroup analyses showed a heterogeneity in the studies with methodological quality of three or more and those with repeated TENS applications. REVIEWER'S CONCLUSIONS TENS and AL-TENS are shown to be effective in pain control over placebo in this review. Heterogeneity of the included studies was observed, which might be due to the different study designs and outcomes used. More well designed studies with a standardized protocol and adequate number of participants are needed to conclude the effectiveness of TENS in the treatment of OA of the knee.
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Affiliation(s)
- M Osiri
- Department of Medicine, Ottawa Hospital, General Campus, 501 Smyth Road, LM-12, Ottawa General Hospital, Ottawa, Ontario, Canada, K1H 8L6.
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Abstract
BACKGROUND Heat and cold therapy are often used as adjuncts in the treatment of rheumatoid arthritis by rehabilitation specialists. OBJECTIVES To evaluate the effects of heat and cold on objective and subjective measures of disease activity in patients with rheumatoid arthritis. SEARCH STRATEGY We searched Medline, Embase, PEDro, Current Contents, Sports Discus and CINAHL up to June 2000. The Cochrane Field of Rehabilitation and related therapies and the Cochrane Musculoskeletal Review Group were also contacted for a search of their specialized registers. Handsearching was conducted on all retrieved articles for additional articles. SELECTION CRITERIA Randomized or controlled clinical trials of ice or heat compared to placebo or active interventions in patients with rheumatoid arthritis and case-control and cohort studies were eligible. No language restrictions were applied. Abstracts were accepted. DATA COLLECTION AND ANALYSIS Two independent reviewers identified potential articles from the literature search. These reviewers extracted data using pre-defined extraction forms. Consensus was reached on all data extraction. Quality was assessed by two reviewers using a 5 point scale that measured the quality of randomization, double-blinding and description of withdrawals. MAIN RESULTS Three studies (79 subjects) met the inclusion criteria. There was no effect on objective measures of disease activity (including inflammation, pain and x-ray measured joint destruction) of either ice versus control or heat versus control. Patients reported that they preferred heat therapy to no therapy (94% like heat therapy better than no therapy). There was no difference in patient preference for heat or ice. No harmful effects of ice or heat were reported. REVIEWER'S CONCLUSIONS Since patients enjoy thermotherapy, and there are no harmful effects, thermotherapy should be recommended as a therapy which can be applied at home as needed to relieve pain. There is no need for further research on the effects of heat or cold for RA.
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Affiliation(s)
- V Welch
- Clinical Epidemiology Unit, Ottawa Hospital - Civic Campus - F6, 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y-4E9.
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