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Rose MA, Barker M, Liese J, Adams O, Ankermann T, Baumann U, Brinkmann F, Bruns R, Dahlheim M, Ewig S, Forster J, Hofmann G, Kemen C, Lück C, Nadal D, Nüßlein T, Regamey N, Riedler J, Schmidt S, Schwerk N, Seidenberg J, Tenenbaum T, Trapp S, van der Linden M. [Guidelines for the Management of Community Acquired Pneumonia in Children and Adolescents (Pediatric Community Acquired Pneumonia, pCAP) - Issued under the Responsibility of the German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Pulmonology (GPP)]. Pneumologie 2020; 74:515-544. [PMID: 32823360 DOI: 10.1055/a-1139-5132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The present guideline aims to improve the evidence-based management of children and adolescents with pediatric community-acquired pneumonia (pCAP). Despite a prevalence of approx. 300 cases per 100 000 children per year in Central Europe, mortality is very low. Prevention includes infection control measures and comprehensive immunization. The diagnosis can and should be established clinically by history, physical examination and pulse oximetry, with fever and tachypnea as cardinal features. Additional signs or symptoms such as severely compromised general condition, poor feeding, dehydration, altered consciousness or seizures discriminate subjects with severe pCAP from those with non-severe pCAP. Within an age-dependent spectrum of infectious agents, bacterial etiology cannot be reliably differentiated from viral or mixed infections by currently available biomarkers. Most children and adolescents with non-severe pCAP and oxygen saturation > 92 % can be managed as outpatients without laboratory/microbiology workup or imaging. Anti-infective agents are not generally indicated and can be safely withheld especially in children of young age, with wheeze or other indices suggesting a viral origin. For calculated antibiotic therapy, aminopenicillins are the preferred drug class with comparable efficacy of oral (amoxicillin) and intravenous administration (ampicillin). Follow-up evaluation after 48 - 72 hours is mandatory for the assessment of clinical course, treatment success and potential complications such as parapneumonic pleural effusion or empyema, which may necessitate alternative or add-on therapy.
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Affiliation(s)
- M A Rose
- Fachbereich Medizin, Johann-Wolfgang-Goethe-Universität Frankfurt/Main und Zentrum für Kinder- und Jugendmedizin, Klinikum St. Georg Leipzig
| | - M Barker
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Emil von Behring, Berlin
| | - J Liese
- Kinderklinik und Poliklinik, Universitätsklinikum an der Julius-Maximilians-Universität Würzburg, Würzburg
| | - O Adams
- Institut für Virologie, Universitätsklinikum Düsseldorf
| | - T Ankermann
- Klinik für Kinder- und Jugendmedizin 1, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - U Baumann
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - F Brinkmann
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ruhr-Universität Bochum
| | - R Bruns
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - M Dahlheim
- Praxis für Kinderpneumologie und Allergologie, Mannheim
| | - S Ewig
- Kliniken für Pneumologie und Infektiologie, Thoraxzentrum Ruhrgebiet, Bochum/Herne
| | - J Forster
- Kinderabteilung St. Hedwig, St. Josefskrankenhaus , Freiburg und Merzhausen
| | | | - C Kemen
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg
| | - C Lück
- Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden
| | - D Nadal
- Kinderspital Zürich, Schweiz
| | - T Nüßlein
- Klinik für Kinder- und Jugendmedizin, Gemeinschaftsklinikum Mittelrhein, Koblenz
| | - N Regamey
- Pädiatrische Pneumologie, Kinderspital Luzern, Schweiz
| | - J Riedler
- Kinder- und Jugendmedizin, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Österreich
| | - S Schmidt
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - N Schwerk
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - J Seidenberg
- Klinik für pädiatrische Pneumologie und Allergologie, Neonatologie, Intensivmedizin und Kinderkardiologie, Klinikum Oldenburg
| | - T Tenenbaum
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim
| | | | - M van der Linden
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Aachen
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Savic LC, Khan DA, Kopac P, Clarke RC, Cooke PJ, Dewachter P, Ebo DG, Garcez T, Garvey LH, Guttormsen AB, Hopkins PM, Hepner DL, Kolawole H, Krøigaard M, Laguna JJ, Marshall SD, Mertes PM, Platt PR, Rose MA, Sabato V, Sadleir PHM, Savic S, Takazawa T, Voltolini S, Volcheck GW. Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations. Br J Anaesth 2019; 123:e82-e94. [PMID: 30916014 DOI: 10.1016/j.bja.2019.01.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 11/30/2022] Open
Abstract
Unsubstantiated penicillin-allergy labels are common in surgical patients, and can lead to significant harm through avoidance of best first-line prophylaxis of surgical site infections and increased infection with resistant bacterial strains. Up to 98% of penicillin-allergy labels are incorrect when tested. Because of the scarcity of trained allergists in all healthcare systems, only a minority of surgical patients have the opportunity to undergo testing and de-labelling before surgery. Testing pathways can be modified and shortened in selected patients. A variety of healthcare professionals can, with appropriate training and in collaboration with allergists, provide testing for selected patients. We review how patients might be assessed, the appropriate testing strategies that can be used, and the minimum standards of safe testing.
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Affiliation(s)
- L C Savic
- Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - D A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - P Kopac
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - R C Clarke
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia
| | - P J Cooke
- Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - P Dewachter
- Service d'Anesthésie-Réanimation, Groupe Hospitalier de Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris 13, Sorbonne-Paris-Cité, Paris, France
| | - D G Ebo
- Department of Immunology, Allergology and Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium
| | - T Garcez
- Department of Immunology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - L H Garvey
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A B Guttormsen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - P M Hopkins
- Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - D L Hepner
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA
| | - H Kolawole
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; Department of Anaesthesia, Peninsula Health, Melbourne, Australia
| | - M Krøigaard
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
| | - J J Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Faculty of Medicine, Alfonso X El Sabio University, ARADyAL, Madrid, Spain
| | - S D Marshall
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; Department of Anaesthesia, Peninsula Health, Melbourne, Australia
| | - P M Mertes
- Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - P R Platt
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia
| | - M A Rose
- Department of Anaesthesia, Royal North Shore Hospital, and University of Sydney, Sydney, NSW, Australia
| | - V Sabato
- Department of Immunology, Allergology and Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium
| | - P H M Sadleir
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia; Department of Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - S Savic
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Takazawa
- Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma, Japan
| | - S Voltolini
- Allergy Unit, Policlinic Hospital San Martino, Genoa, Italy
| | - G W Volcheck
- Division of Allergic Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
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Pedersen AF, Green S, Rose MA. Failure to Investigate Anaesthetic Anaphylaxis Resulting in a Preventable Second Anaphylactic Reaction. Anaesth Intensive Care 2019. [DOI: 10.1177/0310057x1204000619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A. F. Pedersen
- Department of Anaesthesia, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - S. Green
- Department of Anaesthesia, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - M. A. Rose
- Department of Anaesthesia, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Rose MA, Anderson J, Green SL, Yun J, Fernando SL. Morphine and pholcodine-specific IgE have limited utility in the diagnosis of anaphylaxis to benzylisoquinolines. Acta Anaesthesiol Scand 2018; 62:628-634. [PMID: 29368335 DOI: 10.1111/aas.13077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/06/2017] [Accepted: 01/02/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Investigation of immediate hypersensitivity reactions in the perioperative setting involves skin testing and measurement of specific IgE (sIgE) as standard practice. In the case of the neuromuscular blocking agents (NMBAs), the main allergenic epitopes have been shown to be substituted ammonium groups. Commercial assays are available for detection of sIgE to these epitopes using morphine and pholcodine substrates but questions have been raised about the effectiveness of these assays in the diagnosis of benzylisoquinoline anaphylaxis. This study was therefore undertaken to assess the effectiveness of these assays in the diagnosis of hypersensitivity reactions to this group of NMBAs. METHODS Analysis was carried out on all available results for patients assessed at the Royal North Shore Hospital Anaesthetic Allergy Clinic during the period June 2009 to June 2016. Standardised intradermal skin tests were performed with a panel of NMBAs. Measurement of sIgE to morphine and pholcodine was performed via the Phadia ImmunoCAP® system. RESULTS For all patients with positive skin test results to NMBAs which included a benzylisoquinoline NMBA (n = 24), 75% exhibited negative sIgE to both morphine and pholcodine. Where patients were reactive to benzylisoquinoline NMBAs alone (n = 12), 100% exhibited negative sIgE results, indicating 0% sensitivity of the assays relative to skin testing, in this subgroup. CONCLUSION Use of sIgE testing to morphine and pholcodine in the assessment of NMBA immediate hypersensitivity is a valuable tool particularly in the case of reactions to the aminosteroid NMBAs. However, these assays are unreliable in detecting sensitisation to benzylisoquinoline NMBAs.
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Affiliation(s)
- M. A. Rose
- Department of Anaesthesia; Royal North Shore Hospital; Sydney NSW Australia
- University of Sydney; Sydney NSW Australia
| | - J. Anderson
- Immunorheumatology Laboratory; NSW Health Pathology-North; Sydney NSW Australia
| | - S. L. Green
- Department of Anaesthesia; Royal North Shore Hospital; Sydney NSW Australia
| | - J. Yun
- University of Sydney; Sydney NSW Australia
- Department of Immunology and Allergy; Royal North Shore Hospital; Sydney NSW Australia
| | - S. L. Fernando
- University of Sydney; Sydney NSW Australia
- Immunorheumatology Laboratory; NSW Health Pathology-North; Sydney NSW Australia
- Department of Immunology and Allergy; Royal North Shore Hospital; Sydney NSW Australia
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Scolaro RJ, Crilly HM, Maycock EJ, McAleer PT, Nicholls KA, Rose MA, The RIH. Australian and New Zealand Anaesthetic Allergy Group Perioperative Anaphylaxis Investigation Guidelines. Anaesth Intensive Care 2017; 45:543-555. [DOI: 10.1177/0310057x1704500504] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
These guidelines are a consensus document developed by a working party of the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) to provide an approach to the investigation of perioperative anaphylaxis. They focus primarily on the use of skin testing as it is the investigation with the greatest clinical utility for the identification of the likely causative agent and potentially safer alternatives. The practicalities and process of skin testing, its limitations, and the place of other tests are discussed. These guidelines also address the roles of graded challenge and in vitro testing. The implications of anaphylaxis associated with neuromuscular blocking agents, beta-lactam antibiotics, local anaesthetic agents and chlorhexidine are discussed. Evidence for the recommendations is derived from literature searches using the words skin test, allergy, anaphylaxis, anaesthesia, and each of the individual agents listed in these guidelines. The individual articles were then reviewed for suitability for inclusion in these guidelines. Where evidence was not strong, as is the situation for many perioperative agents, expert consensus from the ANZAAG working party was used. These guidelines are intended for use by specialists involved in the investigation of perioperative allergy. They have been approved following peer review by members of ANZAAG and are available on the ANZAAG website: http://www.anzaag.com/anaphylaxis-management/testing-guidelines.pdf .
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Affiliation(s)
- R. J. Scolaro
- Department of Anaesthesia, Sunshine Coast University Hospital, Birtinya, Queensland
| | - H. M. Crilly
- Department of Anaesthesia, The Tweed Hospital, Tweed Heads, New South Wales
| | - E. J. Maycock
- Honorary Anaesthetist, Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Queensland
| | - P. T. McAleer
- Anaesthetist, Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia
| | - K. A. Nicholls
- Immunologist, Department of Immunology, The Royal Melbourne Hospital, Melbourne, Victoria
| | - M. A. Rose
- Staff Anaesthetist, Department of Anaesthesia, Royal North Shore Hospital, Sydney, New South Wales
| | - R. I. H. The
- Immunology Technical Laboratory Specialist, Department of Immunology, Auckland City Hospital, Auckland, New Zealand
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Affiliation(s)
- P T McAleer
- Chair, Australian and New Zealand Anaesthetic Allergy Group Chair, Anaesthetic Allergy Subcommittee of the ANZCA Safety & Quality Committee
| | - L McNicol
- Chair, Mortality Subcommittee of ANZCA Safety & Quality Committee Chair, Victorian Consultative Council on Anaesthetic Mortality and Morbidity
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Haidar YM, Rose MA. Radiation-induced carcinosarcoma of the submandibular gland: case report and review of literature. B-ENT 2016; 12:339-343. [PMID: 29709139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Radiation-induced carcinosarcoma of the submandibular gland: case report and review of literature. Radiation-induced carcinosarcoma (RICS) of the head and neck is a very rare and extremely aggressive entity. We present the case of a 60-year-old man diagnosed with a T2N2cM0 squamous cell carcinoma at the right base of the tongue (BOT). The patient was treated with neoadjuvant chemotherapy and 3D-conformal radiotherapy (3D-CRT) to the BOT and bilateral neck. He developed left submandibular firmness five years after treatment, initially diagnosed as radiation-induced fibrosis. The increasing size of the left submandibular mass two years later prompted further imaging, which showed a 2.2x1.8 cm mass in the left submandibular region in the previously irradiated field. This was diagnosed as a radiation-induced submandibular gland malignancy. This is the first reported case of a RICS in the submandibular gland and demonstrates the importance of early workup and evaluation of submandibular gland pathology in a patient with a history of radiation for a head and neck malignancy.
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Rose MA, Christopoulou D, Myint TTH, de Schutter I. The burden of invasive pneumococcal disease in children with underlying risk factors in North America and Europe. Int J Clin Pract 2014; 68:8-19. [PMID: 23869711 PMCID: PMC4232238 DOI: 10.1111/ijcp.12234] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/19/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Characterisation of risk groups who may benefit from pneumococcal vaccination is essential for the generation of recommendations and policy. METHODS We reviewed the literature to provide information on the incidence and risk of invasive pneumococcal disease (IPD) in at-risk children in Europe and North America. The PubMed database was searched using predefined search terms and inclusion/exclusion criteria for papers reporting European or North American data on the incidence or risk of IPD in children with underlying medical conditions. RESULTS Eighteen references were identified, 11 from North America and 7 from Europe, with heterogeneous study methods, periods and populations. The highest incidence was seen in US children positive for human immunodeficiency virus infection, peaking at 4167 per 100,000 patient-years in 2000. Studies investigating changes in incidence over time reported decreases in the incidence of IPD between the late 1990s and early 2000s. The highest risk of IPD was observed in children with haematological cancers or immunosuppression. Overall, data on IPD in at-risk children were limited, lacking incidence data for a wide range of predisposing conditions. There was, however, a clear decrease in the incidence of IPD in at-risk children after the introduction of 7-valent pneumococcal conjugate vaccine into immunisation programmes, as previously demonstrated in the general population. CONCLUSION Despite the heterogeneity of the studies identified, the available data show a substantial incidence of IPD in at-risk children, particularly those who are immunocompromised. Further research is needed to determine the true risk of IPD in at-risk children, particularly in the post-PCV period, and to understand the benefits of vaccination and optimal vaccination schedules.
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Affiliation(s)
- M A Rose
- Children's Hospital, Goethe University, Frankfurt, Germany
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Rose MA, Buess J, Ventur Y, Zielen S, Herrmann E, Schulze J, Schubert R. Reference ranges and cutoff levels of pneumococcal antibody global serum assays (IgG and IgG2) and specific antibodies in healthy children and adults. Med Microbiol Immunol 2013; 202:285-94. [PMID: 23529214 DOI: 10.1007/s00430-013-0292-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
Abstract
Pneumococcal antibodies represent the acquisition of natural immunity. Determination of pneumococcal antibodies is an important screening tool for immunodeficiencies. Our study generated reference ranges and cutoff levels for pneumococcal antibody global serum assays correlated to a specific pneumococcal antibody ELISA. Specific pneumococcal antibody levels were measured from 457 children undergoing elective surgery and 46 healthy adult volunteers (88 with previous pneumococcal immunization from both groups), 22 severe immunodeficient subjects with ataxia telangiectasia (A-T, negative controls), and age-matched 36 healthy allergic asthmatics. We determined a representative panel of serotype-specific pneumococcal antibodies (serotype 4, 5, 6B, 7F, 14, 18C, 19F, 23F) by ELISA and global pneumococcal IgG and IgG2 antibodies by EIA. In vaccine-naïve healthy subjects, initial pneumococcal IgG geometric mean concentrations of 13.1 μg/ml were low in the first year of life and increased over the time, reaching adult levels (70.5 μg/ml) at age 8-12 years. In parallel, IgG2 antibodies increased from 20.7 % (0.5-1 year old) to adult proportions (>30 %) in preschoolers. Correlation between the pneumococcal IgG screening assay and specific pneumococcal antibody levels was acceptable (Pearson's coefficient r = 0.4455; p = 0.001). Cutoff levels showed high sensitivity, whereas specificity was high to moderate calculated from correlations with the specific ELISA. We provide reference ranges and cutoff levels for the interpretation of specific antibody determinations in the clinical setting. The global pneumococcal IgG/IgG2 assay is a suitable screening tool and correlates with the ELISA serotype-specific pneumococcal antibodies. However, results below our cutoff values should be re-evaluated by serotype-specific ELISA testing.
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Affiliation(s)
- M A Rose
- Department of Pulmonology, Children`S Hospital, Allergy, and Cystic Fibrosis, Goethe-University, Theodor Stern Kai 7, 60590 Frankfurt, Germany.
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Schulze J, Weber S, Oddo S, Rosewich M, Rose MA, Zielen S. [Quality of life for adolescents with vocal cord dysfunction]. Pneumologie 2012; 66:596-601. [PMID: 22872594 DOI: 10.1055/s-0032-1310105] [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: 10/28/2022]
Abstract
BACKGROUND Vocal cord dysfunction (VCD) is a functional breathing disorder. A psychosomatic aetiology has been discussed and associations with depression, anxiety disorders, and social stress have been reported. We have undertaken a screening of behavioural and emotional problems in adolescent patients using standardised questionnaires. METHODS Thirty-one patients (8 - 16 years) with the clinical suspicion of VCD were investigated using the Youth-Self-Report (YSR/11 - 18) and for the assessment of the parents we used the analoguous Child-Behaviour-Checklist (CBCL/6 - 18). YSR and CBCL contain two sub-areas: (a) competence scales that measure the child's participation in activities, social skills and school achievements and (b) items that contain subscales for emotional problems such as depressive and anxiety symptoms, conduct problems such as oppositional defiant problems and aggressive behaviour, social problems and physical complaints. RESULTS On average, the features of VCD patients were not significantly different from those of the reference population. But we did observe tendencies of psychological problems (YSR 16.7 %, CBCL 20 %) compared with the standard (2 %) in the syndrome scales of both questionnaires Adolescents reported particularly more internalising disorders such as social retreat, physical complaint and anxiety and depressive symptoms. The parents reported more often "physical complaints" (13.3 %) and "aggressive behaviour" (10 %). CONCLUSIONS We found tendencies of psychological strain, mainly social retreat, physical complaints and anxiety and depressive symptoms. Further investigations should focus on those emotional problems as well as on psychosomatically caused physical problems. Personality and psychological stress of the parents should be included in the investigation in order to evaluate the reports of the parents on higher aggressive behaviour and enhanced physical problems of their children in relation to their own psychological strain. We suggest family therapies, family counselling, or parental coaching as a therapeutic approach.
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Affiliation(s)
- J Schulze
- Pädiatrische Pneumologie, Allergologie und Mukoviszidose, Zentrum für Kinder- und Jugendmedizin, Klinikum der J. W. Goethe-Universität, Frankfurt am Main.
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Rose MA, Schubert R, Schulze J, Zielen S. Follow-up of probiotic Lactobacillus GG effects on allergic sensitization and asthma in infants at risk. Clin Exp Allergy 2012; 41:1819-21. [PMID: 22107145 DOI: 10.1111/j.1365-2222.2011.03876.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fisher M, Rose MA. Follow-up of patients after testing for anaesthetic allergy. Anaesth Intensive Care 2011; 39:1160. [PMID: 22165385] [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: 05/31/2023]
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Christmann M, Erffa SV, Rosewich M, Rose MA, Schulze J, Zielen S. [The repeatability of forced expiratory manoeuvres in 4- to 6-year-old children with intermittent bronchial asthma in healthy and in exacerbated status]. Pneumologie 2010; 64:745-51. [PMID: 20734282 DOI: 10.1055/s-0030-1255625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The question about the repeatability of forced expiratory manoeuvres in childhood lung function testing is of scientific and clinical interest. The following study investigated to what extent children ≥ 4 to < 7 years of age with intermittent bronchial asthma are able to produce reproducible lung function measurements on the one hand in the healthy status and on the other hand in an exacerbated status. METHOD 64 children at the age of ≥ 4 to < 7 years with intermittent preschool bronchial asthma performed lung function measurements in the healthy status and again in an exacerbated status. FEV (1) values from the measurements were analysed according to ATS/ERS guidelines concerning repeatability. RESULTS According to the new ATS/ERS guidelines 74.6 % of the children could perform at least 2, and 59.3 % could perform 3 repeatable measurements in the healthy status. In the exacerbated status this was 87.5 % and 68.8 %, respectively. There were no significant differences between the healthy and the exacerbated status and between the age groups. Compared to former repeatability criteria, children of this age group can perform significantly more reproducible measurements (p < 0.0001). CONCLUSION The ATS/ERS guidelines from 2007 simplify the repeatability of forced expiratory manoeuvres in children at ≥ 4 to < 7 years of age compared to the former criteria. Repeatability is not reduced in the exacerbated status. 74.6 % of children in this age group can produce repeatable lung function measurements.
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Affiliation(s)
- M Christmann
- Allergologie, Pneumologie und Mukoviszidose, Zentrum für Kinder- und Jugendmedizin, Theodor-Stern-Kai 7, Frankfurt am Main.
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Rose MA, Stieglitz F, Köksal A, Schubert R, Schulze J, Zielen S. Efficacy of probiotic Lactobacillus GG on allergic sensitization and asthma in infants at risk. Clin Exp Allergy 2010; 40:1398-405. [PMID: 20604800 DOI: 10.1111/j.1365-2222.2010.03560.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Probiotics are perceived to exert beneficial effects in the prevention and treatment of allergic diseases. OBJECTIVE There are conflicting data from studies as to an impact on allergic sensitization and asthma. METHODS Our prospective double-blind study randomly assigned 131 children (6-24 months old) with at least two wheezing episodes and a first-degree family history of atopic disease to 6 months of Lactobacillus rhamnosus (LGG, 10(10) colony forming units) or placebo. Atopic dermatitis and asthma-related events (e.g. need of inhalation, symptom-free days) were documented throughout the intervention and 6-month follow-up. We determined IgE, a representative panel of specific IgE, eosinophils, eosinophilic cationic protein, and TGF-beta before, at the end of intervention, and after 6 months of follow-up. RESULTS There were no significant differences as to atopic dermatitis or asthma-related events. In a subgroup with antecedent allergic sensitizations, asthmatic complaints were even slightly worse. We found fewer sensitizations towards aeroallergens after 6 months of LGG (P=0.027) and after 6 months of follow-up (P=0.03). Supplementation was well-tolerated and no severe adverse events occurred. CONCLUSIONS In young children with recurrent wheeze and an atopic family history, oral LGG had no clinical effect on atopic dermatitis or asthma-related events, and only mild effects on allergic sensitization. This effect persisted 6 months after the cessation of the supplementation.
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Affiliation(s)
- M A Rose
- Children's Hospital, Goethe University, Theodor Stern Kai 7, Frankfurt, Germany.
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15
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Rosewich M, Schulze J, Eickmeier O, Telles T, Rose MA, Schubert R, Zielen S. Tolerance induction after specific immunotherapy with pollen allergoids adjuvanted by monophosphoryl lipid A in children. Clin Exp Immunol 2010; 160:403-10. [PMID: 20345983 DOI: 10.1111/j.1365-2249.2010.04106.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Specific immunotherapy (SIT) is a well-established and clinically effective treatment for allergic diseases. A pollen allergoid formulated with the T helper type 1 (Th1)-inducing adjuvant monophosphoryl lipid A (MPL) facilitates short-term SIT. Little is known about mechanisms of tolerance induction in this setting. In a prospective study, 34 patients allergic to grass pollen (25 male, nine female, median age 10.2 years) received a total of 44 SIT courses (20 in the first, 24 in the second) with MPL-adjuvanted pollen allergoids. Immunogenicity was measured by levels of specific immunoglobulin G (IgG(grass)) and IgG4(grass) by antibody blocking properties on basophil activation, and by induction of CD4(+), CD25(+) and forkhead box P3 (FoxP3(+)) regulatory T cells (T(reg)). Specific IgG and IgG4 levels increased only slightly in the first year of SIT. In the second year these changes reached significance (P < 0.0001). In keeping with these findings, we were able to show an increase of T(reg) cells and a decreased release of leukotrienes after the second year of treatment. In the first year of treatment we found little evidence for immunological changes. A significant antibody induction was seen only after the second course of SIT. Short-course immunotherapy with pollen allergoids formulated with the Th1-inducing adjuvant MPL needs at least two courses to establish tolerance.
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Affiliation(s)
- M Rosewich
- Paediatric Pulmonology and Allergology, Goethe University, Frankfurt/Main, Germany.
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16
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Schubert R, Kitz R, Beermann C, Rose MA, Lieb A, Sommerer PC, Moskovits J, Alberternst H, Böhles HJ, Schulze J, Zielen S. Effect of n-3 polyunsaturated fatty acids in asthma after low-dose allergen challenge. Int Arch Allergy Immunol 2008; 148:321-9. [PMID: 19001792 DOI: 10.1159/000170386] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 06/04/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We investigated the anti-inflammatory potential of n-3 polyunsaturated fatty acids (PUFA) on specific bronchial inflammation. Allergic asthmatics were challenged using a low-dose allergen provocation model. METHODS Our parallel double-blinded study randomly assigned 23 house dust mite-allergic asthmatics (aged 22-29 years; 13 females, 10 males) to dietary supplementation with either an n-3 PUFA-enriched fat blend (0.69 g/day) or placebo for 5 weeks. After 3 weeks, the patients were challenged daily with low doses of mite allergen for 2 weeks. Primary outcome parameters were effects on lung function (forced expiratory volume in 1 s, FEV(1)) and exhaled nitric oxide (eNO) as a marker of bronchial inflammation. RESULTS Even before the bronchial challenge, eNO was significantly lower in the n-3 PUFA group (p=0.014). Levels of eNO increased during allergen exposure in both groups, but differences in means were significantly lower in the n-3 PUFA group (p=0.022). During the low-dose allergen challenge, there were no differences between the groups with regard to symptoms, FEV(1) or the allergen dose required to induce deterioration of lung function (PD(20)). Numbers of sputum eosinophils did not differ significantly, while serum eosinophils (10.1+/-0.1.84 vs. 5.79+/-0.69%) as well as changes in eosinophilic cationic protein (20.5+/-9.93 vs. -1.68+/-4.36 ng/ml) and in vitro cysteinyl leukotriene release (2,889+/-872 vs. 1,120+/-173 ng/ml) were significantly lower in the n-3 PUFA group (p<0.05 each). CONCLUSION Our results provide evidence that dietary supplementation with n-3 PUFA is able to reduce bronchial inflammation even after low-dose allergen challenge.
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Affiliation(s)
- R Schubert
- Department of Pediatrics/ZAFES, J.W. Goethe University, Frankfurt/Main, Germany
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Schubert R, Eickmeier O, Garn H, Baer PC, Mueller T, Schulze J, Rose MA, Rosewich M, Renz H, Zielen S. Safety and immunogenicity of a cluster specific immunotherapy in children with bronchial asthma and mite allergy. Int Arch Allergy Immunol 2008; 148:251-60. [PMID: 18849616 DOI: 10.1159/000161585] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 06/10/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cluster specific immunotherapy (SIT) is a modern form of allergen immunotherapy allowing safe administration of high allergen doses in a short time interval compared to classic SIT. In the current study, we investigated the safety profile and immunological effect of cluster SIT in children with allergic asthma due to house dust mite allergy. METHODS A total of 34 children (6-18 years) with allergic asthma were assigned to cluster (n = 22) or classic SIT (n = 12). To achieve a maintenance dose of allergen extract, cluster patients received 14 injections of house dust mite allergen within 6 weeks, whereas the classic SIT group received 14 injections within 14 weeks. Safety was monitored by recording adverse events. Immunogenicity was measured by specific IgG(Mite) and IgG4(Mite), by antibody-blocking properties on basophil activation, and by the T cell subset transcription factors Foxp3, T-bet, and GATA-3. RESULTS There were no significant differences in local and systemic side effects between the two groups. In the cluster group, serum levels of specific IgG(Mite) (p < 0.001) and specific IgG4(Mite) (p < 0.001) significantly increased after 8 weeks, while it took 12 weeks in the classic SIT group. These data were confirmed by blocking CD63 expression as well as release of cysteinyl leukotrienes after in vitro basophil stimulation. No differences in transcription factor expression were found in the two groups. CONCLUSION Cluster SIT is safe in children. Additionally, our data demonstrated an even more rapid induction of specific immune tolerance. Cluster SIT is an attractive alternative to conventional up-dosing schedules with fewer consultations for the patients.
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Affiliation(s)
- R Schubert
- Paediatric Pulmonology and Allergology, Department of Internal Medicine III, J.W. Goethe University, Frankfurt am Main, Germany.
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Stoehr GA, Luecken J, Zielen S, Eber SW, Borrow R, Rose MA. Mode of splenectomy and immunogenicity of meningococcal vaccination in patients with hereditary spherocytosis. Br J Surg 2007; 95:466-71. [PMID: 18161897 DOI: 10.1002/bjs.6008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Splenectomy predisposes patients to invasive disease from pneumococci, meningococci, and Haemophilus influenzae; immunization is mandatory. However, data on the impact of the splenectomy on vaccine immunogenicity are scarce.
Methods
A total of 41 children with hereditary spherocytosis (aged 5·8–14·4 years) had complete (16) or near-total (25) splenectomy. All received one dose of monovalent meningococcal C conjugate vaccine (MCV-C) and, 2 months later, a tetravalent meningococcal polysaccharide vaccine (MPV-ACWY). Serum bactericidal activity and antibodies against serogroups A and C were determined before and after they received MCV-C, and 4 weeks after they received MPV-ACWY.
Results
Before vaccination, only four of the 16 children who had a complete splenectomy were protected against serogroup A, compared with 15 of the 25 who had near-total splenectomy (P < 0·050), with the latter responding to immunization with significantly higher serogroup A serum bactericidal activity: geometric mean (95 per cent confidence interval) 1625.5 (49.9 to 3201.1) versus 980.6 (2.00 to 6204.1) (P < 0·050). All patients achieved putative protective serum bactericidal activity titres (at least 8) against serogroup C.
Conclusion
Near-total splenectomy provides a favourable immunological basis for natural and vaccine-induced protection against meningococcal serogroup A and C infections. Sequential meningococcal vaccination is immunogenic in patients splenectomized for hereditary spherocytosis.
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Affiliation(s)
- G A Stoehr
- Department of Surgery, Georg August University, Goettingen, Germany
| | - J Luecken
- Department of Surgery, Georg August University, Goettingen, Germany
| | - S Zielen
- Children's Hospital, Goethe University, Frankfurt, Germany
| | - S W Eber
- Children's Hospital, Technical University, Munich, Germany
| | - R Borrow
- Vaccine Evaluation Unit, Health Protection Agency North West, Manchester Royal Infirmary, Manchester, UK
| | - M A Rose
- Children's Hospital, Goethe University, Frankfurt, Germany
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Abstract
The present study investigated whether single-dose oral leukotriene receptor antagonists as add-on therapy to short-acting beta-agonists, immediately after allergen challenge, block the late-phase airway response. In total, 35 mild asthmatics (mean age 24 yrs, 19 males) sensitised for house dust mites underwent two courses of bronchial allergen challenge. After the early allergic response (EAR), subjects received salbutamol once and were randomly assigned to either 10 mg of montelukast or placebo (double-blind crossover). To identify a late allergic response, forced expiratory volume in one second (FEV(1)) was monitored over the following 8 h. Baseline exhaled nitric oxide (NO) was determined ahead of each allergen challenge. Baseline NO levels differed significantly depending on the reaction to allergen challenge. In total, 12 subjects showed no significant response, 11 only showed an EAR, and 12 had a dual response and underwent further analysis. The area under the FEV(1) time-response curve 3-8 h after bronchial allergen challenge was -0.77+/-1.68 from the pre-challenge values on montelukast compared with -2.47+/-1.32 on placebo. The baseline exhaled NO fraction of subjects without an EAR was significantly lower than of those presenting a dual response. The results of the present study demonstrate that single-dose leukotriene receptor antagonists given orally right after the early allergic response can significantly inhibit the late allergic response after bronchial allergen challenge.
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Affiliation(s)
- M Rosewich
- Dept of Paediatrics, Frankfurt University, Frankfurt, Germany.
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20
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Reichenbach J, Schubert R, Feinberg J, Beck O, Rosewich M, Rose MA, Zielen S. Impaired interferon-gamma production in response to live bacteria and Toll-like receptor agonists in patients with ataxia telangiectasia. Clin Exp Immunol 2006; 146:381-9. [PMID: 17100756 PMCID: PMC1810411 DOI: 10.1111/j.1365-2249.2006.03221.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2006] [Indexed: 11/30/2022] Open
Abstract
Ataxia telangiectasia (AT) is a pleiotropic autosomal recessive neurodegenerative disorder with associated immunodeficiency and cancer predisposition, caused by mutational inactivation of the ATM gene. Early death usually results from lymphoreticular malignancy or recurrent, chronic respiratory infections. Immune deficiency of AT patients is heterogeneous and involves both humoral and cellular responses. Reports on the number and integrity of immunocompetent cells in AT are conflicting. In the early phase of infection, the interleukin (IL)-12/interferon (IFN)-gamma axis plays a crucial role in first-line defence against pathogens. In a whole blood assay we studied the IL-12/IFN-gamma axis in the immune response of AT cells to the Toll-like receptor agonists lipopolysaccharide and heat-killed Staphylococcus aureus, as well as whole live M. bovis bacille Calmette-Guérin (BCG). The function of AT antigen-presenting cells was normal in terms of IL-12 production, while IFN-gamma production by T and natural killer (NK) cells was severely impaired, even in the presence of adequate co-stimulation by exogenous IL-12.
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Affiliation(s)
- J Reichenbach
- Department of Immunology/Haematology/BMT, University Children's Hospital Zurich, Zurich, Zwitzerland.
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21
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Abstract
Pneumococcal vaccination is advocated for asthmatics. Although routinely performed, data supplying evidence for this recommendation are limited. We examined the immunological background of 215 asthmatic children (2-5 year old) at a university children's hospital and compared the immunogenicity of the recommended pneumococcal vaccines. Testing encompassed serum immunoglobulins, immunoglobulin G (IgG)-subclasses, and pneumococcal antibodies against serotypes 4, 6B, 9V, 14, 18C, 19F and 23F. An infection-prone subgroup received one dose of 23-valent pneumococcal polysaccharide vaccine (PPV-23; n = 38, median age 45 months) or of 7-valent conjugate vaccine (PCV-7; n = 23; median age 35 months). Pneumococcal antibodies were determined again after 4 weeks. Low immunoglobulin- and/or IgG-subclass levels were found in 27 subjects (14 infection-prone). Prevaccination pneumococcal antibody levels ranged from 0.36 to 1.06 microg/ml, depending on the serotype. The percentage of subjects with putative protective antibody levels > or =1.0 microg/ml ranged only from 19.9% to 54.1%, over all. Postvaccination, antibody geometric mean concentrations increased significantly higher in PCV-7 vaccinees for serotype 14 (p < 0.01) and 23F (p < 0.05). Now the percentage of putatively protected subjects ranged from 40.9% (serotype 6B) to 90.9% (serotype 19F) following PCV-7 compared with 31.6% (serotype 6B and 23F) to 81.6% (serotype 19F) in PPV-23 vaccinees. Our data give further evidence for pneumococcal vaccination of asthmatic children. PCV-7 is at least as immunogenic as PPV-23. Moreover, for children suffering from persistent asthma, PCV immunisation should be considered.
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Affiliation(s)
- M A Rose
- Paediatric Pulmonology, Children's Hospital, Goethe University, Frankfurt, Germany.
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22
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Zielen S, Rose MA, Bez C, Jarisch A, Reichenbach J, Hofmann D. Effectiveness of budesonide nebulising suspension compared to disodium cromoglycate in early childhood asthma. Curr Med Res Opin 2006; 22:367-73. [PMID: 16466609 DOI: 10.1185/030079906x89739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/23/2022]
Abstract
OBJECTIVE The optimal treatment for early childhood asthma remains controversial. Budesonide (BUD) has shown superiority over placebo in infants, and over disodium cromoglycate (DSCG) in children aged > 2 years. The aim of this double-blind, randomised, parallel-group study was to compare the effectiveness of nebulised BUD and DSCG in asthmatic children aged < 36 months. RESEARCH DESIGN AND METHODS 82 infants (mean age 18.0 months [range, 11.6-31.2 months]) with suspected asthma (three exacerbations of dyspnoea and wheezing during the past 12 months, with one or more exacerbations in the past 3 months) were treated for 3 months with nebulised BUD (Pulmicort Respules) 0.5 mg/2 mL bid or DSCG 20 mg/2 mL tid. Follow-up was at 6 months. MAIN OUTCOME MEASURES AND RESULTS Patients treated with BUD had a lower exacerbation rate than DSCG-treated patients after 3 months of treatment (5.4% vs. 31.7%; p = 0.003) and towards the end of follow-up (30% vs. 49%; p = 0.062). During treatment, days without cough were 80% and 65% for BUD and DSCG, respectively (p = 0.014), and nights without cough were 89% and 78%, respectively (p = 0.016). Side-effects were mild and of similar frequency in both groups. CONCLUSIONS Inhaled nebulised BUD was well tolerated and more effective than nebulised DSCG in reducing the incidence of asthma exacerbations and days with symptoms. These beneficial effects of BUD were maintained throughout the 6-month follow-up.
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Affiliation(s)
- S Zielen
- J. W. Goethe-University, Children's Hospital, Frankfurt/Main, Germany
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23
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Cranwell MP, Rose MA, Blake M. Chorioptic mange of sheep. Vet Rec 2002; 151:427. [PMID: 12403334] [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: 02/27/2023]
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Benkendorf JL, Prince MB, Rose MA, De Fina A, Hamilton HE. Does indirect speech promote nondirective genetic counseling? Results of a sociolinguistic investigation. Am J Med Genet 2002; 106:199-207. [PMID: 11778980 DOI: 10.1002/ajmg.10012] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [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
To date, research examining adherence to genetic counseling principles has focused on specific counseling activities such as the giving or withholding of information and responding to client requests for advice. We audiotaped 43 prenatal genetic counseling sessions and used data-driven, qualitative, sociolinguistic methodologies to investigate how language choices facilitate or hinder the counseling process. Transcripts of each session were prepared for sociolinguistic analysis of the emergent discourse that included studying conversational style, speaker-listener symmetry, directness, and other interactional patterns. Analysis of our data demonstrates that: 1) indirect speech, marked by the use of hints, hedges, and other politeness strategies, facilitates rapport and mitigates the tension between a client-centered relationship and a counselor-driven agenda; 2) direct speech, or speaking literally, is an effective strategy for providing information and education; and 3) confusion exists between the use of indirect speech and the intent to provide nondirective counseling, especially when facilitating client decision-making. Indirect responses to client questions, such as those that include the phrases "some people" or "most people," helped to maintain counselor neutrality; however, this well-intended indirectness, used to preserve client autonomy, may have obstructed direct explorations of client needs. We argue that the genetic counseling process requires increased flexibility in the use of direct and indirect speech and provide new insights into how "talk" affects the work of genetic counselors.
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Affiliation(s)
- J L Benkendorf
- Department of Obstetrics and Gynecology at Georgetown University Medical Center, Washington DC 20007-2197, USA.
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Abstract
Although its exact mode of action is not known, gabapentin appears to have a unique effect on voltage-dependent calcium ion channels at the postsynaptic dorsal horns and may, therefore, interrupt the series of events that possibly leads to the experience of a neuropathic pain sensation. Gabapentin is especially effective at relieving allodynia and hyperalgesia in animal models. It has been shown to be efficacious in numerous small clinical studies and case reports in a wide variety of pain syndromes. Gabapentin has been clearly demonstrated to be effective for the treatment of neuropathic pain in diabetic neuropathy and postherpetic neuralgia. This evidence, combined with its favourable side-effect profile in various patient groups (including the elderly) and lack of drug interactions, makes it an attractive agent. Therefore, gabapentin should be considered an important drug in the management of neuropathic pain syndromes.
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Affiliation(s)
- M A Rose
- Department of Anaesthesia and Pain Management, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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26
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Abstract
Native folding and splicing by the Saccharomyces cerevisiae mitochondrial bI5 group I intron RNA is facilitated by both the S. cerevisiae CBP2 and Neurospora crassa CYT-18 protein cofactors. Both protein-bI5 RNA complexes splice at similar rates, suggesting that the RNA active site structure is similar in both ribonucleoproteins. In contrast, the two proteins assemble with the bI5 RNA by distinct mechanisms and bind opposing, but partially overlapping, sides of the group I intron catalytic core. Assembly with CBP2 is limited by a slow, unimolecular RNA folding step characterized by a negligible activation enthalpy. We show that assembly with CYT-18 shows four distinctive features. (1) CYT-18 binds stably to the bI5 RNA at the diffusion controlled limit, but assembly to a catalytically active RNA structure is still limited by RNA folding, as visualized directly using time-resolved footprinting. (2) This mechanism of rapid stable protein binding followed by subsequent assembly steps has a distinctive kinetic signature: the apparent ratio of k(off) to k(on), determined in a partitioning experiment, differs from the equilibrium K(d) by a large factor. (3) Assembly with CYT-18 is characterized by a large activation enthalpy, consistent with a rate limiting conformational rearrangement. (4) Because assembly from the kinetically trapped state is faster at elevated temperature, we can identify conditions where CYT-18 accelerates (catalyzes) bI5 RNA folding relative to assembly with CBP2.
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Affiliation(s)
- A E Webb
- Department of Chemistry, University of North Carolina, Chapel Hill, NC 27599-3290, USA
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27
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Abstract
Assembly of almost all ribonucleoprotein complexes involves induced fit in the RNA and, thus, formation of one or more intermediate states. In assembly of the human signal recognition particle (SRP), we show that SRP19 binding to SRP RNA involves obligatory intermediates. An apparent discrepancy exists between the ratio of dissociation and association rate constants, determined in a partitioning experiment, and the equilibrium binding constant; this kinetic signature reflects formation of a stable intermediate in assembly of the ribonucleoprotein complex. Assembly intermediates were observed directly by time-resolved footprinting. SRP19 binds rapidly to SRP RNA to form an initial labile, but structurally specific, encounter complex involving both helices III and IV. Two subsequent steps of structural consolidation yield the native RNA-protein interface. SRP19 binding stabilizes helix IV in the region recognized by SRP54, consistent with protein-protein cooperativity mediated in part by mutual recognition of similar RNA structures. This mechanism illustrates principles general to ribonucleoprotein assembly reactions that rely on recruitment of architectural RNA binding proteins.
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Affiliation(s)
- M A Rose
- Department of Chemistry, University of North Carolina, Chapel Hill 27599-3290, USA
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28
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Abstract
This article describes an international, interdisciplinary, university partnership project to collaborate with health professionals in the city of Cluj-Napoca, Transylvania, Romania, to improve the health status of Romanian workers. Academic and service-based public health nurses from the United States used the model of community competence in outlining the nursing aspect of the project. This model guided the assessment, objectives, collaborative activities, and the outcome evaluation of the project. The dimensions of the model (e.g., commitment, self-other awareness, articulateness, conflict accommodation, management of relations with larger society, and leadership) were used within the context of the political and social environment of the international community.
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Affiliation(s)
- M G Schaal
- Department of Nursing, Thomas Jefferson University College of Health Professions, 130 South 9th Street, Philadelphia, PA 19107, USA.
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Rose MA, Frisby AJ, Hamlin MD, Jones SS. Evaluation of the effectiveness of a Web-based graduate epidemiology course. Comput Nurs 2000; 18:162-7. [PMID: 10939185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
An online epidemiology course was developed, implemented, and evaluated for graduate nursing students through the collaborative efforts of nursing faculty and information, education, and instructional design staff of the library at a health sciences university. This epidemiology course is a core curriculum course for graduate nursing students. The course was piloted with 14 students (one student in Romania); the initial online offering ran concurrently with a traditional classroom section. Extensive evaluation data were collected and analyzed to compare the effectiveness of the classroom and distance-learning formats. Areas of evaluation included objective measures, such as midterm and final examination scores and content analysis comparisons, as well as subjective ratings by the students of time commitments, course objectives, technical aspects of the web-based course, areas of satisfaction or dissatisfaction, and self-confidence regarding epidemiology and computer skills. Recommendations for course development, implementation, and evaluation for similar distance-learning courses will be included.
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Affiliation(s)
- M A Rose
- Thomas Jefferson University, College of Health Professions, Department of Nursing, Philadelphia, PA 19107, USA
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30
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Abstract
In a study to examine the coping styles and quality of life of non-parental caregivers of children with HIV/AIDS, 25 non-parental caregivers used confrontive coping most often and passive and emotive coping much less often. The two most frequently used coping styles were prayer and efforting to maintain some control over the situation. Quality of life correlations showed that support from family/friends was significantly related to all of the quality of life subscales. Time spent caring for the HIV-positive child was significantly inversely related to all aspects of quality of life. The conclusions drawn from the study were that interventions are needed to help support caregivers of children with HIV/AIDS. Examples of primary, secondary, and tertiary prevention measures for health professionals are discussed.
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Affiliation(s)
- M A Rose
- College of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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31
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Abstract
The purpose of this study was to explore the quality of life and coping styles of caregivers of children with HIV/AIDS and to identify if there were differences between mothers and alternative caregivers in these areas. There were 54 mother-caregivers and 25 alternative caregivers in the study. The alternative caregivers scored significantly higher in each area of quality of life than the mothers, except for physical health. The mothers used passive and emotive coping significantly more than the alternative caregivers. The study concluded that caregivers provide support to children with HIV/AIDS, but they also need physical and emotional support themselves. Nurses must be aware of the importance of providing interventions for these caregivers to improve coping mechanisms, decrease stress, and thereby improve their quality of life.
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Affiliation(s)
- M A Rose
- Department of Nursing, Thomas Jefferson University College of Health Professions, Philadelphia, PA, USA
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Abstract
1. Ketamine has a number of effects that suggest that it may interact with alpha- and beta-adrenoceptors. To date, the experimental evidence for this has been indirect and has been based on physiological studies using competitive blocking agents. In the present study we sought to determine from receptor binding studies whether ketamine binds directly to alpha- and beta-adrenoceptors. 2. Membrane preparations of alpha 1- and beta 2-adrenergic binding sites were obtained from urinary bladder and urethrae of sheep. These binding sites were characterized by saturation analyses using [3H]-prazosin for alpha 1-adrenoceptor binding sites and [125I]-cyanopindolol (CYP) for the beta 2-adrenoceptor binding sites. The receptors were further characterized by displacement studies using selective and non-selective antagonists. 3. Studies in which ketamine was used to displace [3H]-prazosin revealed a Kd of 3.40 +/- 1.23 x 10(-3) mol/L for ketamine binding to alpha 1-adrenoceptors. Displacement studies of [125I]-CYP by ketamine showed a Kd of 0.35 +/- 0.03 x 10(-3) mol/L for ketamine binding to beta 2-adrenoceptors. 4. We conclude that ketamine interacts directly with both alpha 1- and beta 2-adrenoceptors and that such interactions probably explain the reported effects of this agent on the vasculature and the bronchial tree.
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MESH Headings
- Adrenergic alpha-Antagonists/metabolism
- Animals
- Binding, Competitive
- Drug Interactions
- Excitatory Amino Acid Antagonists/metabolism
- Excitatory Amino Acid Antagonists/pharmacology
- Iodine Radioisotopes
- Iodocyanopindolol
- Ketamine/metabolism
- Ketamine/pharmacology
- Kinetics
- Pindolol/analogs & derivatives
- Pindolol/metabolism
- Prazosin/metabolism
- Receptors, Adrenergic, alpha-1/drug effects
- Receptors, Adrenergic, alpha-1/metabolism
- Receptors, Adrenergic, beta-2/drug effects
- Receptors, Adrenergic, beta-2/metabolism
- Sheep
- Stimulation, Chemical
- Substrate Specificity
- Tritium
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Affiliation(s)
- R K Bevan
- University Department of Surgery, Prince Henry's Hospital, Sydney, New South Wales, Australia
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33
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Patrick DL, Richardson M, Starks HE, Rose MA, Kinne S. Rethinking prevention for people with disabilities. Part II: A framework for designing interventions. Am J Health Promot 1997; 11:261-3. [PMID: 10172933 DOI: 10.4278/0890-1171-11.4.261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D L Patrick
- Center for Disability Policy and Research, University of Washington, Seattle 98195-7660, USA
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Abstract
The purpose of this study was to examine the effect of an age-specific AIDS education program on HIV/AIDS knowledge, perceived susceptibility to AIDS, and perceived severity of AIDS in older adults. The health belief model served as a framework. The age-specific AIDS education program was developed based on a knowledge, beliefs, and behaviors survey of 458 older adults at senior citizen centers. The program included case study presentations of actual older people with AIDS along with an emphasis on myths identified in the initial survey. There was a significant increase in total knowledge about AIDS (p < .001), perceived susceptibility (p < .01), and perceived severity (p < .001) after the educational program. Based on the results of this study, nurses are in an excellent position to provide primary and secondary AIDS prevention strategies for all age groups, including the older adult population.
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Affiliation(s)
- M A Rose
- Allegheny University of the Health Sciences, School of Nursing, Philadelphia, PA 19102, USA
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Minoia J, Rose MA. Attitudes toward condom use among female college students. J N Y State Nurses Assoc 1996; 27:4-7. [PMID: 9060717] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to explore attitudes toward condom use, identify the frequency of condom usage, and examine the relationship between attitudes and condom use among sexually active female college students. This descriptive study used a convenience sample of 47 female college students attending a rural county family planning clinic. Students who reported condom use scored significantly higher on the Condom Attitudes Scale than those not using condoms. Other significant differences between condom and noncondom users were noted. The results provide insight into strategies for improving safer sexual behavior through nursing interventions for college populations.
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Affiliation(s)
- J Minoia
- Cortland County Health Department, Jacobus Center for Reproductive Health, USA
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Abstract
This descriptive study explored the quality of life and coping methods of HIV positive women (N = 52) with children. The sample consisted of women with HIV/AIDS who answered an adapted Padilla Quality of Life Index and the Jalowiec Coping Scale. Among the psychological, physical, and social quality of life subscales, social quality of life was rated highest and the psychological scale rated the lowest. Among the three styles of coping, confrontive was used most frequently, passive and emotive less frequently. Significant relationships between coping and quality of life were examined. It is essential that nurses working with women with HIV disease be aware of their common concerns and provide effective strategies to improve quality of life such as enhancing decision making and coping skills within the context of the family unit.
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Affiliation(s)
- M A Rose
- School of Nursing, Medical College of Pennsylvania/Hahnemann University, Philadelphia, USA
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Affiliation(s)
- M A Rose
- Medical College of Pennsylvania/Hahneman University School of Nursing in Philadelphia, USA
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Rose MA, Shrader-Bogen CL, Korlath G, Priem J, Larson LR. Identifying patient symptoms after radiotherapy using a nurse-managed telephone interview. Oncol Nurs Forum 1996; 23:99-102. [PMID: 8628716] [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: 02/01/2023]
Abstract
PURPOSE/OBJECTIVES To identify patients' symptoms following completion of radiotherapy for common cancers by a nurse-managed telephone interview. DESIGN Quality assurance project. SETTING Radiation therapy department in a community hospital in a large midwestern city. SAMPLE One hundred eleven patients treated by radiotherapy for primary cancer of the prostate, head/neck, lung, and breast. METHODS Two time points of data collection: nurses completed an end-of-treatment symptom evaluation within the last five days of treatment and conducted telephone interviews 14-21 days post-therapy. Interview questions were based on each individual's end-of-treatment symptoms and common site-specific side effects. MAIN RESEARCH VARIABLES Symptoms at end of treatment and 14-21 days after therapy completion, nursing assessments and interventions, and length of telephone interview. FINDINGS At the end of treatment, 104 (94%) patients were experiencing symptoms. Nurses contacted 106 (95%) patients by telephone 14-21 days after therapy completion and assessed symptoms in 84 (79%) patients. Nineteen (18%) patients reported the development of a new symptom. Nurses independently managed 95% of the calls. CONCLUSIONS The majority of patients experienced symptoms in the immediate post-therapy period. Telephone follow-up interviews served as a mechanism for evaluating short-term morbidity and provided the opportunity for nurses to intervene with many patients. IMPLICATIONS FOR NURSING PRACTICE A nurse-managed telephone follow-up program can be used as a component of a quality improvement process in radiation centers to assess patients' post-treatment symptoms and provide education and support.
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Affiliation(s)
- M A Rose
- Hollings Cancer Center, Medical University of South Carolina, Charleston, USA
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39
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Rose MA. Knowledge of human immunodeficiency virus and acquired immunodeficiency syndrome, perception of risk, and behaviors among older adults. Holist Nurs Pract 1995; 10:10-7. [PMID: 7593362 DOI: 10.1097/00004650-199510000-00004] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In a study of knowledge and beliefs about human immunodeficiency virus among older persons, 458 senior center participants completed a questionnaire derived from the Health Belief Model. The older adults had a fairly good knowledge base about acquired immunodeficiency syndrome (AIDS). Although they recognized the seriousness of the disease, they generally did not believe that they were susceptible to AIDS. Those who expressed an interest in receiving AIDS education had significantly higher perceived susceptibility scores than those who did not. African American respondents were statistically more interested in AIDS education than white or Hispanic respondents. Recommendations for interventions and further research are discussed.
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Abstract
BACKGROUND The accuracy and completeness of oncology (tumor) registry patient follow-up information directly affects the validity of the oncology registry system for determining outcomes, as a quality assurance measure, and for research activities. At this institution, if a hospital-based patient encounter has not been identified during the previous year, a follow-up letter is sent to the attending physician to obtain current information about the patient. Difficulties using this method include (1) correct identification of the appropriate physician (2) constraints on physician and staff time to provide information, and (3) accuracy, currentness, and completeness of information provided. METHODS A study was conducted to compare the accuracy and completeness of the oncology registry patient follow-up information obtained from three sources: responses from the patient, responses from the physician, and affiliated clinic chart reviews. Seven hundred ninety-one patient and physician letters were sent during a 2-month period, and 122 clinic charts were reviewed. RESULTS Physicians responded more frequently than patients (82% vs. 58%) (P < 0.003). From the responses received, requested information regarding recurrence, treatment, quality of survival, and survival was obtained most frequently from patients. However, it was difficult to ascertain information about cancer status from patient responses. Patients supplied more current follow-up information than physicians or the clinic chart reviews. CONCLUSIONS A follow-up system that delivers accurate and complete information while maintaining efficiency is a critical aspect of an oncology registry. Requesting follow-up information from the patient before physician contact or chart review allows for more current information while maintaining accuracy regarding cancer recurrence, treatment, quality of survival, and survival. Consequently, staff time required for obtaining follow-up information from physicians and/or chart reviews is lessened and costs decreased.
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Affiliation(s)
- C L Murray
- Park Nicollet Medical Center, Minneapolis, Minnesota, USA
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Abstract
STUDY OBJECTIVE To identify the oncology patient population presenting to the emergency department and examine the causes and clinical management of oncology symptoms in the ED. DESIGN Retrospective review of 5,640 adult patients, with the following variables identified for oncology patients presenting to the ED: age, sex, cancer type, cancer stage, previous cancer treatment, previous hospitalization, presenting symptoms, treatment provided in the ED, admission and discharge data, and day, time, and length of ED visit. SETTING Community teaching hospital with annual ED census of 31,000. PARTICIPANTS All adult oncology patients who presented to the ED during the study period. We identified these patients by cross-referencing ED logs and tumor registry records. RESULTS Cancer history was identified for 284 of the 5,640 adult ED admissions (5%). Forty-three percent (n = 122) of the 284 patients with cancer history had an oncology-related ED visit. The most common symptoms of these patients were gastrointestinal (48%), pain (40%), neurologic (38%), cardiac (25%), and pulmonary (23%). Ten percent of patients with oncology-related ED visits died during the admission, and 48% died within 1 year of the ED visit. CONCLUSION Oncology patients present to the ED with symptoms of undiagnosed malignancy, complications of cancer treatment, and acute disease-related symptoms. Knowledge of an individual's cancer history and ability to recognize oncologic symptoms are important to the management of oncology patients.
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Affiliation(s)
- K K Swenson
- Methodist Hospital Cancer Program, HealthSystem Minnesota, Minneapolis, USA
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Larson-Presswalla J, Rose MA, Cornett P. Empathic learning: an innovative teaching strategy to improve attitudes toward caring for persons with HIV/AIDS. J Assoc Nurses AIDS Care 1995; 6:19-22. [PMID: 7662924 DOI: 10.1016/s1055-3290(95)80013-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The authors conducted a pretest-posttest experimental study to explore the effect of an innovative teaching strategy ("The Circle of Life") on nursing students' knowledge, attitudes, and concerns about caring for persons with AIDS (PWAs). The students (N = 43) who participated in the intervention demonstrated a statistically significant improvement in attitudes toward PWAs. Interventions such as this one, which engage the affective response, have potential for improving attitudes toward caring for individuals with stigmatizing conditions.
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Beard C, Buswell L, Rose MA, Noll L, Johnson D, Coleman CN. Phase II trial of external beam radiation with etanidazole (SR 2508) for the treatment of locally advanced prostate cancer. Int J Radiat Oncol Biol Phys 1994; 29:611-6. [PMID: 7516321 DOI: 10.1016/0360-3016(94)90467-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the efficacy and toxicity of the addition of etanidazole (ETA) to external beam radiation. METHODS AND MATERIALS Fifty eight previously untreated patients with locally advanced adenocarcinoma of the prostate were entered on a Phase II trial of etanidazole (ETA) combined with standard external beam radiation therapy. ETA was given concurrently with irradiation. Four patients received less than 25% of the intended dose of ETA and were ineligible for further analysis. The stage of the remaining patients were T2c-11, T3-39, T4-1, bulky local recurrence after prostatectomy-1, and T3, N1-2. RESULTS Forty-five of 54 patients (83.3%) achieved a clinical complete response (CCR) in the prostate and seminal vesicles as judged by digital rectal exam (DRE). Responses were rapid with a median time to CCR of 3.4 months, range 0-22.8 months. Local control was maintained in 82% of the patients who achieved a CCR. Fifteen of 32 eligible patients with a normal DRE underwent prostate biopsies from 12-20 months after treatment, seven had negative biopsies (46.6%). Distant metastases occurred in 18 patients (33.3%). Pretreatment prostatic specific antigen (PSA), Gleason score, and stage were not associated with treatment outcome in a univariate analysis. CONCLUSION While ETA plus radiation was associated with a rapid CCR, the overall treatment outcome of these patients appeared to be similar to published reports of patients receiving RT alone. The rapid response rate may imply biologic activity of the ETA. In future trials, it may be reasonable to focus on patients at lower risk for the subsequent development of distant disease.
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Affiliation(s)
- C Beard
- Joint Center for Radiation Therapy, Harvard Medical School, Boston, MA 02115
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44
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Rose MA. Health concerns of women with HIV/AIDS. J Assoc Nurses AIDS Care 1993; 4:39-45. [PMID: 8400159] [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: 01/30/2023]
Abstract
The author's purpose was to explore the health concerns of women with HIV/AIDS. Eleven HIV-positive women were interviewed using the Omaha System to organize the interview data for content analysis. Data were classified into environmental, health-behavioral, physiological, and psychosocial concerns. Comparisons of the African-American and white women presented more similarities than differences, except for noncompliance with zidovudine therapy. Implications of this study for health professionals include the need to identify support systems for women with HIV/AIDS, to identify ways to encourage women to focus on their own health, to assess for depression and suicide risk, and to refer to appropriate community resources in a timely fashion.
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Affiliation(s)
- M A Rose
- University of South Florida College of Nursing, Tampa
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Abstract
This investigation evaluated the effect of a peer-education program on preventing cardiovascular disease in older persons. Peer leaders at two urban senior housing residences were provided with training on cardiovascular disease and its risk factors, strategies to reduce the risk factors, and communication skills. Baseline and follow-up data were collected on residents at the two intervention and two control sites. The dependent variables were knowledge of cardiovascular disease risk factors; perceived self-efficacy to reduce calories, dietary fat and salt intake, to lose weight, to stop smoking, and to exercise regularly; and self-reported cardiovascular risk behaviors. Analysis of individual change scores between baseline and follow-up surveys showed a statistically significant increase in overall knowledge of heart disease, dietary self-efficacy, and exercise self-efficacy for the intervention group compared with the control group. This program appeared to benefit the individuals who lived in housing residences where the peer educators also resided.
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Affiliation(s)
- M A Rose
- University of South Florida, College of Nursing, Tampa 33612
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46
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Rose MA, Alexander KJ. Implementation issues in home healthcare universal precautions. J Nurs Adm 1992; 22:51-6. [PMID: 1469488] [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: 12/27/2022]
Abstract
Universal precautions in home healthcare are essential, yet cost and compliance monitoring are major barriers to their implementation. To help administrators ensure adherence to universal precautions, the authors present specific strategies, including management commitment, a comprehensive training program sensitive to the educational level of the employee, and participation of employees in the continuing implementation and evaluation of the universal precautions policy.
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Affiliation(s)
- M A Rose
- University of South Florida, College of Nursing, Tampa
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Coleman CN, Buswell L, Noll L, Riese N, Rose MA. The efficacy of pharmacokinetic monitoring and dose modification of etanidazole on the incidence of neurotoxicity: results from a phase II trial of etanidazole and radiation therapy in locally advanced prostate cancer. Int J Radiat Oncol Biol Phys 1992; 22:565-8. [PMID: 1310497 DOI: 10.1016/0360-3016(92)90877-k] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Fifty-four patients have been entered on a Phase II trial to study the efficacy of etanidazole (ETA) for locally advanced prostate cancer. The primary goal was to study the incidence of and time to a complete response for patients receiving ETA and radiation therapy. The secondary goal was to prospectively evaluate the utility of pharmacokinetic monitoring and dose-modification of the incidence and severity of the dose-limiting peripheral neurotoxicity. Within a constant radiation therapy regimen, the dose of ETA was either (a) unmodified (2 g/m2, 3 times weekly for 17 doses); (b) altered by a schedule modification of either number of doses or dose adjustment; or (c) individualization of single dose size so that the total number of doses (19 doses) were maintained but the single dose size was adjusted to keep the total AUC of plasma concentration versus time to less than 40 mM-hr. Sufficient efficacy data are not yet available. The use of drug dose modification has reduced the incidence of neurotoxicity from (a) unmodified: 17/26 = 65% (1 grade II); (b) schedule adjustment: 5/9 = 55% (no grade II); and (c) individualized dose modification: 1/19 (no grade II) = 6%. The minimum number of time points needed to accurately assess the AUC will be determined. Pharmacokinetic monitoring will be important in the use of ETA so that drug underdosing can be avoided while minimizing the risk of serious neurotoxicity.
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Affiliation(s)
- C N Coleman
- Joint Center for Radiation Therapy, Harvard Medical School, Boston, MA 02115
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Rose MA. Intervention strategies for smoking cessation. The role of oncology nursing. Cancer Nurs 1991; 14:225-31. [PMID: 1933841] [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: 12/29/2022]
Abstract
The role of oncology nurses concerned with the health effects of cigarette smoking may often be defined as dealing with the morbidity and mortality associated with tobacco use--caring for individuals diagnosed with tobacco-related malignancies. As current treatment methods of many of these malignancies offer little hope of cure, oncology nurses need to diverge from these traditional roles and include a focus on primary prevention activities. An essential component of these activities is a knowledge of smoking cessation education strategies and an understanding of the methods that motivate and assist individuals to quit smoking.
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Affiliation(s)
- M A Rose
- Methodist Hospital Cancer Center, Minneapolis, MN 55440
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50
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Olivotto IA, Rose MA, Osteen RT, Love S, Cady B, Silver B, Recht A, Harris JR. Late cosmetic outcome after conservative surgery and radiotherapy: analysis of causes of cosmetic failure. Int J Radiat Oncol Biol Phys 1989; 17:747-53. [PMID: 2777664 DOI: 10.1016/0360-3016(89)90061-8] [Citation(s) in RCA: 203] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Although the majority of patients with early breast cancer treated with conservative surgery and radiotherapy have acceptable cosmetic outcomes, the specific causes of a less-than-acceptable result are not well known. To assess the technical factors associated with late cosmetic failure, we reviewed the records of 593 patients treated with conservative surgery and radiotherapy at the Joint Center for Radiation Therapy, Boston, between 1968 and 1981. Median follow-up was 76 months with a range of 37-186 months. Using a 4-point scoring system (excellent, good, fair, poor) patients were noted to have cosmetic "failure" if scored as either fair or poor. Cosmetic results were similar at 3, 5, and 7 years with excellent or good scores seen in 88%, 90%, and 78% of patients, respectively. Three technical factors were associated with a significant worsening of the cosmetic results. The resection of 70 cm3 or more of breast tissue was more common among the failed patients than among matched patients with good or excellent results (p = 0.03). Eighty-nine percent of patients treated with a tangent pair technique had excellent results at 5 years compared to 69% of patients treated with a three-field technique (p = 0.004). The use of a larger volume implant was associated with a greater risk of a fair or poor cosmetic result compared to the use of a smaller volume implant. We conclude that overall cosmesis has been acceptable in this series, but there are technical (surgery and radiotherapy) factors which can be modified to optimize the cosmetic result without compromising local tumor control.
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Affiliation(s)
- I A Olivotto
- Division of Radiation Oncology, Cancer Control Agency of British Columbia, Vancouver, Canada
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