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Serruys PW, Gao C, Ninomiya K, Hara H, Garg S, Onuma Y, Kappetein AP, Mohr FW, Mack M. Ten years survival benefit of CABG or PCI based on individual prediction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
To compare the observed and individual predicted mortalities according to the SYNTAX score II 2020 (SSII-2020) in the all-comers SYNTAX population, and retrospectively assess the appropriateness of revascularization with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three vessel disease (3VD) and/or left main disease (LMCAD).
Methods
Internal and external validation of the SSII-2020 to predict 10-year all-cause death was performed in the respective randomized and registry SYNTAX populations. Differences in individual predicted mortalities following CABG or PCI were ranked and displayed with the observed mortalities. The proportions of screened patients deriving a survival benefit from CABG or PCI were determined retrospectively.
Results
A total of 2602 participants (as-treated population) were included in the randomized and registry cohorts. In the randomized cohort, all-cause mortality at 10 years, as an average treatment effect, was 23.8% (199/865) with CABG and 28.6% (249/901) with PCI, with a differential survival benefit of 4.6% (95% CI: 0.58% to 8.7%, log-rank p value=0.023). In the CABG and PCI registries, mortalities were 27.8% (167/644) and 55.4% (99/192), respectively. Calibration and discrimination of the SSII-2020 was helpful in CABG and PCI patients in the randomized and registry cohorts. In the PCI registry, the SSII-2020 underestimated mortality since specific comorbidities that entail high mortality are not included in the formula (C-index: 0.72, intercept: 0.38, slope: 0.66), whilst in the CABG registry, it predicted mortality with a helpful calibration and discrimination (C-index: 0.70, intercept: 0.00, slope: 0.76). The proportions of patients with a predicted survival benefit following CABG and PCI were respectively 78.3% (1383/1766) and 21.7% (383/1766) in the randomized cohort, and 82.4% (2143/2602) and 17.7% (459/2602) in the whole SYNTAX trial population.
Conclusion
In the randomized and registry cohort of this all-comers population with 3VD and/or LMCAD, there was reasonable agreement between the individual predicted and observed mortalities after CABG or PCI, such that the predicted 10-year survival benefit might be helpful in determining the appropriateness of each modality of revascularization.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The SYNTAX Extended Survival study was supported by the German Foundation of Heart Research (Frankfurt am Main, Germany). The SYNTAX trial, during 0-5 years follow-up, was funded by Boston Scientific Corporation (Marlborough, MA, USA). Both sponsors had no role in the study design, data collection, data analyses, and interpretation of the study data, nor were involved in the decision to publish the final manuscript. The principal investigators and authors had complete scientific freedom.
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Affiliation(s)
- P W Serruys
- National University of Ireland , Galway , Ireland
| | - C Gao
- National University of Ireland , Galway , Ireland
| | - K Ninomiya
- National University of Ireland , Galway , Ireland
| | - H Hara
- National University of Ireland , Galway , Ireland
| | - S Garg
- Royal Blackburn Hospital , Blackburn , United Kingdom
| | - Y Onuma
- National University of Ireland , Galway , Ireland
| | - A P Kappetein
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - F W Mohr
- Heart Center of Leipzig , Leipzig , Germany
| | - M Mack
- Baylor Scott and White The Heart Hospital , Plano , United States of America
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Mack M, Luzum M, Wesorick DH. Annals for Hospitalists - July 2022. Ann Intern Med 2022. [PMID: 35849838 DOI: 10.7326/awho202207190] [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)
- Megan Mack
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - Matthew Luzum
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - David H Wesorick
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
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3
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Mack M, Luzum M, Wesorick DH. Annals for Hospitalists - May 2022. Ann Intern Med 2022. [PMID: 35576603 DOI: 10.7326/awho202205170] [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)
- Megan Mack
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - Matthew Luzum
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - David H Wesorick
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
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Mack M, Luzum M, Wesorick DH. Annals for Hospitalists - April 2022. Ann Intern Med 2022; 175:HO4. [PMID: 35436429 DOI: 10.7326/awho202204190] [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)
- Megan Mack
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - Matthew Luzum
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - David H Wesorick
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
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Mack M, Luzum M, Wesorick DH. Annals for Hospitalists - March 2022. Ann Intern Med 2022; 175:HO3. [PMID: 35286835 DOI: 10.7326/awho202203150] [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)
- Megan Mack
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - Matthew Luzum
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - David H Wesorick
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
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Sheffield V, Hartley S, Stansfield RB, Mack M, Blackburn S, Vaughn VM, Heidemann L, Chang R, Lukela JR. Gendered Expectations: the Impact of Gender, Evaluation Language, and Clinical Setting on Resident Trainee Assessment of Faculty Performance. J Gen Intern Med 2022; 37:714-722. [PMID: 34405349 PMCID: PMC8904706 DOI: 10.1007/s11606-021-07093-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Gender inequity is pervasive in academic medicine. Factors contributing to these gender disparities must be examined. A significant body of literature indicates men and women are assessed differently in teaching evaluations. However, limited data exist on how faculty gender affects resident evaluation of faculty performance based on the skill being assessed or the clinical practice settings in which the trainee-faculty interaction occurs. OBJECTIVE Evaluate for gender-based differences in the assessment of general internal medicine (GIM) faculty physicians by trainees in inpatient and outpatient settings. DESIGN Retrospective cohort study SUBJECTS: Inpatient and outpatient GIM faculty physicians in an Internal Medicine residency training program from July 1, 2015, to December 31, 2018. MAIN MEASURES Faculty scores on trainee teaching evaluations including overall teaching ability and Accreditation Council for Graduate Medical Education (ACGME) competencies (medical knowledge [MK], patient care [PC], professionalism [PROF], interpersonal and communication skills [ICS], practice-based learning and improvement [PBLI], and systems-based practice [SBP]) based on the institutional faculty assessment form. KEY RESULTS In total, 3581 evaluations by 445 trainees (55.1% men, 44.9% women) assessing 161 GIM faculty physicians (50.3% men, 49.7% women) were included. Male faculty were rated higher in overall teaching ability (male=4.69 vs. female=4.63, p=0.003) and in four of the six ACGME competencies (MK, PROF, PBLI, and SBP) based on our institutional evaluation form. In the inpatient setting, male faculty were rated more favorably for overall teaching (male = 4.70, female = 4.53, p=<0.001) and across all ACGME competencies. The only observed gender difference in the outpatient setting favored female faculty in PC (male = 4.65, female = 4.71, p=0.01). CONCLUSIONS Male and female GIM faculty performance was assessed differently by trainees. Gender-based differences were impacted by the setting of evaluation, with the greatest difference by gender noted in the inpatient setting.
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Affiliation(s)
- Virginia Sheffield
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Hartley
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Megan Mack
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Staci Blackburn
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Valerie M Vaughn
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lauren Heidemann
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Robert Chang
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Mack M, Luzum M, Wesorick DH. Annals for Hospitalists - February 2022. Ann Intern Med 2022; 175:HO2. [PMID: 35157820 DOI: 10.7326/awho202202150] [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)
- Megan Mack
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - Matthew Luzum
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - David H Wesorick
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
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Mack M, Luzum M, Wesorick DH. Annals for Hospitalists - January 2022. Ann Intern Med 2022; 175:HO1. [PMID: 35038399 DOI: 10.7326/awho202201180] [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)
- Megan Mack
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - Matthew Luzum
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - David H Wesorick
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
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9
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Mack M, Luzum M, Wesorick DH. Annals for Hospitalists - December 2021. Ann Intern Med 2021; 174:HO12. [PMID: 34929128 DOI: 10.7326/awho202112210] [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)
- Megan Mack
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - Matthew Luzum
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - David H Wesorick
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
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10
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Mack M, Luzum M, Wesorick DH. Annals for Hospitalists - November 2021. Ann Intern Med 2021; 174:HO11. [PMID: 34781729 DOI: 10.7326/awho202111160] [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)
- Megan Mack
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - Matthew Luzum
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - David H Wesorick
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
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11
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Eddens T, Mack M, McCormick M, Chong H, Kalpatthi R. A042 TRENDS IN PEDIATRIC PRIMARY IMMUNODEFICIENCY: INCIDENCE, UTILIZATION, HEMATOPOIETIC STEM CELL TRANSPLANTATION, AND MORTALITY. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.030] [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: 11/30/2022]
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12
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Messersmith L, Mack M, Cordell J. Effect of Severe Acute Respiratory Syndrome Coronavirus 2 on Blood Product Utilization in the Community Hospital Setting. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Blood products are a major expense for the laboratory, with an intricate balance between maintaining adequate supply and expiring products. Blood product wastage rates are typically less than 2%. The SARS-CoV-2 (SARS-CoV-2) pandemic has created a multifaceted challenge in blood utilization. Difficulties in predicting product usage, decreased supply, and transportation delays put hospitals at risk of increased blood product destruction. In this study, we analyze the effect of the SARS-CoV-2 pandemic on blood utilization in the community hospital setting, in order to develop improved laboratory management strategies for decreasing unit wastage.
Methods/Case Report
Quality indicators of blood utilization from 2012 to 2021 were retrospectively reviewed. Data was collected for packed red blood cells (pRBCs), platelets, and plasma. Units transfused, expired/destroyed, and total percent discarded were recorded for each month. Average transfusion and destruction rates were calculated for each product. Blood product utilization from 2020 was compared to years 2012-2019 using Pearson correlation, linear regression, and student paired t-tests.
Results (if a Case Study enter NA)
1,042 units were reviewed. For pRBCs, there was a strong correlation between 2020 and increased destruction compared to 2012-2019 (R= 0.8, p=0.005). There was no significant change in pRBC transfusions in 2020 compared to 2018 and 2019 (p= 0.3, p= 0.2). There were fewer pRBC transfusions in 2020 compared to 2016 and 2017 (p= 0.006, p=0.01). For platelets, there was increased destruction in 2020 compared to 2012-2019 (p= 0.01-0.04) and no significant change in usage (p= 0.3-0.5).
Conclusion
During the 2020 SARS-CoV-2 pandemic, there was a significant increase in blood product wastage. There was no significant increase in transfused pRBCs or platelet units, suggesting the increased destruction was not due to an overall increase in transfusions. Blood products are a major cost for laboratory and further investigation of these findings is warranted to mitigate continued wastage.
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Affiliation(s)
- L Messersmith
- Martin Army Community Hospital, Ft. Benning, Georgia, UNITED STATES
| | - M Mack
- Martin Army Community Hospital, Ft. Benning, Georgia, UNITED STATES
| | - J Cordell
- Martin Army Community Hospital, Ft. Benning, Georgia, UNITED STATES
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Mack M, Luzum M, Wesorick DH. Annals for Hospitalists - October 2021. Ann Intern Med 2021; 174:HO10. [PMID: 34662176 DOI: 10.7326/awho202110190] [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)
- Megan Mack
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - Matthew Luzum
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - David H Wesorick
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
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Mack M, Luzum M, Wesorick DH. Annals for Hospitalists - September 2021. Ann Intern Med 2021; 174:HO9. [PMID: 34543602 DOI: 10.7326/awho202109210] [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)
- Megan Mack
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - Matthew Luzum
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - David H Wesorick
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
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15
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Mack M, Luzum M, Wesorick DH. Annals for Hospitalists - August 2021. Ann Intern Med 2021; 174:HO8. [PMID: 34399075 DOI: 10.7326/awho202108170] [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)
- Megan Mack
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - Matthew Luzum
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
| | - David H Wesorick
- From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)
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Wang F, Trier A, Li F, Kim S, Chen Z, Chai J, Mack M, Morrison S, Hamilton J, Baek J, Yang T, Heul AMV, Xu A, Xie Z, Dong X, Kubo M, Hu H, Hsieh C, Dong X, Liu Q, Margolis D, Ardeleanu M, Miller M, Kim B. 201 A basophil-neuronal axis promotes itch. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.222] [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: 11/24/2022]
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17
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Hara H, Takahashi K, Klaveren D, Ono M, Kawashima H, Kappetein P, Mohr F, Mack M, Holmes D, Morice M, Davierwala P, Head S, Thuijs D, Onuma Y, Serruys P. Ten-year all-cause death after percutaneous or surgical revascularization for men and women with multivessel or left main coronary artery disease: insights from the SYNTAX extended survival study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In patients with complex coronary artery disease (CAD), women favored coronary artery bypass grafting surgery (CABG) compared to percutaneous coronary intervention (PCI) at 5 years in the SYNTAX trial, whereas mortality rates after PCI and CABG were not different in men. On the other hand, poor outcomes of women undergoing PCI were not observed in the PRECOMBAT and BEST trials.
The long-term optimal revascularization strategy according to gender has not been fully evaluated.
Purpose
In the SYNTAX Extended Survival (SYNTAXES) study, no significant difference existed in all-cause death between PCI and CABG at 10 years. This study aimed to assess treatment effect of PCI and CABG for 10-year all-cause death according to gender.
Methods
The SYNTAXES study evaluated vital status up to 10 years in 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to treatment with CABG or PCI in the SYNTAX trial, and the pre-specified primary endpoint was all-cause death at 10 years. In this prespecified analysis, all-cause death at 10 years according to gender in patients undergoing PCI or CABG was evaluated.
Results
Of 1800 patients, 402 (22.3%) were women and 1398 (77.7%) were men. In women, the rate of mortality was significantly higher in the PCI arm at 5 years than in the CABG arm (19.3% vs. 10.3%; Log-rank p=0.010, Figure A), but the rates of mortality were not different at 10 years between the PCI and CABG arms (33.0% vs. 32.5%; Log-rank p=0.600, Figure A). In men, the mortality rate tended to be higher in the PCI arm at 10 years than in the CABG arm (27.0% vs. 22.5%; Log-rank p=0.082, Figure B), although the mortality rates were not different at 5 years between the PCI and CABG arms (12.4% vs. 12.3%; Log-rank p=0.957, Figure B).
Conclusion
The efficacy of CABG observed at 5 years disappeared at 10 years in women, whereas the efficacy of CABG became apparent after 5 years in men.
Figure 1
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Erasmus University Medical Centre, Rotterdam, Netherlands, reference: MEC-2016-716
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Affiliation(s)
- H Hara
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - K Takahashi
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - D Klaveren
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - M Ono
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - H Kawashima
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - P Kappetein
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - F Mohr
- Heart Center of Leipzig, Leipzig, Germany
| | - M Mack
- Baylor University Medical Center, Dallas, United States of America
| | - D Holmes
- Mayo Clinic, Rochester, United States of America
| | - M Morice
- Jacques Cartier Private Hospital, Massy, France
| | | | - S Head
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Thuijs
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | - P Serruys
- National University of Ireland, Galway, Ireland
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Gao C, Wang R, Takahashi K, Kawashima H, Van Geuns R, Onuma Y, Morice M, Davierwala P, Holmes D, Mack M, Mohr F, Kappetein A, Head S, Thuijs D, Serruys P. Treatment of complex coronary artery disease in patients with diabetes mellitus and chronic kidney disease: 10-year results comparing outcomes of CABG and PCI in the SYNTAXES trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of the SYNTAX trial, which was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease. The SYNTAXES study is the first randomized trial that reported the complete 10-year data on all-cause death in patients with complex coronary artery disease.
Purpose
Patients with coronary artery disease (CAD) and concomitant diabetes mellitus (DM) or chronic kidney disease (CKD) are more susceptible to major adverse cardiovascular and cerebrovascular events. However, to date, the long-term prognosis and which revascularization strategy was associated with better clinical outcomes for patients with complex coronary artery disease and concomitant with DM and CKD have not been documented.
Methods
In this sub-analysis of the SYNTAXES trial, a total of 1,638 patients were classified into four subgroups according to the DM and CKD status: DM−/CKD− (n=999, 60.1%), DM+/CKD− (n=323, 19.7%), DM−/CKD+ (n=231, 14.1%), and DM+/CKD+ (n=85, 5.2%). The treatment effects of PCI and CABG were analyzed in each subgroup. The primary endpoint was all-cause death at 10 years.
Results
Compared with the DM−/CKD− patients, patients with DM+/CKD+ were older, more often had a history of stroke, hypertension, heart failure, and were more frequently presented with total occlusion, bifurcation lesion and three-vessel disease. At 10 years, patients with DM+/CKD+ had a 3.94-fold higher incidence of all-cause mortality compared with DM−/CKD− individuals (54.1% versus 18.9%, 95% CI [2.85–5.44]). Patients with DM−/CKD+ (38.1%, HR 2.36; 95% CI [1.83–5.44]) or DM+/CKD− (28.2%, HR 1.61; 95% CI [1.26–2.07]) had intermediate risk profile. For DM+/CKD+ patients, compared with PCI, those who underwent CABG were associated with lower incidence of all-cause mortality (64.3% versus 44.2%, adjusted HR 0.52; 95% CI [0.27–0.99], p=0.047, pinteraction=0.443). The number of needed-to-treat to reduce mortality for CABG was 12.
Conclusion
In the SYNTAX population, patients with DM and CKD are at markedly increased risk of long-term mortality rate compared with patients one or neither of these risk factors. For patients with both comorbidities, CABG was associated with better clinical outcome compared with PCI. These findings should be interpreted as hypothesis-generating.
Figure 1. Kaplan-Meier curves showing the clinical events according to treatment and DM/CKD status.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boston Scientific Corporation
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Affiliation(s)
- C Gao
- Xijing Hospital of the Fourth Military Medical University, Xi'an, China
| | - R.T Wang
- Xijing Hospital of the Fourth Military Medical University, Xi'an, China
| | | | - H Kawashima
- National University of Ireland, Galway, Ireland
| | - R.J Van Geuns
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | - M.C Morice
- ICPS Ramsay-Generale de Sante, Massy, France
| | | | - D Holmes
- Mayo Clinic, Rochester, United States of America
| | - M Mack
- Baylor Scott & White Health, Dallas, United States of America
| | - F Mohr
- Heart Center of Leipzig, Leipzig, Germany
| | - A Kappetein
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - S Head
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Thuijs
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - P.W Serruys
- National University of Ireland, Galway, Ireland
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19
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Hara H, Takahashi K, Ono M, Gao C, Wang R, Kappetein P, Mohr F, Mack M, Holmes D, Morice M, Davierwala P, Head S, Thuijs D, Onuma Y, Serruys P. Impact of periprocedural myocardial infarction on 10-year mortality after percutaneous coronary intervention or coronary artery bypass grafting for multivessel or left main coronary artery disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Periprocedural myocardial infarction (PMI) occurs frequently after both percutaneous coronary intervention (PCI) and bypass grafting surgery (CABG) in patients with complex coronary artery disease (CAD), and PMI has been shown to have a detrimental impact on mortality. On the other hand, long-term impact of PMI on mortality has not been fully evaluated.
Purpose
This study aimed to assess the impact of PMI according to SCAI definition on 10-year all-cause death in patients with complex CAD.
Methods
The SYNTAX Extended Survival (SYNTAXES) study evaluated vital status up to 10 years in 1800 patients with de novo three-vessel disease and/or left main coronary artery disease randomized to treatment with CABG or PCI in the SYNTAX trial. Blood was sampled for creatine kinase (CK) pre- and post-revascularisation, and the cardiac specific MB iso-enzyme (CK-MB) was determined only if the CK ratio ≥2 x the upper limit of normal (ULN). If the CK ratio <2 ULN, CK-MB assessment was not mandated. In this analysis, patients with at least one blood sampling within 48 hours of the procedure were included. PMI was defined as follows; peak CK-MB measured within 48 hours of the procedure ≥10 x ULN, or ≥5 x ULN with new Q-waves in 2 contiguous leads or new persistent left bundle branch block.
Results
Of 1800 patients, 1679 (93.2%) patients were included. Of 877 patients treated with PCI, PMI occurred in 26 patients (3.0%), whereas 14 (1.7%) PMIs were observed in 802 patients treated with CABG. Compared with patients without PMI, patients with PMI presented with unstable angina more frequently (45.0% vs. 28.7, p=0.033), and had a higher rate of bifurcation lesion (87.5% vs. 72.5, p=0.046). PMI was associated with a higher all-cause mortality at 10 years compared with no PMI (55.3% vs. 25.4%; Log-rank p<0.001, Figure), which was mainly driven by a high mortality rate within 1 year. In patients undergoing PCI, the mortality rates were significantly higher in patients with PMI not only within 1 year (Log-rank p<0.001) but also beyond one year (Log-rank p=0.016), compare to patients without PMI (Figure). On the other hand, in patients undergoing CABG, a higher mortality rate in patients with PMI was observed until 1 year (Log-rank p<0.001), but the impact of PMI on mortality beyond one year after CABG subsided (Log-rank p=0.308) (Figure 1).
Conclusion
PMI was associated with a poor prognosis at 10 years. The impact of PMI on mortality was strong within one year. Of note, the impact of PMI on mortality persisted beyond 1 year only in patients undergoing PCI. Patients who were treated with PCI and suffered PMI need careful follow-up beyond one year after revascularization.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Hara
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - K Takahashi
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - M Ono
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - C Gao
- University Hospital Nijmegen, Nijmegen, Netherlands (The)
| | - R Wang
- University Hospital Nijmegen, Nijmegen, Netherlands (The)
| | - P Kappetein
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - F Mohr
- Heart Center of Leipzig, Leipzig, Germany
| | - M Mack
- Baylor University Medical Center, Dallas, United States of America
| | - D Holmes
- Mayo Clinic, Rochester, United States of America
| | - M Morice
- Jacques Cartier Private Hospital, Massy, France
| | | | - S Head
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Thuijs
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | - P Serruys
- National University of Ireland, Galway, Ireland
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20
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Ono M, Takahashi K, Hara H, Gao C, Wang R, Kappetein P, Mohr F, Mack M, Holmes D, Morice M, Davierwala P, Head S, Onuma Y, Thuijs D, Serruys P. Ten-year all-cause death in elderly patients undergoing percutaneous coronary intervention or coronary artery bypass grafting: a prespecified subgroup analysis of the SYNTAX Extended Survival study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary artery disease is the leading cause of death among elderly men and women worldwide. The aging society worldwide will lead to increasing numbers of elderly patients with multivessel coronary artery disease. Although age is recognized as one of the most important factors in a decision-making for revascularization of multivessel coronary artery disease, the very long-term outcomes in patients undergoing revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is still unclear.
Objectives
The aim of the present study was to investigate the association between revascularization strategies and 10-year outcomes in elderly patients.
Methods
The SYNTAX Extended Survival (SYNTAXES) study (NCT 03417050) is an investigator-driven extension of follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries, enrolling 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to revascularization strategy with CABG versus PCI in the SYNTAX trial. Patients were divided into two groups according to the prespecified threshold of 70 years old; elderly patients (>70 years) and non-elderly patients (≤70 years). The primary endpoint of this study was all-cause death at 10 years.
Results
Out of 1,800 patients, 575 patients (31.9%) were classified as elderly (>70 years). The mean age ± standard deviation (SD) of the elderly patients and the non-elderly patients was 75.8±3.6 years and 60.1±7.4 years, respectively. Of note, elderly patients were more frequently female than non-elderly patients (33.6% vs. 17.1%, p<0.001). As expected, the elderly patients had higher prevalence of chronic kidney disease (43.4% vs. 7.9%, p<0.001), had higher anatomical SYNTAX score (30.2±11.8 vs 28.0±11.2 p<0.001) when compared to those of the non-elderly patients.
Up to 10 years, all-cause death occurred in 42.7% and 18.9% in the elderly and non-elderly patients, respectively (Log-rank p<0.001). The cubic spline curve showed an exponentially increase in all-cause death at 10 years according to the increase of age both in the PCI arm and the CABG arm. At 10 years, there was no significant difference in the risk of all-cause death between CABG vs. PCI either in elderly patients (41.5% vs. 44.0%; Log-rank p=0.53) or non-elderly patients (16.6% vs. 21.1%; Log-rank p=0.051).
Conclusion
CABG and PCI were equipoise in terms of risk of all-cause death at 10 years in patients with de novo 3VD and/or LMCAD irrespective of their age when stratified according to the prespecified threshold of 70 years old.
Kaplan-Meier curves
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Foundation of Heart Research
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Affiliation(s)
- M Ono
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | | | - H Hara
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | - C Gao
- Radboud University Medical Center, Department of Cardiology, Nijmegen, Netherlands (The)
| | - R Wang
- Radboud University Medical Center, Department of Cardiology, Nijmegen, Netherlands (The)
| | - P Kappetein
- Erasmus University Medical Centre, Department of Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - F Mohr
- Heart Center of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - M Mack
- Baylor University Medical Center, Department of Cardiothoracic Surgery, Dallas, United States of America
| | - D Holmes
- Mayo Clinic, Department of Cardiovascular Diseases and Internal Medicine, Rochester, United States of America
| | - M Morice
- Jacques Cartier Private Hospital, Département of Cardiologie, Massy, France
| | - P Davierwala
- Heart Center of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - S Head
- Erasmus University Medical Centre, Department of Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - Y Onuma
- National University of Ireland, Department of Cardiology, Galway, Ireland
| | - D Thuijs
- Erasmus University Medical Centre, Department of Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - P Serruys
- Imperial College London, NHLI, London, United Kingdom
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Abstract
Hospitalists represent a rapidly emerging specialty group that treats a large proportion of hospitalized patients with infections. Antimicrobial stewardship programs and hospitalist groups that focus on building a collaborative approach have been extremely successful in optimizing antimicrobial prescribing and improving patient outcomes. We discuss the tools needed to build collaborative relationships, summarize published examples of successful stewardship-hospitalist collaboration, and provide guidance on developing collaborative interventions.
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Affiliation(s)
- Megan Mack
- Department of Internal Medicine, Michigan Medicine, University of Michigan, School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Adamo Brancaccio
- Department of Pharmacy Services, Michigan Medicine, University of Michigan, College of Pharmacy, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Kayla Popova
- Department of Pharmacy Services, Michigan Medicine, University of Michigan, College of Pharmacy, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jerod Nagel
- Department of Pharmacy Services, Michigan Medicine, University of Michigan, College of Pharmacy, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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22
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Noack T, Thuijs D, Kappetein P, Serruys P, Mohr FW, Morice MC, Mack M, Holmes D, Davierwala P, Head S. Ten Year Survival after Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention: The SYNTAX Extended Survival (SYNTAXES) Study. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705342] [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: 10/24/2022]
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23
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Rockwell H, Mack M, Famula T, Sandmeyer L, Bauer B, Dwyer A, Lassaline M, Beeson S, Archer S, McCue M, Bellone RR. Genetic investigation of equine recurrent uveitis in Appaloosa horses. Anim Genet 2019; 51:111-116. [PMID: 31793009 DOI: 10.1111/age.12883] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 01/05/2023]
Abstract
Equine recurrent uveitis (ERU) is characterized by intraocular inflammation that often leads to blindness in horses. Appaloosas are more likely than any other breed to develop insidious ERU, distinguished by low-grade chronic intraocular inflammation, suggesting a genetic predisposition. Appaloosas are known for their white coat spotting patterns caused by the leopard complex spotting allele (LP) and the modifier PATN1. A marker linked to LP on ECA1 and markers near MHC on ECA20 were previously associated with increased ERU risk. This study aims to further investigate these loci and identify additional genetic risk factors. A GWAS was performed using the Illumina Equine SNP70 BeadChip in 91 horses. Additive mixed model approaches were used to correct for relatedness. Although they do not reach a strict Bonferroni genome-wide significance threshold, two SNPs on ECA1 and one SNP each on ECA12 and ECA29 were among the highest ranking SNPs and thus warranted further analysis (P = 1.20 × 10-5 , P = 5.91 × 10-6 , P = 4.91 × 10-5 , P = 6.46 × 10-5 ). In a second cohort (n = 98), only an association with the LP allele on ECA1 was replicated (P = 5.33 × 10-5 ). Modeling disease risk with LP, age and additional depigmentation factors (PATN1 genotype and extent of roaning) supports an additive role for LP and suggests an additive role for PATN1. Genotyping for LP and PATN1 may help predict ERU risk (AUC = 0.83). The functional role of LP and PATN1 in ERU development requires further investigation. Testing samples across breeds with leopard complex spotting patterns and a denser set of markers is warranted to further refine the genetic components of ERU.
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Affiliation(s)
- H Rockwell
- Veterinary Genetics Laboratory, Department of Population Health and Reproduction, School of Veterinary Medicine, University of California - Davis, Davis, 95616, CA, USA
| | - M Mack
- Veterinary Genetics Laboratory, Department of Population Health and Reproduction, School of Veterinary Medicine, University of California - Davis, Davis, 95616, CA, USA
| | - T Famula
- Appaloosa Project, Davis, 95616, CA, USA
| | - L Sandmeyer
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5B4, Canada
| | - B Bauer
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5B4, Canada
| | - A Dwyer
- Genesee Valley Equine Clinic, LLC, Scottsville, NY, 14546, USA
| | - M Lassaline
- Department of Radiological and Surgical Sciences, School of Veterinary Medicine, University of California - Davis, Davis, CA, 95616, USA
| | - S Beeson
- Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St Paul, MN, 55108, USA
| | - S Archer
- Appaloosa Project, Sayward, V0P 1R0, BC, Canada
| | - M McCue
- Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St Paul, MN, 55108, USA
| | - R R Bellone
- Veterinary Genetics Laboratory, Department of Population Health and Reproduction, School of Veterinary Medicine, University of California - Davis, Davis, 95616, CA, USA
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24
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Abraham W, Lindenfeld J, Mack M, Ellis J, Morishetti D, Weissman N, Stone G. 1386Reduction of mitral regurgitation in patients with heart failure and secondary mitral regurgitation: relationship between changes in brain natriuretic peptide and outcomes from the COAPT trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Brain natriuretic peptide (BNP) is a well-established predictor of hospitalization and death in patients with heart failure (HF). In the COAPT trial, treatment of patients with HF and secondary mitral regurgitation (SMR) with transcatheter mitral valve repair (TMVr) reduced the 2-year rates of all-cause mortality and HF hospitalization compared with maximally-tolerated guideline-directed medical therapy (GDMT) alone. Whether these improvements in outcomes were reflected in serial changes in BNP levels has not been reported.
Purpose
Herein, we report the first results of serial changes in BNP levels by treatment group in patients from the COAPT trial.
Methods
614 patients with HF and 3+ or 4+ SMR were randomized 1:1 to TMVr + GDMT or GDMT alone. Key inclusion criteria included NYHA functional class II-IVa (ambulatory), ischemic or non-ischemic cardiomyopathy with LVEF 20%-50% and LVESD ≤70 mm. Baseline BNP or NT-proBNP levels were drawn at baseline and at 6 and 12 months. For the present analysis NT-proBNP (pg/ml) values were converted to BNP values (pg/ml) using a ratio of 7 to 1.
Results
At baseline, mean values of BNP were not significantly different between treatment groups (945 pg/ml vs. 964 pg/ml in the TMVr + GDMT and GDMT groups respectively, p=0.84). At 6 months, mean values of BNP in the TMVr + GDMT group were significantly lower than in the GDMT alone group (690 pg/ml vs 893 pg/ml, p=0.02) but not at 12 months (584 pg/ml vs. 728 pg/ml, p=0.22). By analysis of covariance, BNP decreased to a greater degree after TMVr + GDMT compared with GDMT only at both 6 and 12 months (least squares mean differences of −121 pg/ml and −166 pg/ml respectively, both p<0.05) (Figure).
Change in BNP level from baseline
Conclusions
In patients with HF and 3+ or 4+ SMR enrolled in the COAPT trial, reduction of SMR with TMVr reduced BNP compared with maximally-tolerated GDMT only, a change which paralleled the reductions noted in all-cause mortality and HF hospitalizations with TMVr.
Acknowledgement/Funding
Abbott
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Affiliation(s)
- W Abraham
- The Ohio State University, Departments of Medicine, Physiology, and Cell Biology, and the Davis Heart & Lung Institute, Columbus, United States of America
| | - J Lindenfeld
- Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville, United States of America
| | - M Mack
- Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas, United States of America
| | - J Ellis
- Abbott, Santa Clara, United States of America
| | | | - N Weissman
- MedStar Health Research Institute, Hyattsville, United States of America
| | - G Stone
- New York Presbyterian Hospital, Columbia University Medical Center, and The Cardiovascular Research, New York, United States of America
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25
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Burns EN, Bordbari MH, Mienaltowski MJ, Affolter VK, Barro MV, Gianino F, Gianino G, Giulotto E, Kalbfleisch TS, Katzman SA, Lassaline M, Leeb T, Mack M, Müller EJ, MacLeod JN, Ming-Whitfield B, Alanis CR, Raudsepp T, Scott E, Vig S, Zhou H, Petersen JL, Bellone RR, Finno CJ. Generation of an equine biobank to be used for Functional Annotation of Animal Genomes project. Anim Genet 2018; 49:564-570. [PMID: 30311254 DOI: 10.1111/age.12717] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2018] [Indexed: 12/13/2022]
Abstract
The Functional Annotation of Animal Genomes (FAANG) project aims to identify genomic regulatory elements in both sexes across multiple stages of development in domesticated animals. This study represents the first stage of the FAANG project for the horse, Equus caballus. A biobank of 80 tissue samples, two cell lines and six body fluids was created from two adult Thoroughbred mares. Ante-mortem assessments included full physical examinations, lameness, ophthalmologic and neurologic evaluations. Complete blood counts and serum biochemistries were also performed. At necropsy, in addition to tissue samples, aliquots of serum, ethylenediaminetetraacetic acid (EDTA) plasma, heparinized plasma, cerebrospinal fluid, synovial fluid, urine and microbiome samples from all regions of the gastrointestinal and urogenital tracts were collected. Epidermal keratinocytes and dermal fibroblasts were cultured from skin samples. All tissues were grossly and histologically evaluated by a board-certified veterinary pathologist. The results of the clinical and pathological evaluations identified subclinical eosinophilic and lymphocytic infiltration throughout the length of the gastrointestinal tract as well as a mild clinical lameness in both animals. Each sample was cryo-preserved in multiple ways, and nuclei were extracted from selected tissues. These samples represent the first published systemically healthy equine-specific biobank with extensive clinical phenotyping ante- and post-mortem. The tissues in the biobank are intended for community-wide use in the functional annotation of the equine genome. The use of the biobank will improve the quality of the reference annotation and allow all equine researchers to elucidate unknown genomic and epigenomic causes of disease.
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Affiliation(s)
- E N Burns
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - M H Bordbari
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - M J Mienaltowski
- Department of Animal Science, College of Agricultural and Environmental Sciences, University of California-Davis, Davis, CA, 95616, USA
| | - V K Affolter
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - M V Barro
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - F Gianino
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - G Gianino
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - E Giulotto
- Department of Biology and Biotechnology, University of Pavia, via Ferrata 1, Pavia, I-27100, Italy
| | - T S Kalbfleisch
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Louisville, Louisville, KY, 40292, USA
| | - S A Katzman
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95618, USA
| | - M Lassaline
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95618, USA
| | - T Leeb
- Institute of Genetics, Vetsuisse Faculty, University of Bern, Bern, 3001, Switzerland
| | - M Mack
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - E J Müller
- Department of Biomedical Research, Molecular Dermatology and Stem Cell Research, Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, 3001, Switzerland.,Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, 3001, Switzerland
| | - J N MacLeod
- Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, KY, 40546, USA
| | - B Ming-Whitfield
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - C R Alanis
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - T Raudsepp
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, 77845, USA
| | - E Scott
- Department of Animal Science, College of Agricultural and Environmental Sciences, University of California-Davis, Davis, CA, 95616, USA
| | - S Vig
- Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - H Zhou
- Department of Animal Science, College of Agricultural and Environmental Sciences, University of California-Davis, Davis, CA, 95616, USA
| | - J L Petersen
- Department of Animal Science, University of Nebraska - Lincoln, Lincoln, NE, 68583, USA
| | - R R Bellone
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA.,Veterinary Genetics Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - C J Finno
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
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Mack M, Brestoff J, Niu H, Whelan T, Oetjen L, Bodet N, Wang F, Xu A, Park E, Margolis D, Yokoyama W, Kim B. 1017 Natural killer cell dysregulation underlies atopic dermatitis. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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27
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Foolad F, Huang AM, Nguyen CT, Colyer L, Lim M, Grieger J, Li J, Revolinski S, Mack M, Gandhi T, Wainaina JN, Eschenauer G, Patel TS, Marshall VD, Nagel J. A multicentre stewardship initiative to decrease excessive duration of antibiotic therapy for the treatment of community-acquired pneumonia. J Antimicrob Chemother 2018; 73:1402-1407. [DOI: 10.1093/jac/dky021] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/05/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Farnaz Foolad
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Angela M Huang
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cynthia T Nguyen
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - Lindsay Colyer
- Department of Pharmacy, Michigan Medicine, Ann Arbor, MI, USA
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Megan Lim
- Department of Pharmacy, Michigan Medicine, Ann Arbor, MI, USA
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Jessica Grieger
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
| | - Julius Li
- Department of Pharmacy, Ochsner Medical Center, New Orleans, LA, USA
| | - Sara Revolinski
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin School of Pharmacy, Milwaukee, WI, USA
| | - Megan Mack
- Division of Hospital Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Tejal Gandhi
- Division of Infectious Diseases, Michigan Medicine, Ann Arbor, MI, USA
| | - J Njeri Wainaina
- Section of Perioperative Medicine and Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gregory Eschenauer
- Department of Pharmacy, Michigan Medicine, Ann Arbor, MI, USA
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Twisha S Patel
- Department of Pharmacy, Michigan Medicine, Ann Arbor, MI, USA
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Vincent D Marshall
- Department of Pharmacy, Michigan Medicine, Ann Arbor, MI, USA
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Jerod Nagel
- Department of Pharmacy, Michigan Medicine, Ann Arbor, MI, USA
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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Foolad F, Huang A, Nguyen C, Colyer L, Lim M, Grieger J, Revolinski S, Li J, Mack M, Gandhi T, Wainaina JN, Eschenauer G, Patel T, Marshall V, Nagel J. A Multicenter Stewardship Initiative to Decrease Excessive Duration of Antibiotic Therapy for the Treatment of Community-Acquired Pneumonia (CAP). Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx162.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hospitals have implemented multifaceted approaches to quickly identify CAP, start timely therapy, and reduce hospital readmission, yet there has been minimal focus on providing appropriate duration of therapy. The IDSA CAP guidelines recommend 5 days of antibiotic therapy for patients that are clinically stable and quickly defervesce. However, previous publications suggest duration of therapy for CAP may be unnecessarily prolonged.
Methods
The objective of this multicenter, quasi-experimental study of hospitalized patients with CAP was to assess the impact of a prospective 6-month stewardship intervention on total duration of antibiotic therapy and associated clinical outcomes. All centers updated institutional CAP guidelines to promote IDSA-concordant durations of therapy and provided education to pharmacists and prescribers. Daily patient-specific prospective audit and feedback was provided by infectious diseases stewardship pharmacists to optimize compliance with guideline recommendations.
Results
A total of 600 patients were included (307 in the historic control group and 293 in the stewardship intervention group). The stewardship intervention led to significantly increased rates of compliance with IDSA duration of therapy recommendations (5.6% vs. 41.4%, P< < 0.01) and significantly reduced the duration of therapy for CAP (9 vs. 6 days, P < 0.01). Inappropriate days of antibiotic therapy was reduced in the intervention group (4 vs. 1.6 days, P < 0.01), and total avoidance of 720 excessive days of antibiotic therapy. Clinical outcomes, including mortality, length of hospitalization, readmission to hospital with pneumonia, presentation to the ER/clinic with pneumonia within 30 days of discharge, and incidence of C. difficilecolitis, were not different between groups.
Conclusion
This multicenter evaluation of a prospective stewardship intervention in hospitalized CAP patients reduced the total duration of antibiotic therapy and increased compliance with guideline-concordant duration of therapy without adversely affecting patient outcomes.
This project was funded through a competitive stewardship grant provided by Merck & Co.
Disclosures
A. Huang, Merck: Grant Investigator, Research grant; C. Nguyen, Merck: Grant Investigator, Research grant; J. Grieger, Merck: Grant Investigator, Research grant; S. Revolinski, Merck: Grant Investigator, Research grant; J. Li, Merck: Grant Investigator, Research grant; M. Mack, Merck: Grant Investigator, Research grant; J. N. Wainaina, Merck: Grant Investigator, Research grant; G. Eschenauer, Merck: Grant Investigator, Research grant; T. Patel, Merck: Grant Investigator, Research grant; V. Marshall, Merck: Grant Investigator, Research grant; J. Nagel, Merck: Grant Investigator, Research grant
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Affiliation(s)
- Farnaz Foolad
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Angela Huang
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Megan Lim
- Michigan Medicine, Ann Arbor, Michigan
| | - Jessica Grieger
- The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Sara Revolinski
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Julius Li
- Ochsner Medical Center, New Orleans, Louisiana
| | | | - Tejal Gandhi
- Internal Medicine, Division of Infectious Diseases, Michigan Medicine, Ann Arbor, Michigan
| | - J Njeri Wainaina
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
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Petrilli CM, Heidemann L, Mack M, Durance P, Chopra V. Letter to the Editor, The Authors Reply: "Cost and Utility of Thrombophilia Testing". J Hosp Med 2017; 12:784. [PMID: 29190304 DOI: 10.12788/jhm.2822] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We thank Dr. Berse and colleagues for their correspondence about our paper. We are pleased they agreed with our conclusion: Thrombophilia testing has limited clinical utility in most inpatient settings.
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Affiliation(s)
- Christopher M Petrilli
- Department of Internal Medicine, Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA.
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Lauren Heidemann
- Department of Internal Medicine, Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Megan Mack
- Department of Internal Medicine, Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Paul Durance
- Department of Quality Improvement Operations, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vineet Chopra
- Department of Internal Medicine, Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Baumgarten H, Squiers J, Filardo G, Di J, Mack M. Prospective Real-World Evaluation of an Interdisciplinary Blood Management Protocol for Patients Undergoing Cardiac Surgery. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598919] [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: 10/20/2022]
Affiliation(s)
- H. Baumgarten
- Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
| | - J.J. Squiers
- Baylor, Scott & White Research Institute, Dallas, United States
| | - G. Filardo
- Department of Epidemiology, Baylor, Scott & White Health, Dallas, United States
| | - J.M. Di
- Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, United States
| | - M. Mack
- Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, United States
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Arsalan M, Weferling M, Hecker F, Filardo G, Kim W, Pollock B, Van Linden A, Arsalan-Werner A, Renker M, Doss M, Kalbas S, Hamm C, Liebetrau C, Mack M, Walther T. TAVR Risk Scoring Using Established versus New Scoring Systems: Role of the New STS/ACC Model. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598905] [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: 10/20/2022]
Affiliation(s)
- M. Arsalan
- Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
| | - M. Weferling
- Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
| | - F. Hecker
- Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
| | - G. Filardo
- Baylor Scott and White Health, Department of Epidemiology, Dallas, United States
| | - W.K. Kim
- Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
| | - B. Pollock
- Baylor Scott and White Health, Department of Epidemiology, Dallas, United States
| | - A. Van Linden
- Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
| | | | - M. Renker
- Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
| | - M. Doss
- Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
| | - S. Kalbas
- Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
| | - C. Hamm
- Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
| | - C. Liebetrau
- Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
| | - M. Mack
- The Heart Hospital Baylor Plano, Plano, United States
| | - T. Walther
- Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
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Arsalan M, Filardo G, Pollock B, Kim W, Liebetrau C, Squiers J, Van Linden A, Arsalan-Werner A, Hamm C, Mack M, Walther T. Prognostic Value of Baseline Hemoglobin on Short- and Mid-Term Clinical Outcomes after Transcatheter Aortic Valve Implantation. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598908] [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: 10/20/2022]
Affiliation(s)
- M. Arsalan
- Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
| | - G. Filardo
- Baylor Scott and White Health, Department of Epidemiology, Dallas, United States
| | - B. Pollock
- Baylor Scott and White Health, Department of Epidemiology, Dallas, United States
| | - W.K. Kim
- Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
| | - C. Liebetrau
- Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
| | - J. Squiers
- The Heart Hospital Baylor Plano, Plano, United States
| | - A. Van Linden
- Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
| | | | - C. Hamm
- Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
| | - M. Mack
- The Heart Hospital Baylor Plano, Plano, United States
| | - T. Walther
- Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
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Foolad F, Huang A, Nguyen C, Mack M, Gandhi T, Eschenauer G, Patel T, Marshall V, Colyer L, Lim M, Nagel J. Impact of a Multi-Faceted Stewardship Intervention on Duration of Antibiotic Therapy for the Treatment of Community-Acquired Pneumonia (CAP). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.732] [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)
- Farnaz Foolad
- University of Michigan Health System, Ann Arbor, Michigan
| | - Angela Huang
- Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Megan Mack
- University of Michigan Health System, Ann Arbor, Michigan
| | - Tejal Gandhi
- Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Twisha Patel
- University of Michigan Health System, Ann Arbor, Michigan
| | - Vince Marshall
- University of Michigan Health System, Ann Arbor, Michigan
| | - Lindsay Colyer
- University of Michigan Health System, Ann Arbor, Michigan
| | - Megan Lim
- University of Michigan Health System, Ann Arbor, Michigan
| | - Jerod Nagel
- University of Michigan Health System, Ann Arbor, Michigan
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Zimmermann J, Kühl AA, Weber M, Grün JR, Löffler J, Haftmann C, Riedel R, Maschmeyer P, Lehmann K, Westendorf K, Mashreghi MF, Löhning M, Mack M, Radbruch A, Chang HD. T-bet expression by Th cells promotes type 1 inflammation but is dispensable for colitis. Mucosal Immunol 2016; 9:1487-1499. [PMID: 26883725 DOI: 10.1038/mi.2016.5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/03/2016] [Indexed: 02/04/2023]
Abstract
The transcription factor T-bet is highly expressed by Th cells isolated from the inflamed intestine of Crohn's disease patients, and has been regarded a critical driver of murine T cell-induced colitis. However, we show here that T-bet expression by Th cells is not required for the manifestation of T-cell-induced colitis in the presence of segmented filamentous bacteria and Helicobacter hepaticus. T-bet expression by Th cells controls their survival and localization, their repertoire of chemokine and chemokine receptor expression, the accumulation of monocytes and macrophages in the inflamed colon, and their differentiation to the M1 type, i.e., type 1 inflammation. Nevertheless, T-bet-deficient Th cells efficiently induce colitis, as reflected by weight loss, diarrhea, and colon histopathology. T-bet-deficient Th cells differentiate into Th1/17 cells, able to express IFN-γ and IL-17A upon restimulation. While neutralization of IL-17A exacerbated colitis induced by wild-type or T-bet-deficient Th cells, neutralization of IFN-γ completely abolished colitis.
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Affiliation(s)
- J Zimmermann
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - A A Kühl
- Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - M Weber
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - J R Grün
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - J Löffler
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - C Haftmann
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - R Riedel
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - P Maschmeyer
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - K Lehmann
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - K Westendorf
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - M-F Mashreghi
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - M Löhning
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - M Mack
- Universitätsklinikum Regensburg, Regensburg, Germany
| | - A Radbruch
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - H D Chang
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
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Petrilli CM, Heidemann L, Mack M, Durance P, Chopra V. Inpatient inherited thrombophilia testing. J Hosp Med 2016; 11:801-804. [PMID: 27782379 DOI: 10.1002/jhm.2616] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Christopher M Petrilli
- Department of Medicine, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Lauren Heidemann
- Department of Medicine, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Megan Mack
- Department of Medicine, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Paul Durance
- Department of Quality Improvement Operations, University of Michigan, Ann Arbor, Michigan
| | - Vineet Chopra
- Department of Medicine, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Schiechl G, Hermann FJ, Rodriguez Gomez M, Kutzi S, Schmidbauer K, Talke Y, Neumayer S, Goebel N, Renner K, Brühl H, Karasuyama H, Obata-Ninomiya K, Utpatel K, Evert M, Hirt SW, Geissler EK, Fichtner-Feigl S, Mack M. Basophils Trigger Fibroblast Activation in Cardiac Allograft Fibrosis Development. Am J Transplant 2016; 16:2574-88. [PMID: 26932231 DOI: 10.1111/ajt.13764] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/29/2016] [Accepted: 02/22/2016] [Indexed: 01/25/2023]
Abstract
Fibrosis is a major component of chronic cardiac allograft rejection. Although several cell types are able to produce collagen, resident (donor-derived) fibroblasts are mainly responsible for excessive production of extracellular matrix proteins. It is currently unclear which cells regulate production of connective tissue elements in allograft fibrosis and how basophils, as potential producers of profibrotic cytokines, are involved this process. We studied this question in a fully MHC-mismatched model of heart transplantation with transient depletion of CD4(+) T cells to largely prevent acute rejection. The model is characterized by myocardial infiltration of leukocytes and development of interstitial fibrosis and allograft vasculopathy. Using depletion of basophils, IL-4-deficient recipients and IL-4 receptor-deficient grafts, we showed that basophils and IL-4 play crucial roles in activation of fibroblasts and development of fibrotic organ remodeling. In the absence of CD4(+) T cells, basophils are the predominant source of IL-4 in the graft and contribute to expansion of myofibroblasts, interstitial deposition of collagen and development of allograft vasculopathy. Our results indicated that basophils trigger the production of various connective tissue elements by myofibroblasts. Basophil-derived IL-4 may be an attractive target for treatment of chronic allograft rejection.
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Affiliation(s)
- G Schiechl
- Department of Internal Medicine II, Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - F J Hermann
- Department of Internal Medicine II, Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - M Rodriguez Gomez
- Department of Internal Medicine II, Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - S Kutzi
- Department of Internal Medicine II, Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - K Schmidbauer
- Department of Internal Medicine II, Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Y Talke
- Department of Internal Medicine II, Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - S Neumayer
- Department of Internal Medicine II, Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - N Goebel
- Department of Internal Medicine II, Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - K Renner
- Department of Internal Medicine II, Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - H Brühl
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - H Karasuyama
- Department of Immune Regulation, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - K Obata-Ninomiya
- Department of Immune Regulation, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - K Utpatel
- Department of Pathology, University Hospital Regensburg, Regensburg, Germany
| | - M Evert
- Department of Pathology, University Hospital Regensburg, Regensburg, Germany
| | - S W Hirt
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - E K Geissler
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Fichtner-Feigl
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany.,RCI Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany
| | - M Mack
- Department of Internal Medicine II, Nephrology, University Hospital Regensburg, Regensburg, Germany.,RCI Regensburg Center for Interventional Immunology, University of Regensburg, Regensburg, Germany
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Mack M. Einsatzgebiete in der HNO. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Arsalan M, Squiers J, Herbert M, Mac Hannaford J, Chamogeorgakis T, Moore D, Harrington K, Mack M, Brinkman W. Hospital Volume Impacts Outcomes in the Treatment of Type A Aortic Dissection. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mack M. Entzündliche Läsionen. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mack M. Speechless: Radiology of the larynx. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fischer S, Vogl T, Kresing M, Marzi I, Zangos S, Mack M, Eichler K. Minimally invasive screw fixation of fractures in the cervical and thoracic spine: CT-controlled pre-surgical guidewire implantation in clinical routine. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Petrilli CM, Mack M, Petrilli JJ, Hickner A, Saint S, Chopra V. Understanding the role of physician attire on patient perceptions: a systematic review of the literature--targeting attire to improve likelihood of rapport (TAILOR) investigators. BMJ Open 2015; 5:e006578. [PMID: 25600254 PMCID: PMC4312788 DOI: 10.1136/bmjopen-2014-006578] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Despite a growing body of literature, uncertainty regarding the influence of physician dress on patients' perceptions exists. Therefore, we performed a systematic review to examine the influence of physician attire on patient perceptions including trust, satisfaction and confidence. SETTING, PARTICIPANTS, INTERVENTIONS AND OUTCOMES We searched MEDLINE, Embase, Biosis Previews and Conference Papers Index. Studies that: (1) involved participants ≥18 years of age; (2) evaluated physician attire; and (3) reported patient perceptions related to attire were included. Two authors determined study eligibility. Studies were categorised by country of origin, clinical discipline (eg, internal medicine, surgery), context (inpatient vs outpatient) and occurrence of a clinical encounter when soliciting opinions regarding attire. Studies were assessed using the Downs and Black Scale risk of bias scale. Owing to clinical and methodological heterogeneity, meta-analyses were not attempted. RESULTS Of 1040 citations, 30 studies involving 11 533 patients met eligibility criteria. Included studies featured patients from 14 countries. General medicine, procedural (eg, general surgery and obstetrics), clinic, emergency departments and hospital settings were represented. Preferences or positive influence of physician attire on patient perceptions were reported in 21 of the 30 studies (70%). Formal attire and white coats with other attire not specified was preferred in 18 of 30 studies (60%). Preference for formal attire and white coats was more prevalent among older patients and studies conducted in Europe and Asia. Four of seven studies involving procedural specialties reported either no preference for attire or a preference for scrubs; four of five studies in intensive care and emergency settings also found no attire preference. Only 3 of 12 studies that surveyed patients after a clinical encounter concluded that attire influenced patient perceptions. CONCLUSIONS Although patients often prefer formal physician attire, perceptions of attire are influenced by age, locale, setting and context of care. Policy-based interventions that target such factors appear necessary.
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Affiliation(s)
- Christopher Michael Petrilli
- Division of General Internal Medicine, The Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan Mack
- Division of General Internal Medicine, The Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Jennifer Janowitz Petrilli
- Division of General Internal Medicine, The Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andy Hickner
- Division of General Internal Medicine, The Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Sanjay Saint
- Division of General Internal Medicine, The Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Vineet Chopra
- Division of General Internal Medicine, The Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Köbel M, Madore J, Ramus SJ, Clarke BA, Pharoah PDP, Deen S, Bowtell DD, Odunsi K, Menon U, Morrison C, Lele S, Bshara W, Sucheston L, Beckmann MW, Hein A, Thiel FC, Hartmann A, Wachter DL, Anglesio MS, Høgdall E, Jensen A, Høgdall C, Kalli KR, Fridley BL, Keeney GL, Fogarty ZC, Vierkant RA, Liu S, Cho S, Nelson G, Ghatage P, Gentry-Maharaj A, Gayther SA, Benjamin E, Widschwendter M, Intermaggio MP, Rosen B, Bernardini MQ, Mackay H, Oza A, Shaw P, Jimenez-Linan M, Driver KE, Alsop J, Mack M, Koziak JM, Steed H, Ewanowich C, DeFazio A, Chenevix-Trench G, Fereday S, Gao B, Johnatty SE, George J, Galletta L, Goode EL, Kjær SK, Huntsman DG, Fasching PA, Moysich KB, Brenton JD, Kelemen LE. Evidence for a time-dependent association between FOLR1 expression and survival from ovarian carcinoma: implications for clinical testing. An Ovarian Tumour Tissue Analysis consortium study. Br J Cancer 2014; 111:2297-307. [PMID: 25349970 PMCID: PMC4264456 DOI: 10.1038/bjc.2014.567] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/03/2014] [Accepted: 10/02/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Folate receptor 1 (FOLR1) is expressed in the majority of ovarian carcinomas (OvCa), making it an attractive target for therapy. However, clinical trials testing anti-FOLR1 therapies in OvCa show mixed results and require better understanding of the prognostic relevance of FOLR1 expression. We conducted a large study evaluating FOLR1 expression with survival in different histological types of OvCa. METHODS Tissue microarrays composed of tumour samples from 2801 patients in the Ovarian Tumour Tissue Analysis (OTTA) consortium were assessed for FOLR1 expression by centralised immunohistochemistry. We estimated associations for overall (OS) and progression-free (PFS) survival using adjusted Cox regression models. High-grade serous ovarian carcinomas (HGSC) from The Cancer Genome Atlas (TCGA) were evaluated independently for association between FOLR1 mRNA upregulation and survival. RESULTS FOLR1 expression ranged from 76% in HGSC to 11% in mucinous carcinomas in OTTA. For HGSC, the association between FOLR1 expression and OS changed significantly during the years following diagnosis in OTTA (Pinteraction=0.01, N=1422) and TCGA (Pinteraction=0.01, N=485). In OTTA, particularly for FIGO stage I/II tumours, patients with FOLR1-positive HGSC showed increased OS during the first 2 years only (hazard ratio=0.44, 95% confidence interval=0.20-0.96) and patients with FOLR1-positive clear cell carcinomas (CCC) showed decreased PFS independent of follow-up time (HR=1.89, 95% CI=1.10-3.25, N=259). In TCGA, FOLR1 mRNA upregulation in HGSC was also associated with increased OS during the first 2 years following diagnosis irrespective of tumour stage (HR: 0.48, 95% CI: 0.25-0.94). CONCLUSIONS FOLR1-positive HGSC tumours were associated with an increased OS in the first 2 years following diagnosis. Patients with FOLR1-negative, poor prognosis HGSC would be unlikely to benefit from anti-FOLR1 therapies. In contrast, a decreased PFS interval was observed for FOLR1-positive CCC. The clinical efficacy of FOLR1-targeted interventions should therefore be evaluated according to histology, stage and time following diagnosis.
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Affiliation(s)
- M Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - J Madore
- Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada
- Melanoma Institute Australia, University of Sydney, Royal Prince Alfred Hospital, Gloucester House–level 3, Missenden Road, Camperdown, NSW 2050, Australia
| | - S J Ramus
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - B A Clarke
- Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, University of Toronto, 610 Univeristy Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - P D P Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - S Deen
- Department of Histopathology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - D D Bowtell
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
- Department of Biochemistry and Molecular Biology, University of Melbourne, 30 Flemington Road, Melbourne, VIC 3010, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, 30 Flemington Road, Melbourne, VIC 3010, Australia
| | - K Odunsi
- Department of Gynecological Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - U Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - C Morrison
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - S Lele
- Department of Gynecological Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - W Bshara
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - L Sucheston
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - A Hein
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - F C Thiel
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - D L Wachter
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - M S Anglesio
- Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada
| | - E Høgdall
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark
- Department of Pathology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2370 Herlev, Denmark
| | - A Jensen
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark
| | - C Høgdall
- The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Ø, Denmark
| | - K R Kalli
- Department of Medical Oncology, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - B L Fridley
- Department of Biostatistics, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - G L Keeney
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Stabile 13, Rochester, MN 55905, USA
| | - Z C Fogarty
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - R A Vierkant
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - S Liu
- Anatomic Pathology Research Laboratory, Calgary Laboratory Services, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - S Cho
- Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - G Nelson
- Department of Obstetrics and Gynecology, Division of Oncology, Tom Baker Cancer Centre, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - P Ghatage
- Department of Obstetrics and Gynecology, Division of Oncology, Tom Baker Cancer Centre, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - S A Gayther
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - E Benjamin
- Department of Pathology, Cancer Institute, University College London, Maple House, 149 Tottenham Court Road, London WC1E 6JJ, UK
| | - M Widschwendter
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, 74 Huntley Street, London WC1E 6AU, UK
| | - M P Intermaggio
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - B Rosen
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - M Q Bernardini
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - H Mackay
- Department of Medicine, Division of Medical Oncology, University of Toronto, Princess Margaret Hospital, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - A Oza
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - P Shaw
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - M Jimenez-Linan
- Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
| | - K E Driver
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - J Alsop
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - M Mack
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - J M Koziak
- Department of Population Health Research, Alberta Health Services-Cancer Care, 2210 2nd Street SW, Calgary, AB, T2S 3C3, Canada
| | - H Steed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB T5H 3V9, Canada
| | - C Ewanowich
- Department of Laboratory Medicine and Pathology, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB T5H 3V9, Canada
| | - A DeFazio
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, NSW 2145, Australia
| | - G Chenevix-Trench
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD,4006, Australia
| | - S Fereday
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - B Gao
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, NSW 2145, Australia
| | - S E Johnatty
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD,4006, Australia
| | - J George
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - L Galletta
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - AOCS Study Group
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - E L Goode
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, 200 First Street SW Charlton 6, Rochester, MN 55905, USA
| | - S K Kjær
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark
- The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Ø, Denmark
| | - D G Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada
- Centre For Translational and Applied Genomics, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - K B Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - J D Brenton
- National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
- Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Hills Road, Cambridge CB2 0XZ, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
- Cambridge Experimental Cancer Medicine Centre, Cambridge CB2 0RE, UK
| | - L E Kelemen
- Department of Public Health Sciences, Medical University of South Carolina and Hollings Cancer Center, 135 Cannon Street, Charleston, SC 29425, USA
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46
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Köbel M, Madore J, Ramus SJ, Clarke BA, Pharoah PDP, Deen S, Bowtell DD, Odunsi K, Menon U, Morrison C, Lele S, Bshara W, Sucheston L, Beckmann MW, Hein A, Thiel FC, Hartmann A, Wachter DL, Anglesio MS, Høgdall E, Jensen A, Høgdall C, Kalli KR, Fridley BL, Keeney GL, Fogarty ZC, Vierkant RA, Liu S, Cho S, Nelson G, Ghatage P, Gentry-Maharaj A, Gayther SA, Benjamin E, Widschwendter M, Intermaggio MP, Rosen B, Bernardini MQ, Mackay H, Oza A, Shaw P, Jimenez-Linan M, Driver KE, Alsop J, Mack M, Koziak JM, Steed H, Ewanowich C, DeFazio A, Chenevix-Trench G, Fereday S, Gao B, Johnatty SE, George J, Galletta L, Goode EL, Kjær SK, Huntsman DG, Fasching PA, Moysich KB, Brenton JD, Kelemen LE. Evidence for a time-dependent association between FOLR1 expression and survival from ovarian carcinoma: implications for clinical testing. An Ovarian Tumour Tissue Analysis consortium study. Br J Cancer 2014. [PMID: 25349970 DOI: 10.1038/bjc.2014.567] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Folate receptor 1 (FOLR1) is expressed in the majority of ovarian carcinomas (OvCa), making it an attractive target for therapy. However, clinical trials testing anti-FOLR1 therapies in OvCa show mixed results and require better understanding of the prognostic relevance of FOLR1 expression. We conducted a large study evaluating FOLR1 expression with survival in different histological types of OvCa. METHODS Tissue microarrays composed of tumour samples from 2801 patients in the Ovarian Tumour Tissue Analysis (OTTA) consortium were assessed for FOLR1 expression by centralised immunohistochemistry. We estimated associations for overall (OS) and progression-free (PFS) survival using adjusted Cox regression models. High-grade serous ovarian carcinomas (HGSC) from The Cancer Genome Atlas (TCGA) were evaluated independently for association between FOLR1 mRNA upregulation and survival. RESULTS FOLR1 expression ranged from 76% in HGSC to 11% in mucinous carcinomas in OTTA. For HGSC, the association between FOLR1 expression and OS changed significantly during the years following diagnosis in OTTA (Pinteraction=0.01, N=1422) and TCGA (Pinteraction=0.01, N=485). In OTTA, particularly for FIGO stage I/II tumours, patients with FOLR1-positive HGSC showed increased OS during the first 2 years only (hazard ratio=0.44, 95% confidence interval=0.20-0.96) and patients with FOLR1-positive clear cell carcinomas (CCC) showed decreased PFS independent of follow-up time (HR=1.89, 95% CI=1.10-3.25, N=259). In TCGA, FOLR1 mRNA upregulation in HGSC was also associated with increased OS during the first 2 years following diagnosis irrespective of tumour stage (HR: 0.48, 95% CI: 0.25-0.94). CONCLUSIONS FOLR1-positive HGSC tumours were associated with an increased OS in the first 2 years following diagnosis. Patients with FOLR1-negative, poor prognosis HGSC would be unlikely to benefit from anti-FOLR1 therapies. In contrast, a decreased PFS interval was observed for FOLR1-positive CCC. The clinical efficacy of FOLR1-targeted interventions should therefore be evaluated according to histology, stage and time following diagnosis.
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Affiliation(s)
- M Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - J Madore
- 1] Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada [2] Melanoma Institute Australia, University of Sydney, Royal Prince Alfred Hospital, Gloucester House-level 3, Missenden Road, Camperdown, NSW 2050, Australia
| | - S J Ramus
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - B A Clarke
- Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, University of Toronto, 610 Univeristy Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - P D P Pharoah
- 1] Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK [2] Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - S Deen
- Department of Histopathology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - D D Bowtell
- 1] Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia [2] Department of Biochemistry and Molecular Biology, University of Melbourne, 30 Flemington Road, Melbourne, VIC 3010, Australia [3] Sir Peter MacCallum Department of Oncology, University of Melbourne, 30 Flemington Road, Melbourne, VIC 3010, Australia
| | - K Odunsi
- Department of Gynecological Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - U Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - C Morrison
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - S Lele
- 1] Department of Gynecological Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA [2] Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - W Bshara
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - L Sucheston
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - A Hein
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - F C Thiel
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - D L Wachter
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - M S Anglesio
- Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada
| | - E Høgdall
- 1] Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark [2] Department of Pathology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2370 Herlev, Denmark
| | - A Jensen
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark
| | - C Høgdall
- The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Ø, Denmark
| | - K R Kalli
- Department of Medical Oncology, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - B L Fridley
- Department of Biostatistics, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - G L Keeney
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Stabile 13, Rochester, MN 55905, USA
| | - Z C Fogarty
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - R A Vierkant
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN 55905, USA
| | - S Liu
- Anatomic Pathology Research Laboratory, Calgary Laboratory Services, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - S Cho
- Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - G Nelson
- Department of Obstetrics and Gynecology, Division of Oncology, Tom Baker Cancer Centre, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - P Ghatage
- Department of Obstetrics and Gynecology, Division of Oncology, Tom Baker Cancer Centre, University of Calgary, Foothills Medical Center, 1403 29 ST NW, Calgary, AB T2N 2T9, Canada
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - S A Gayther
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - E Benjamin
- Department of Pathology, Cancer Institute, University College London, Maple House, 149 Tottenham Court Road, London WC1E 6JJ, UK
| | - M Widschwendter
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, 74 Huntley Street, London WC1E 6AU, UK
| | - M P Intermaggio
- Department of Preventive Medicine, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Harlyne Norris Research Tower, 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - B Rosen
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - M Q Bernardini
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - H Mackay
- Department of Medicine, Division of Medical Oncology, University of Toronto, Princess Margaret Hospital, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - A Oza
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - P Shaw
- Department of Obstetrics and Gynecology, University of Toronto, Princess Margaret Cancer Centre, 610 University Avenue, M-700, Toronto, ON M5T 2M9, Canada
| | - M Jimenez-Linan
- 1] Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK [2] National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK
| | - K E Driver
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - J Alsop
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - M Mack
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - J M Koziak
- Department of Population Health Research, Alberta Health Services-Cancer Care, 2210 2nd Street SW, Calgary, AB, T2S 3C3, Canada
| | - H Steed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB T5H 3V9, Canada
| | - C Ewanowich
- Department of Laboratory Medicine and Pathology, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB T5H 3V9, Canada
| | - A DeFazio
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, NSW 2145, Australia
| | - G Chenevix-Trench
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD,4006, Australia
| | - S Fereday
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - B Gao
- Department of Gynaecological Oncology and Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, NSW 2145, Australia
| | - S E Johnatty
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD,4006, Australia
| | - J George
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | - L Galletta
- Department of Cancer Genomics and Genetics, Peter MacCallum Cancer Centre, Locked Bag I, A'Beckett Street, East Melbourne, VIC 8006, Australia
| | | | - E L Goode
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, 200 First Street SW Charlton 6, Rochester, MN 55905, USA
| | - S K Kjær
- 1] Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Ø, Denmark [2] The Juliane Marie Center, Department of Obstetrics and Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Ø, Denmark
| | - D G Huntsman
- 1] Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5E 4E6, Canada [2] Centre For Translational and Applied Genomics, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - P A Fasching
- 1] Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitaetsstrasse 21-23, 91054 Erlangen, Germany [2] Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - K B Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - J D Brenton
- 1] National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 2QQ, UK [2] Department of Oncology, University of Cambridge, Hutchison/MRC Research Centre, Hills Road, Cambridge CB2 0XZ, UK [3] Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK [4] Cambridge Experimental Cancer Medicine Centre, Cambridge CB2 0RE, UK
| | - L E Kelemen
- Department of Public Health Sciences, Medical University of South Carolina and Hollings Cancer Center, 135 Cannon Street, Charleston, SC 29425, USA
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Manojlovich M, Chase VJ, Mack M, Conroy MK, Belanger K, Zawol D, Corr KM, Fowler KE, Viglianti E. Using A3 thinking to improve the STAT medication process. J Hosp Med 2014; 9:540-4. [PMID: 24916107 DOI: 10.1002/jhm.2222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Received: 01/22/2014] [Revised: 04/01/2014] [Accepted: 05/07/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although the term STAT conveys a sense of urgency, it is sometimes used to circumvent a system that may be too slow to accomplish tasks in a timely manner. We describe a quality-improvement project undertaken by a US Department of Veterans Affairs (VA) hospital to improve the STAT medication process. METHODS We adapted A3 Thinking, a problem-solving process common in Lean organizations, to our problem. In the discovery phase, a color-coded flow map of the existing process was constructed, and a real-time STAT order was followed in a modified "Go to the Gemba" exercise. In the envisioning phase, the team brainstormed to come up with as many improvement ideas as possible, which were then prioritized based on the anticipated effort and impact. The team then identified initial experiments to be carried out in the experimentation phase; each experiment followed a standard Plan-Do-Study-Act cycle. RESULTS On average, the number of STAT medications ordered per month decreased by 9.5%. The average time from STAT order entry to administration decreased by 21%, and time from medication delivery to administration decreased by 26%. Improvements were also made in technician awareness of STAT medications and nurse notification of STAT medication delivery. CONCLUSIONS Adapting A3 Thinking for process improvement was a low-cost/low-tech option for a VA facility. The A3 Thinking process led to a better understanding of the meaning of STAT across disciplines, and promoted a collaborative culture in which other hospital-wide problems may be addressed in the future.
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Affiliation(s)
- Milisa Manojlovich
- Division of Nursing Business and Health Systems, University of Michigan School of Nursing, Ann Arbor, Michigan; VA Ann Arbor Hospital Outcomes Program of Excellence (HOPE) Initiative, Ann Arbor, Michigan
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Westhovens R, Weinblatt M, Han C, Kim L, Mack M, Lu J, Baker D, Mendelsohn A, Bingham C. FRI0266 Health-Related Quality of Life of Patients with Rheumatoid Arthritis Achieving DAS28 Remission, Improvement in Physical Function and NO Radiographic Progression after Treatment with Intravenous Golimumab. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany T, Han C, Inman R. OP0170 Achieving ASDAS-CRP major improvement and inactive disease in patients with ankylosing spondylitis after treatment with golimumab is associated with normalized health related quality of life: Two-year results from the go-raise trial. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.1853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kay J, Fleischmann R, Keystone E, Hsia E, Doyle M, Hsu B, Mack M, Beutler A, Braun J, Kavanaugh A. SAT0133 Golimumab 3-year safety update: An analysis of pooled data from the long term extensions of randomized, double-blind, placebo-controlled studies in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.3080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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