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Eley V, Peters N, Woods C, Llewellyn S, Derboghossian T, Ogg M, Rickard CM, Chin A. Perioperative arterial catheterization: A prospective evaluation of ultrasound, infection, and patient-focused outcomes. J Vasc Access 2024:11297298241246300. [PMID: 38659089 DOI: 10.1177/11297298241246300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is little information regarding complications of arterial catheterization in modern clinical care. We aimed to determine the incidence of abnormal duplex vascular ultrasound and catheter related infections following perioperative arterial catheterization. METHODS Patients requiring arterial catheterization for elective surgery were included and insertion details collected prospectively. Duplex ultrasound evaluation was performed 24 h after catheter removal. Symptomatic patients were identified by self-reported questionnaire. On Day 7, patients answered questions by telephone, related to the insertion site, pain, and function. Results of catheter tip and blood culture analyses were sought. Univariate associations of patient and surgical characteristics with abnormal ultrasound were assessed with p < 0.05 considered significant. RESULTS Of 339 catheterizations, 105 (40%) had ultrasound evaluation. Catheters were indwelling for median (IQR, range) duration of 6.0 h (4.4-8.2, 1.8-28) with no catheter-related infections. There were 16 (15.2%, 95% CI 9.0%-23.6%) abnormal results, including 14 radial artery thromboses, one radial artery dissection, and one radial vein thrombosis. Those with abnormal ultrasound results were more likely to have had Arrow catheters inserted (68.8% vs 27%, p = 0.023) and more than one skin puncture (37.5% vs 26.8%, p = 0.031). Two of the 16 (12.5%) patients with abnormal ultrasound results reported new symptoms related to the hand compared with nine of the 88 (10.2%) with normal results (p = 0.1). No patients required urgent referral for management. CONCLUSIONS Thrombosis was the most common abnormality and was usually asymptomatic. There were no infections, few post-operative symptoms, and minimal functional impairment following arterial catheterization.
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Affiliation(s)
- Victoria Eley
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nathan Peters
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Christine Woods
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Stacey Llewellyn
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD, Australia
| | - Teal Derboghossian
- Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Murray Ogg
- Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
| | - Claire M Rickard
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Diseases Institute, Metro North Health, Herston, Brisbane, QLD, Australia
- Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, Brisbane, QLD, Australia
| | - Adrian Chin
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Maibach F, Czaplinski A, Peters N, Paliantonis A. A case report on concomitant reversible cerebral vasoconstriction syndrome and transient global amnesia. Cortex 2024; 172:49-53. [PMID: 38159443 DOI: 10.1016/j.cortex.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Reversible Cerebral Vasoconstriction Syndrome clinically presents as severe headaches with or without neurological deficits accompanied by multilocal caliber variation of the cerebral arteries on imaging studies. Transient Global Amnesia is a benign neurological condition that implies sudden temporary antero- and retrograde amnesia. The exact pathophysiological mechanisms involved in transient global amnesia and reversible cerebral vasoconstriction syndrome remain unclear but suggest similar pathways as both can be triggered by factors that activate the sympathetic nervous system. We herein discuss a potential relationship of the two conditions in a 65-year-old woman that initially presented herself to the emergency department with temporary memory impairment, indicating Transient Global Amnesia. Four days later, the patient revealed a thunderclap headache accompanied by a subarachnoid hemorrhage with transient segmental narrowing of the arteries of the anterior circulation on neuroimaging. In this case report we hypothesize that Reversible Cerebral Vasoconstriction Syndrome might be a potential cause for the clinical symptoms and imaging patterns with Transient Global Amnesia as a possible prodromal stage of Reversible Cerebral Vasoconstriction Syndrome.
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Affiliation(s)
- F Maibach
- Neurology Clinic, Zürich, Switzerland
| | | | - N Peters
- Neurology Clinic, Zürich, Switzerland; University of Basel, Basel, Switzerland
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Peters N, Williamson F, Bauer MJ, Llewellyn S, Snelling PJ, Marsh N, Harris PNA, Stewart AG, Rickard CM. Comparison of Low-Level to High-Level Disinfection in Eliminating Microorganisms From Ultrasound Transducers Used on Skin: A Noninferiority Randomized Controlled Trial. J Ultrasound Med 2023; 42:2525-2534. [PMID: 37306253 DOI: 10.1002/jum.16286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION There is a lack of international consensus as to whether high- or low-level disinfection (HLD or LLD) is required for ultrasound (US) transducers used during percutaneous procedures. This study compared the effectiveness of LLD to HLD on US transducers contaminated with microorganisms from skin. METHODS Two identical linear US transducers repeatedly underwent either LLD or HLD during the study. Randomization determined which of these transducers was applied to left and right forearms of each participant. Swabs taken from transducers before and after reprocessing were plated then incubated for 4-5 days, after which colony forming units (CFU) were counted and identified. The primary hypothesis was the difference in the proportion of US transducers having no CFUs remaining after LLD and HLD would be less than or equal to the noninferiority margin of -5%. RESULTS Of the 654 recruited participants 73% (n = 478) had microbial growth from both transducers applied to their left and right forearms before reprocessing. These were included in the paired noninferiority statistical analysis where, after disinfection, all CFUs were eliminated in 100% (95% CI: 99.4-100.0%) of HLD transducer samples (n = 478) and 99.0% (95% CI: 97.6-99.7%) of LLD transducer samples (n = 473). The paired difference in the proportion of transducers having all CFUs eliminated between LLD and HLD was -1.0% (95% CI: -2.4 to -0.2%, P-value <.001). CONCLUSIONS Disinfection with LLD is noninferior to HLD when microorganisms from skin have contaminated the transducer. Therefore, using LLD for US transducers involved in percutaneous procedures would present no higher infection risk compared with HLD.
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Affiliation(s)
- Nathan Peters
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Frances Williamson
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Michelle J Bauer
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Stacey Llewellyn
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Peter J Snelling
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Emergency Department, Gold Coast University Hospital, Southport, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
| | - Patrick N A Harris
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia
- Central Microbiology, Pathology Queensland, Brisbane, Australia
| | - Adam G Stewart
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia
- Central Microbiology, Pathology Queensland, Brisbane, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute, Metro North Hospitals and Health Service, Brisbane, Australia
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4
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Schults JA, Marsh N, Ullman AJ, Kleidon TM, Ware RS, Byrnes J, Young E, Hall L, Keijzers G, Cullen L, Calleja P, McTaggart S, Peters N, Watkins S, Corley A, Brown C, Lin Z, Williamson F, Burgess L, Macfarlane F, Cooke M, Battley C, Rickard CM. Improving difficult peripheral intravenous access requires thought, training and technology (DART 3): a stepped-wedge, cluster randomised controlled trial protocol. BMC Health Serv Res 2023; 23:587. [PMID: 37286977 DOI: 10.1186/s12913-023-09499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) are the most used invasive medical device in healthcare. Yet around half of insertion attempts are unsuccessful leading to delayed medical treatments and patient discomfort of harm. Ultrasound-guided PIVC (USGPIVC) insertion is an evidence-based intervention shown to improve insertion success especially in patients with Difficult IntraVenous Access (BMC Health Serv Res 22:220, 2022), however the implementation in some healthcare settings remains suboptimal. This study aims to co-design interventions that optimise ultrasound guided PIVC insertion in patients with DIVA, implement and evaluate these initiatives and develop scale up activities. METHODS A stepped-wedge cluster randomized controlled trial will be conducted in three hospitals (two adult, one paediatric) in Queensland, Australia. The intervention will be rolled out across 12 distinct clusters (four per hospital). Intervention development will be guided by Michie's Behavior Change Wheel with the aim to increase local staff capability, opportunity, and motivation for appropriate, sustainable adoption of USGPIVC insertion. Eligible clusters include all wards or departments where > 10 PIVCs/week are typically inserted. All clusters will commence in the control (baseline) phase, then, one cluster per hospital will step up every two months, as feasible, to the implementation phase, where the intervention will be rolled out. Implementation strategies are tailored for each hospital by local investigators and advisory groups, through context assessments, staff surveys, and stakeholder interviews and informed by extensive consumer interviews and consultation. Outcome measures align with the RE-AIM framework including clinical-effectiveness outcomes (e.g., first-time PIVC insertion success for DIVA patients [primary outcome], number of insertion attempts); implementation outcomes (e.g., intervention fidelity, readiness assessment) and cost effectiveness outcomes. The Consolidated Framework for Implementation Research framework will be used to report the intervention as it was implemented; how people participated in and responded to the intervention; contextual influences and how the theory underpinning the intervention was realised and delivered at each site. A sustainability assessment will be undertaken at three- and six-months post intervention. DISCUSSION Study findings will help define systematic solutions to implement DIVA identification and escalation tools aiming to address consumer dissatisfaction with current PIVC insertion practices. Such actionable knowledge is critical for implementation of scale-up activities. TRIAL REGISTRATION Prospectively registered (Australian and New Zealand Clinical Trials Registry; ACTRN12621001497897).
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Affiliation(s)
- Jessica A Schults
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia.
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia.
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia.
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
| | - Nicole Marsh
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Amanda J Ullman
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Tricia M Kleidon
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Joshua Byrnes
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Emily Young
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Lisa Hall
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Gerben Keijzers
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
- Department of Emergency Medicine, Gold Coast University Hospital Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Pauline Calleja
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
- School of Nursing, Midwifery & Social Science, Central Queensland University, Queensland, Australia
| | - Steven McTaggart
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Nathan Peters
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Stuart Watkins
- Department of Emergency Medicine, Gold Coast University Hospital Southport, Queensland, Australia
| | - Amanda Corley
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Christine Brown
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Zhen Lin
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Frances Williamson
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
- Jamieson Trauma Institute, Herston, QLD, Australia
| | - Luke Burgess
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Fiona Macfarlane
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
| | - Callan Battley
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Claire M Rickard
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
- Nursing Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Queensland, Australia
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Maulucci F, Disanto G, Bianco G, Pileggi M, Fischer U, Padlina G, Strambo D, Michel P, Kahles T, Nedeltchev K, Fisch U, Bonati L, Kägi G, Escribano Paredes JB, Carrera E, Nyffeler T, Bolognese M, Wegener S, Luft A, Schelosky L, Medlin F, von Reding A, Peters N, Renaud S, Mono ML, Remonda L, Machi P, Psychogios MN, Kaesmacher J, Mordasini P, Cereda CW. Endovascular therapy outcome in isolated posterior cerebral artery occlusion strokes: A multicenter analysis of the Swiss Stroke Registry. Eur Stroke J 2023; 8:575-580. [PMID: 37231695 PMCID: PMC10334166 DOI: 10.1177/23969873221150125] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
PURPOSE There is little data on the safety and efficacy of endovascular treatment (EVT) in comparison with intravenous thrombolysis (IVT) in acute ischemic stroke due to isolated posterior cerebral artery occlusion (IPCAO). We aimed to investigate the functional and safety outcomes of stroke patients with acute IPCAO treated with EVT (with or without prior bridging IVT) compared to IVT alone. METHODS We did a multicenter retrospective analysis of data from the Swiss Stroke Registry. The primary endpoint was overall functional outcome at 3 months in patients undergoing EVT alone or as part of bridging, compared with IVT alone (shift analysis). Safety endpoints were mortality and symptomatic intracranial hemorrhage. EVT and IVT patients were matched 1:1 using propensity scores. Differences in outcomes were examined using ordinal and logistic regression models. FINDINGS Out of 17,968 patients, 268 met the inclusion criteria and 136 were matched by propensity scores. The overall functional outcome at 3 months was comparable between the two groups (EVT vs IVT as reference category: OR = 1.42 for higher mRS, 95% CI = 0.78-2.57, p = 0.254). The proportion of patients independent at 3 months was 63.2% in EVT and 72.1% in IVT (OR = 0.67, 95% CI = 0.32-1.37, p = 0.272). Symptomatic intracranial hemorrhages were overall rare and present only in the IVT group (IVT = 5.9% vs EVT = 0%). Mortality at 3 months was also similar between the two groups (IVT = 0% vs EVT = 1.5%). CONCLUSION In this multicenter nested analysis, EVT and IVT in patients with acute ischemic stroke due to IPCAO were associated with similar overall good functional outcome and safety. Randomized studies are warranted.
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Affiliation(s)
- F Maulucci
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - G Disanto
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - G Bianco
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - M Pileggi
- Stroke Centre, Interventional and Diagnostic Neuroradiology, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - U Fischer
- Department of Neurology, University Hospital Bern, Bern, Switzerland
- Department of Neurology and Stroke Centre, University Hospital Basel, Basel, Switzerland
| | - G Padlina
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - D Strambo
- Lausanne University Hospital, Stroke Centre, Neurology Service, Lausanne, Switzerland
| | - P Michel
- Lausanne University Hospital, Stroke Centre, Neurology Service, Lausanne, Switzerland
| | - T Kahles
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - K Nedeltchev
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - U Fisch
- Department of Neurology and Stroke Centre, University Hospital Basel, Basel, Switzerland
| | - L Bonati
- Department of Neurology and Stroke Centre, University Hospital Basel, Basel, Switzerland
| | - G Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - E Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - T Nyffeler
- Luzerner Kantonsspital, Centre of Neurology and Neurorehabilitation, Luzern, Switzerland
| | - M Bolognese
- Luzerner Kantonsspital, Centre of Neurology and Neurorehabilitation, Luzern, Switzerland
| | - S Wegener
- Universitätsspital Zürich, Neurology, Zürich, Switzerland
| | - A Luft
- Universitätsspital Zürich, Neurology, Zürich, Switzerland
| | - L Schelosky
- Kantonsspital Münsterlingen, Division of Neurology, Münsterlingen, Switzerland
| | - F Medlin
- Stroke Unit, Division of Neurology, HFR Fribourg, Fribourg, Switzerland
| | - A von Reding
- Neurology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - N Peters
- Stroke Centre, Klinik Hirslanden, Zurich, Switzerland
| | - S Renaud
- Division of Neurology, Pourtalès Hospital, Neuchatel, Switzerland
| | - M-L Mono
- Stadtspital Waid und Triemli, Stroke Unit, Zürich, Switzerland
| | - L Remonda
- Department of Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - P Machi
- Department of Interventional Neuroradiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - M-N Psychogios
- Department of Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - J Kaesmacher
- University Hospital Bern, Inselspital, Interventional Neuroradiology, Bern, Switzerland
| | - P Mordasini
- University Hospital Bern, Inselspital, Interventional Neuroradiology, Bern, Switzerland
| | - C W Cereda
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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6
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de Graaff MR, Hogenbirk RNM, Janssen YF, Elfrink AKE, Liem RSL, Nienhuijs SW, de Vries JPPM, Elshof JW, Verdaasdonk E, Melenhorst J, van Westreenen HL, Besselink MGH, Ruurda JP, van Berge Henegouwen MI, Klaase JM, den Dulk M, van Heijl M, Hegeman JH, Braun J, Voeten DM, Würdemann FS, Warps ALK, Alberga AJ, Suurmeijer JA, Akpinar EO, Wolfhagen N, van den Boom AL, Bolster-van Eenennaam MJ, van Duijvendijk P, Heineman DJ, Wouters MWJM, Kruijff S, Koningswoud-Terhoeve CL, Belt E, van der Hoeven JAB, Marres GMH, Tozzi F, von Meyenfeldt EM, Coebergh RRJ, van den Braak, Huisman S, Rijken AM, Balm R, Daams F, Dickhoff C, Eshuis WJ, Gisbertz SS, Zandbergen HR, Hartemink KJ, Keessen SA, Kok NFM, Kuhlmann KFD, van Sandick JW, Veenhof AA, Wals A, van Diepen MS, Schoonderwoerd L, Stevens CT, Susa D, Bendermacher BLW, Olofsen N, van Himbeeck M, de Hingh IHJT, Janssen HJB, Luyer MDP, Nieuwenhuijzen GAP, Ramaekers M, Stacie R, Talsma AK, Tissink MW, Dolmans D, Berendsen R, Heisterkamp J, Jansen WA, de Kort-van Oudheusden M, Matthijsen RM, Grünhagen DJ, Lagarde SM, Maat APWM, van der Sluis PC, Waalboer RB, Brehm V, van Brussel JP, Morak M, Ponfoort ED, Sybrandy JEM, Klemm PL, Lastdrager W, Palamba HW, van Aalten SM, Tseng LNL, van der Bogt KEA, de Jong WJ, Oosterhuis JWA, Tummers Q, van der Wilden GM, Ooms S, Pasveer EH, Veger HTC, Molegraafb MJ, Nieuwenhuijs VB, Patijn GA, van der Veldt MEV, Boersma D, van Haelst STW, van Koeverden ID, Rots ML, Bonsing BA, Michiels N, Bijlstra OD, Braun J, Broekhuis D, Brummelaar HW, Hartgrink HH, Metselaar A, Mieog JSD, Schipper IB, de Steur WO, Fioole B, Terlouw EC, Biesmans C, Bosmans JWAM, Bouwense SAW, Clermonts SHEM, Coolsen MME, Mees BME, Schurink GWH, Duijff JW, van Gent T, de Nes LCF, Toonen D, Beverwijk MJ, van den Hoed E, Keizers B, Kelder W, Keller BPJA, Pultrum BB, van Rosum E, Wijma AG, van den Broek F, Leclercq WKG, Loos MJA, Sijmons JML, Vaes RHD, Vancoillie PJ, Consten ECJ, Jongen JMJ, Verheijen PM, van Weel V, Arts CHP, Jonker J, Murrmann-Boonstra G, Pierie JPEN, Swart J, van Duyn EB, Geelkerken RH, de Groot R, Moekotte NL, Stam A, Voshaar A, van Acker GJD, Bulder RMA, Swank DJ, Pereboom ITA, Hoffmann WH, Orsini M, Blok JJ, Lardenoije JHP, Reijne MMPJ, van Schaik P, Smeets L, van Sterkenburg SMM, Harlaar NJ, Mekke S, Verhaakt T, Cancrinus E, van Lammeren GW, Molenaar IQ, van Santvoort HC, Vos AWF, Schouten- van der Velden AP, Woensdregt K, Mooy-Vermaat SP, Scharn DM, Marsman HA, Rassam F, Halfwerk FR, Andela AJ, Buis CI, van Dam GM, ten Duis K, van Etten B, Lases L, Meerdink M, de Meijer VE, Pranger B, Ruiter S, Rurenga M, Wiersma A, Wijsmuller AR, Albers KI, van den Boezem PB, Klarenbeek B, van der Kolk BM, van Laarhoven CJHM, Matthée E, Peters N, Rosman C, Schroen AMA, Stommel MWJ, Verhagen AFTM, van der Vijver R, Warlé MC, de Wilt JHW, van den Berg JW, Bloemert T, de Borst GJ, van Hattum EH, Hazenberg CEVB, van Herwaarden JA, van Hillegerberg R, Kroese TE, Petri BJ, Toorop RJ, Aarts F, Janssen RJL, Janssen-Maessen SHP, Kool M, Verberght H, Moes DE, Smit JW, Wiersema AM, Vierhout BP, de Vos B, den Boer FC, Dekker NAM, Botman JMJ, van Det MJ, Folbert EC, de Jong E, Koenen JC, Kouwenhoven EA, Masselink I, Navis LH, Belgers HJ, Sosef MN, Stoot JHMB. Impact of the COVID-19 pandemic on surgical care in the Netherlands. Br J Surg 2022; 109:1282-1292. [PMID: 36811624 PMCID: PMC10364688 DOI: 10.1093/bjs/znac301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/14/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands. METHODS A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018-2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates. RESULTS Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018-2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001). CONCLUSION The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.
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Affiliation(s)
- Michelle R de Graaff
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.,Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, the Netherlands
| | - Rianne N M Hogenbirk
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Yester F Janssen
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Arthur K E Elfrink
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ronald S L Liem
- Department of Surgery, Dutch Obesity Clinic, Gouda, the Netherlands.,Department of Surgery, Groene Hart Hospital, Gouda, the Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Jan-Willem Elshof
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - Emiel Verdaasdonk
- Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Marc G H Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Joost M Klaase
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marcel den Dulk
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Johannes H Hegeman
- Department of Surgery, Ziekenhuisgroep Twente Almelo-Hengelo, Almelo, Hengelo, the Netherlands
| | - Jerry Braun
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Daan M Voeten
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Franka S Würdemann
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anne-Loes K Warps
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anna J Alberga
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - J Annelie Suurmeijer
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Erman O Akpinar
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nienke Wolfhagen
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | | | | | - David J Heineman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
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Peters N, Thomas J, Woods C, Rickard C, Marsh N. Remotely supervised ultrasound-guided peripheral intravenous cannulation training: A prospective cohort study examining success rates and patient experience. Australas J Ultrasound Med 2022; 25:176-185. [PMID: 36405792 PMCID: PMC9644440 DOI: 10.1002/ajum.12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Ultrasound-guided peripheral intravenous cannulation (USGPIVC) benefits patients with difficult intravenous access (DIVA) through visualising otherwise non-visible and non-palpable veins. Supervised live-case training is an important component of learning this skill, but supervisor availability can present a barrier limiting or delaying staff completing their training. Aims The aim of this study was to determine the first-attempt success rate of newly trained USGPIVC inserters using remote supervision and timely written feedback based on app-based screen recordings taken during insertion. Secondary aims were overall procedural success, and inserter and patient experiences. Methods This study is an observational cohort study carried out between October and December 2021. Fourteen newly trained junior medical officers (JMOs) were eligible to utilise USGPIVC on a minimum of five consenting patients while simultaneously recording the ultrasound screen during insertion to capture their technique. Feedback was generated following expert review of these recordings against a standardised feedback tool. Results Average first-attempt success was 71% (n = 72) in the 102 patients recruited. The average time for JMOs to receive feedback was 30 h, and 13 JMOs (93%) felt well supported and completed the remote training pathway. The majority of patients were female (n = 59; 58%), were aged 41-80 years (n = 75; 74%) and had ≥2 risk factors for DIVA (n = 57; 56%). Conclusions First-attempt success rates were similar when comparing remote supervision used in this study to direct supervision used by other studies.This finding supports incorporating remote supervision into training guidelines for USGPIVC as an alternative method of supervision, particularly when supervisor availability is limited.
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Affiliation(s)
- Nathan Peters
- Department of Anaesthesia and Perioperative MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- University of QueenslandBrisbaneQueenslandAustralia
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Joel Thomas
- Department of Anaesthesia and Perioperative MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- University of QueenslandBrisbaneQueenslandAustralia
| | - Christine Woods
- Department of Anaesthesia and Perioperative MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- University of QueenslandBrisbaneQueenslandAustralia
| | - Claire Rickard
- University of QueenslandBrisbaneQueenslandAustralia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Alliance for Vascular Access Teaching and Research GroupGriffith UniversityBrisbaneQueenslandAustralia
- Metro North Hospitals and Health ServiceBrisbaneQueenslandAustralia
| | - Nicole Marsh
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Alliance for Vascular Access Teaching and Research GroupGriffith UniversityBrisbaneQueenslandAustralia
- Metro North Hospitals and Health ServiceBrisbaneQueenslandAustralia
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8
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Peters N, Morley H, Khalique S, Scalzo S, Patel R, Gunaydin U, Funingana G, Evans J, Papadatos-Pastos D, Banjeri U, Basu B, Niewiarowski A, Symeonides S, Kelly F, Sawretse L, Bacon C, Robinson M, Gelb T, Blakemore S, Cook N. Evaluation of membrane type 1 metalloproteinase (MT1-MMP/MMP14) expression as a prognostic biomarker in patients with solid tumours screened for a Phase I/II trial. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01114-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Bernard-Tessier A, Nykanen P, Utriainen T, Cook N, Barthelemy P, Baldini C, Peters N, Ikonen T, Pohjanjousi P, Karimaa M, Malkki J, Toivanen P, Garratt C, Fizazi K. 1420P The pharmacokinetics and the pharmacodynamic effect of ODM-208, an inhibitor of cholesterol side-chain cleavage enzyme (CYP11A1). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Taylor J, Dhoss E, Black M, Llewellyn S, Peters N. Anaesthetist’s adherence to aseptic ultrasound practices when performing Ultrasound Guided Peripheral Intravenous Cannulation (USGPIVC). A quality improvement project. Acta Anaest Belg 2022. [DOI: 10.56126/73.3.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Sterile ultrasound covers and conducting mediums are recommended when performing ultrasound guided percutaneous procedures to minimise risk of infection to the patient. Purpose manufactured ultrasound transducer cover kits meet these requirements. Transparent dressings meet some of these requirements however, they are not approved for use as ultrasound transducer covers. We recognised that our departmental practice may not adhere to these standards.
Objective: The primary objective was to identify and improve the rate of adherence to the recommended aseptic precautions by anaesthetists performing ultrasound guided percutaneous procedures at the Department of Anaesthesia, Royal Brisbane and Women’s Hospital, the largest tertiary referral hospital in Queensland, Australia. Secondary objectives were to identify types and rates of use of various probe covers and ultrasound conductive mediums used.
Design: A complete quality improvement cycle was undertaken using a plan, do, study, act model. Methods: Firstly, a departmental wide voluntary survey was distributed in March 2019 focused on practitioner’s baseline aseptic practices for ultrasound guided peripheral intravenous cannulation (USGPIVC). Subsequently a suite of interventions were undertaken between May 2019 to April 2020 focusing on highlighting recommended aseptic practices through the use of high-quality sterile transducer covers and sterile conducting mediums for all ultrasound guided percutaneous procedures. Components of the intervention included the development of a departmental policy, educational activities, and improving equipment availability and access. A post- intervention follow up audit was repeated in April 2020 to measure changes in practice. Results: Of 134 anaesthetic consultants or trainees 58 completed the pre-intervention survey and 47 completed the post- intervention survey. After the intervention the use of recommended transducer covers and conducting mediums increased from 10.3% to 76.6% and 58.6% to 83.0% respectively. Participants were more likely to choose both a recommended transducer cover and conducting medium than at least one non-recommended option ([OR] 20.4, 95% CI: 7.1 - 58.4). There was a 122% increase in the number of recommended transducer cover kits ordered when comparing stock inventory over a six-month period before and after the intervention.
Conclusion: Adherence to the recommended aseptic precautions for USGPIVC improved after the implementation of educational interventions.
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11
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Peters N, Scott J, Issa A, Fankhauser C, Lee E, Churchill J, Oliveria P, Tran A, Lau M, Parnham A, Sangar V, Graham D. 1311P Penile cancer in North-West England: A 5-year analysis of epidemiology, risk factors and outcomes in a supraregional centre. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1444] [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] Open
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12
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Peters N, Bambury RM, Power DG, McCarthy L, Lyons C, Kelly P, Jamaluddin MF. Radium-223 in the Treatment of Metastatic Castrate-Resistant Prostate Cancer. Ir Med J 2022; 115:536. [PMID: 35416462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Radium 223 (Ra-223) has been successfully utilised for the treatment of men with metastatic castrate resistant prostate cancer (mCRPC). To date, no real world outcomes from its use in the Irish population have been described. Methods All men referred to our institution for Ra-223 from September 2016 to March 2019 were included. Patient demographics, treatments received, toxicities and outcomes were recorded. Overall survival (OS) and progression free survival (PFS) were analysed using the Kaplan-Meier method. Results Complete data was available for 54 men. Median age was 75 years (range 61-86 years). The median number of prior systemic treatments for mCRPC was 2 (range 0-4). Median ECOG performance status was 1 at the start of treatment and 2 at completion. The median number of Ra-223 cycles received was 4 with 37%(n=20) completing all 6 planned cycles. The most common treatment-related toxicity was fatigue seen in 52% of patients ( n=28). Improved pain scores were documented in 76% of men requiring opioid analgesia at the start of treatment. The median OS was 7 months. A good ECOG performance status, fewer than 6 bone metastases, normal alkaline phosphatase level at start of treatment and chemotherapy naivety were associated with improved OS. Conclusions Ra-223 is a moderately well tolerated palliative treatment amongst Irish men with mCRPC.
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Affiliation(s)
- N Peters
- Department of Medical Oncology, Cork University Hospital
| | - R M Bambury
- Department of Medical Oncology, Cork University Hospital
| | - D G Power
- Department of Medical Oncology, Cork University Hospital
| | - L McCarthy
- Department of Radiation Oncology, Cork University Hospital
| | - C Lyons
- Department of Radiation Oncology, Cork University Hospital
| | - P Kelly
- Department of Radiation Oncology, Cork University Hospital
- Department of Radiation Oncology, Bon Secours University Hospital
| | - M F Jamaluddin
- Department of Radiation Oncology, Cork University Hospital
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13
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Ortega Franco A, Adamson-Raieste A, Rahman R, Pihlak R, Peters N, Scott JA, Aruketty S, Thomson C, Dransfield S, Henshaw A, Ward A, Cutts T, Carter L, Thistlethwaite F, Cook N, Graham D, Stevenson J, Krebs M. 44P Value of comprehensive genomic profiling in pre-screening patients for NTRK fusion in STARTRK2 trial: Single centre experience. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Madan R, Dey T, Goyal S, Bansal D, Trehan A, Peters N, Chatterjee D, Ballari N, Khosla D. PO-1436 Burden of pediatric oncology in radiotherapy department:A tertiary care center experience from India. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07887-7] [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: 10/20/2022]
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15
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Galazis C, Vimalesvaran K, Zaman S, Petri C, Howard J, Linton N, Peters N, Cole G, Bharath AA, Varela M. Framework for large-scale automatic curation of heterogeneous cardiac MRI (ACUR MRI). Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.131] [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
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UKRI CDT in AI for Healthcare http://ai4health.io and British Heart Foundation
Background
Data curation is an important process that structures and organises data, supporting research and the development of artificial intelligence models. However, manually curating a large volume of medical data is a time-consuming, repetitive and costly process that puts additional strain on clinical experts. The curation becomes more complex and demanding as more data sources are used. This leads to an introduction of disparity in the data structure and protocols.
Purpose
Here, we propose an automatic framework to curate large volumes of heterogenous cardiac MRI scans acquired across different sites and scanner vendors. Our framework requires minimal expert involvement throughout and works directly on DICOM images from the scanner or PACS. The resulting structured standardised data allow for straightforward image analysis, hypothesis testing and the training and application of artificial intelligence models.
Methods
It is broken down into three main components
anonymisation, cataloguing and outlier detection (see Figure 1). Anonymisation automatically removes any identifiable patient information from the DICOM image attributes. These data are replaced with anonymised labels, whilst maintaining relevant longitudinal information from each patient. DICOM attributes are also used to automatically group the different images according to imaging sequence (e.g. CINE, Delayed-Enhancement, T1 maps), acquisition geometry (e.g. short-axis, 2-chamber, 4-chamber) and imaging attributes (e.g. slice thickness, TE, TR), for easier querying. The sorting characteristics are flexible and can easily be defined by the user. Finally, we detect and flag, for subsequent manual inspection, any outliers within those groups, based on the similarity levels of chosen DICOM attributes. This framework additionally offers interactive image visualisation to allow users to assess its performance in real time.
Results
We tested the performance of ACUR CMRI on 26,668 CMR image series (723,531 images) from 858 patient examinations, which took place across two sites in four different scanners. With an average execution time per patient of 100 seconds, ACUR was able to sort imaging data with 1191 different sequence names into 43 categories. The framework can be freely downloaded from https://bitbucket.org/cmr-ai-working-group/acur/.
Conclusions
We present ACUR, an automatic framework to curate large volumes of heterogeneous cardiac MRI data. We show how it can quickly and automatically curate data, grouping it according to desired imaging characteristics defined in DICOM attributes. The proposed framework is flexible and ideally suited as a pre-processing tool for large biomedical imaging data studies.
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Affiliation(s)
- C Galazis
- Imperial College London, Department of Computing, Faculty of Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - K Vimalesvaran
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - S Zaman
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - C Petri
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - J Howard
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - N Linton
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - N Peters
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - G Cole
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - AA Bharath
- Imperial College London, Department of Bioengineering, Faculty of Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - M Varela
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
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Patel K, Li X, Xu X, Sun L, Ardissino M, Punjabi P, Purkayastha S, Peters N, Ware J, Ng FS. Increasing adiposity and metabolic dysfunction prolong QTc interval and increase risk of ventricular arrhythmias: results from the UK Biobank. Europace 2021. [DOI: 10.1093/europace/euab116.109] [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
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research
Background/purpose: Small-scale studies have associated obesity and metabolic ill-health with QTc interval prolongation. Whether these associations are modulated by an underlying genetic predilection and translate into higher risks of ventricular arrhythmias (VA) is unknown.
Methods
Using the UK Biobank and adjusted multivariate regression analysis, we studied the associations between QTc and clinical measures of adiposity and metabolic ill-health. A polygenic risk score was used to determine whether these associations are modulated by a genetic predilection for QTc prolongation. We compared QTc between four clinical phenotypes defined according to presence (+) or absence (-) of obesity (Ob), and metabolic ill-health (MU). Logistic regression was used to calculate odds ratios (OR) for VA amongst these groups.
Results
23,683 individuals (11,563 male, mean age 61.0 + 7.5years) had ECG and clinical data available. QTc prolongs with increasing body mass index (0.76ms/kg/m2, 95%CI: 0.68-0.83ms/kg/m2), body fat (0.45ms/%, 95%CI:0.39-0.50ms/%), hip girth (0.35ms/cm, 95%CI:0.31-0.39ms/cm) and waist girth (0.32ms/cm, 95%CI:0.29-0.35ms/cm); all p < 0.001. Genetically determined repolarisation reserve has no significant modulatory effect on the QTc-prolonging effects of increasing adiposity. Referenced to Ob-MU-, Ob + MU- and Ob-MU+ independently prolong QTc to a comparable extent, and Ob + MU+ has an additive effect on QTc prolongation. With reference to Ob-MU-, OR for VA in Ob-MU+ males and females were 5.96 (95%CI:4.70-7.55) and 5.10 (95%CI:3.34-7.80), respectively. OR for Ob + MU+ were 6.99 (95%CI:5.72-8.54) and 3.56 (95%CI:2.66-4.77) in males and females, respectively, (all p < 0.001, see Table).
Conclusion
Adiposity and metabolic perturbation prolong QTc to a similar extent, and their co-existence exerts an additive effect. These effects are independent of genetically determined repolarisation reserve. Despite their comparable QTc prolonging effects, metabolic ill-health is associated with higher OR for VA than obesity. VA in obesity and metabolic dysfunctionReference phenotypeOb + MU-Ob-MU+Ob + MU+Ob-MU+male1.10(0.87-1.39)ns5.96 (4.70-7.55)***6.99(5.72-8.54)***female0.87(0.64-1.18)ns5.10(3.34-7.80)***3.56(2.66-4.77)***Ob + MU-male--6.01(4.98-7.26)***female--5.61(4.18-7.52)***Ob + MU+male--1.25(1.05-1.49)*female--1.16(0.80-1.68)nsOb, obese; MU, metabolically unhealthy; +, presence; -, absence; ns, non-significant; *p < 0.05; ***p < 0.001. Abstract Figure. QTc in obesity and metabolic dysfunction
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Affiliation(s)
- K Patel
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - X Li
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - X Xu
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - L Sun
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Ardissino
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - P Punjabi
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Purkayastha
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - N Peters
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - J Ware
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - FS Ng
- National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
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Peters N. Different minimum requirements for transducer cleaning and disinfection between the Australian Standard and the ASUM/ACIPC joint guideline. Australas J Ultrasound Med 2020; 23:269-270. [PMID: 34765408 PMCID: PMC8411711 DOI: 10.1002/ajum.12208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Nathan Peters
- Department of Anaesthesia and Perioperative MedicineRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
- School of MedicineUniversity of QueenslandSt LuciaQueenslandAustralia
- Department of SurgeryUniversity of MelbourneParkvilleVictoriaAustralia
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18
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Peters N, Wohlfahrt P, Hofmann C, Möhler C, Makocki S, Richter C. OC-0697: Particle therapy: Assessing clinical benefit of direct stopping-power prediction from dual-energy CT. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00719-2] [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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19
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Weadick C, Peters N, Connolly R, O’Reilly S. Breast cancer among immigrants: An Irish experience. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30815-7] [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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20
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Bernhart JA, La Valley EA, Kaczynski AT, Wilcox S, Jake-Schoffman DE, Peters N, Dunn CG, Hutto B. Investigating Socioeconomic Disparities in the Potential Healthy Eating and Physical Activity Environments of Churches. J Relig Health 2020; 59:1065-1079. [PMID: 30132179 PMCID: PMC6384145 DOI: 10.1007/s10943-018-0687-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Faith-based settings have the potential to improve health in underresourced communities, but little research has quantified and compared health-promoting elements in church environments. This study examines the number of potential indoor and outdoor physical activity opportunities, healthy eating opportunities, healthy living media, and total environmental resources present in churches (n = 54) in a rural, southeastern US county and the relationship between these resources and neighborhood income. In our sample, most churches offered potential indoor and outdoor opportunities for physical activity and healthy eating opportunities, with more variability in the number of healthy living media items on display compared to other environmental components. Common potential opportunities present in churches for physical activity included a fellowship hall and green/open space, while potential opportunities for healthy eating frequently included a refrigerator and sink. Compared to those in medium- and high-income neighborhoods, churches in low-income neighborhoods scored higher on measures of potential outdoor physical activity opportunities and lower on measures of total potential environment resources, healthy eating opportunities, healthy living media, and indoor physical activity opportunities, though only indoor physical activity opportunities reached statistical significance. Potential opportunities for using existing resources in and around churches for health promotion should be investigated further, particularly in rural areas.
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Affiliation(s)
- John A Bernhart
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Elizabeth A La Valley
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Andrew T Kaczynski
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Danielle E Jake-Schoffman
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nathan Peters
- School of Human Movement, Sport and Leisure Studies, Bowling Green University, Bowling Green, OH, USA
| | - Caroline G Dunn
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
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22
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Peters N, Greally M, Breen K, Fabre A, Blazkova S. Immunotherapy- A double Edged Sword; A case of Fatal Myocarditis and Complete Response. Ir Med J 2019; 112:937. [PMID: 31411390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- N Peters
- Galway University Hospital, Galway, Ireland
| | - M Greally
- Galway University Hospital, Galway, Ireland
| | - K Breen
- St.Vincents University Hospital, Dublin, Ireland
| | - A Fabre
- St.Vincents University Hospital, Dublin, Ireland
| | - S Blazkova
- Galway University Hospital, Galway, Ireland
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23
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Peters N, Wohlfahrt P, Bolsi A, Dahlgren C, De Marzi L, Ellerbrock M, Fracchiolla F, Free J, Gomà C, Góra J, Kajdrowicz T, MacKay R, Molinelli S, Nørrevang O, Rinaldi I, Rompokos V, Van der Tol P, Vermeren X, Richter C. OC-0667 Experimental assessment of inter-centre variation and accuracy in SPR prediction within the EPTN. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31087-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Peters N, Schubert M, Geppert JP, Moehrle M. Micrographic controlled surgery of basal cell carcinomas: rapid lump examination in comparison with haematoxylin and eosin-stained paraffin sections. Br J Dermatol 2019; 181:399-400. [PMID: 30729494 DOI: 10.1111/bjd.17740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- N Peters
- Department of Dermatology, University Hospital, Liebermeisterstraße 25, D-72076, Tuebingen, Germany
| | - M Schubert
- Department of Dermatology, University Hospital, Liebermeisterstraße 25, D-72076, Tuebingen, Germany.,Artemed Fachklinik Muenchen, D-80336, Muenchen, Germany
| | - J-P Geppert
- Dr Geppert and colleagues, Institute for Pathology, Cytology and Dermatohistology, D-72072, Tuebingen, Germany
| | - M Moehrle
- Department of Dermatology, University Hospital, Liebermeisterstraße 25, D-72076, Tuebingen, Germany.,Praxisklinik Tuebingen - Haut und Venen, D-72072, Tuebingen, Germany
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25
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Canty D, Barth J, Yang Y, Peters N, Palmer A, Royse A, Royse C. Comparison of learning outcomes for teaching focused cardiac ultrasound to physicians: A supervised human model course versus an eLearning guided self- directed simulator course. J Crit Care 2018; 49:38-44. [PMID: 30359924 DOI: 10.1016/j.jcrc.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 08/02/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Focused cardiac ultrasound (FCU) training in critical care is restricted by availability of instructors. Supervised training may be substituted by self-directed learning with an ultrasound simulator guided by automated electronic learning, enabling scalability. MATERIALS AND METHODS We prospectively compared learning outcomes in novice critical care physicians after completion of a supervised one-and-a-half-day workshop model with a self-guided course utilizing a simulator over four weeks. Both groups had identical pre-workshop on-line learning (20h). Image quality scores were compared using FCU performed on humans without pathology. Interpretive knowledge was compared using 20MCQ tests. RESULTS Of 161 eligible, 145 participants consented. Total Image quality scores were higher in the Simulator group (95.2% vs. 66.0%, P < .001) and also higher for each view (all P < .001). Interpretive knowledge was not different before (78.6% vs. 79.0%) and after practical training (74.7% vs. 76.1%) and at 3 months (81.0% vs. 77.0%, all P > .1). Including purchase of the simulator and ultrasound equipment, the simulator course required lower direct costs (AUD$796 vs. $1724 per participant) and instructor time (0.5 vs.1.5 days) but similar participant time (2.8 vs. 3.0 days). CONCLUSIONS Self-directed learning with ultrasound simulators may be a scalable alternative to conventional supervised teaching with human models.
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Affiliation(s)
- David Canty
- Director of Ultrasound Simulation and Senior Lecturer, Department of Surgery, University of Melbourne. Consultant Anaesthetist, Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Department of Medicine, Monash University, Australia.
| | | | - Yang Yang
- Consultant Intensvisit, Western Health. Honorary Senior Lecturer, Department of Surgery, University of Melbourne, Australia
| | - Nathan Peters
- Consultant Anaesthetist, Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Honorary Lecturer, Department of Surgery, University of Melbourne, Australia
| | - Andrew Palmer
- New Star Professor of Medical Research and the Head of the Health Economics Research Unit, Menzies Institute for Medical Research, Australia
| | - Alistair Royse
- Professor, Department of Surgery, University of Melbourne, Consultant Cardiothoracic Surgeon, Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Australia
| | - Colin Royse
- Professor, Department of Surgery, University of Melbourne, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Australia
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26
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Peters N, Schubert M, Metzler G, Geppert JP, Moehrle M. Diagnostic accuracy of a new ex vivo confocal laser scanning microscope compared to H&E-stained paraffin slides for micrographic surgery of basal cell carcinoma. J Eur Acad Dermatol Venereol 2018; 33:298-304. [PMID: 30198589 DOI: 10.1111/jdv.15243] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND For safe excision of malignant skin tumours, complete negative surgical margins are mandatory. The gold standard for analysis is frozen sections or paraffin-embedded haematoxylin and eosin (H&E)-stained slides. The production of H&E-stained slides is time-consuming (>20 h) while wounds remain unclosed. An upcoming method is confocal laser scanning microscopy (CLSM), a technique that scans unfixed fresh tissue rapidly. OBJECTIVE Evaluation of the process to generate and analyse CLSM images and assessment of the accuracy to detect basal cell carcinoma (BCC) tissue. METHODS Digital microscopic images were generated by the Histolog Scanner v1 from 544 fresh specimens of 148 BCCs that had been stained with a 0.01% proflavine solution. CLSM images were compared to the histological diagnoses of the corresponding H&E-stained slides. RESULTS A total of 525 images could be analysed. The sensitivity was 73% (95% CI = [65.27%; 80.47%]), and the specificity was 96% (95% CI = [93.40%; 97.60%]). Detection of BCCs in punch biopsies was certainly detected (sensitivity of 100%). The median total time to generate and evaluate a CLSM image was 5.17 min (maximum 20.17 min and minimum 2.05 min). The greatest challenge was flattening the specimen to assure complete representation of the surgical margins. CONCLUSION Confocal laser scanning microscopy is a time-saving and very effective alternative to classical paraffin-embedded or frozen sections. Patient treatment could be improved due to shorter hospital stays or faster outpatient therapy due to reduced intervals between surgical stages. Diagnostic accuracy of the microscope used still must be improved.
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Affiliation(s)
- N Peters
- Department of Dermatology, University Hospital, Tuebingen, Germany
| | - M Schubert
- Department of Dermatology, University Hospital, Tuebingen, Germany.,Artemed Fachklinik Muenchen, Muenchen, Germany
| | - G Metzler
- Department of Dermatology, University Hospital, Tuebingen, Germany
| | | | - M Moehrle
- Department of Dermatology, University Hospital, Tuebingen, Germany.,Praxisklinik Tuebingen - Haut und Venen, Tuebingen, Germany
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27
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Shun-Shin M, Arnold A, Keene D, Howard J, Sohaib A, Lim PB, Tanner M, Lefroy D, Peters N, Kanagaratnam P, Davies DW, Francis D, Whinnett Z. P1829The magnitude of LV activation time reduction with His bundle pacing over biventricular pacing in LBBB predicts the incremental improvement in acute cardiac function. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1829] [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: 11/12/2022] Open
Affiliation(s)
- M Shun-Shin
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Arnold
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D Keene
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - J Howard
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Sohaib
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - P B Lim
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - M Tanner
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D Lefroy
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - N Peters
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - P Kanagaratnam
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D W Davies
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D Francis
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Z Whinnett
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
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28
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Jabbour R, Kapnisi K, Mawad D, Handa B, Couch L, Mansfield C, Perbillini F, Terracciano C, Stevens M, Lyon A, Smith G, Peters N, Ng FS, Harding S. P5705Conductive polymers affect myocardial conduction velocity but are not pro-arrhythmic. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5705] [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: 11/13/2022] Open
Affiliation(s)
- R Jabbour
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - K Kapnisi
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - D Mawad
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - B Handa
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - L Couch
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - C Mansfield
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - F Perbillini
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - C Terracciano
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - M Stevens
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - A Lyon
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - G Smith
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - N Peters
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - F S Ng
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
| | - S Harding
- Imperial College Healthcare NHS Trust, imperial, London, United Kingdom
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29
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Fladt J, Hofmann L, Coslovsky M, Imhof A, Seiffge DJ, Polymeris A, Thilemann S, Traenka C, Sutter R, Schaer B, Kaufmann BA, Peters N, Bonati LH, Engelter ST, Lyrer PA, De Marchis GM. Fast-track versus long-term hospitalizations for patients with non-disabling acute ischaemic stroke. Eur J Neurol 2018; 26:51-e4. [PMID: 30035829 DOI: 10.1111/ene.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to assess the feasibility and safety of fast-track hospitalizations in a selected cohort of patients with stroke. METHODS Patients hospitalized at the Stroke Center of the University Hospital Basel, Switzerland, with an acute ischaemic stroke confirmed on magnetic resonance diffusion-weighted imaging were included. Neurological deficits of the included patients were non-disabling, i.e. not interfering with activities of daily living and compatible with a direct discharge home. Patients with premorbid disability were excluded. All patients were admitted to the Stroke Center for ≥24 h. Two study groups were compared - fast-track hospitalizations (≤72 h) and long-term hospitalizations (>72 h). The primary end-point was a composite of any unplanned rehospitalization for any reason within 3 months since hospital discharge and a modified Rankin Scale 3-6 at 3 months. Adjustment for confounders was done using the inverse probability of treatment weights (IPTW). RESULTS Amongst the 521 patients who met the inclusion criteria, fast-track hospitalizations were performed in 79 patients (15%). In the fast-track group, seven patients (8.9%) met the primary end-point, compared to 37 (8.4%) in the long-term group [odds ratio (OR) 1.06, 95% confidence interval (CI) 0.42-2.34, P = 0.88]. After weighting for IPTW, the odds of the primary end-point remained similar between the two arms (ORIPTW 1.27, 95% CI 0.51-3.16, P = 0.61). The costs of fast-track hospitalizations were lower, on average, by $4994. CONCLUSIONS Fast-track hospitalizations including a full workup proved to be feasible, showed no increased risk and were less expensive than long-term hospitalizations.
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Affiliation(s)
- J Fladt
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - L Hofmann
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - M Coslovsky
- Department of Clinical Research, Clinical Trial Unit, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - A Imhof
- Medical and Finance Controlling Division, University Hospital of Basel, Basel, Switzerland
| | - D J Seiffge
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - A Polymeris
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - S Thilemann
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - C Traenka
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - R Sutter
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland.,Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - B Schaer
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - B A Kaufmann
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - N Peters
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland.,Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, University of Basel, Basel, Switzerland
| | - L H Bonati
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - S T Engelter
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland.,Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, University of Basel, Basel, Switzerland
| | - P A Lyrer
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - G M De Marchis
- Neurology Department and Stroke Center, University Hospital of Basel, University of Basel, Basel, Switzerland
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Buchberger AMS, Baumann A, Johnson F, Peters N, Piontek G, Storck K, Pickhard A. The role of oral anticoagulants in epistaxis. Eur Arch Otorhinolaryngol 2018; 275:2035-2043. [PMID: 29936627 PMCID: PMC6060781 DOI: 10.1007/s00405-018-5043-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/16/2018] [Indexed: 01/13/2023]
Abstract
Purpose The purpose of this retrospective study was to identify the impact of oral anticoagulants on epistaxis with the focus on new oral anticoagulants. Methods The study was conducted at the Department for Ear- Nose- and Throat (ENT), Head and Neck Surgery, Technical University Munich, Germany. All patients presenting in 2014 with the diagnosis of epistaxis to a specialized ENT accident and emergency department were identified and analyzed in clinical data and medication. Results 600 adult cases, with a median age of 66.6 years were identified with active bleeding. 66.8% of all cases were anticoagulated. Classic oral anticoagulants (COAC) were three times more common in patients than new-generation oral anticoagulants (NOAC). Recurrent bleeding was significantly associated with oral anticoagulants (OAC) (p = 0.014) and bleeding location was most often anterior (p = 0.006). In contrast, severe cases, which required surgery or embolization were significantly more likely in non-anticoagulated middle-aged patients with posterior bleedings (p < 0.05). In our epistaxis cohort, OAC were highly overrepresented (40%) when compared to the general German population (1%) but COAC as well as NOAC played only a minor role in severe courses of epistaxis. Conclusion Oral anticoagulation, especially with new-generation drugs, is not associated with more complicated and severe courses of epistaxis, but rather with recurrent bleeding. One should keep this information in mind when triaging the patient in the emergency room and when planning further procedures.
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Affiliation(s)
- A M S Buchberger
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A Baumann
- Department of Otolaryngology Head and Neck Surgery, Helios Amper-Klinikum Dachau, Krankenhausstraße 15, 85221, Dachau, Germany.
| | - F Johnson
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - N Peters
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - G Piontek
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - K Storck
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A Pickhard
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Schubert V, Bender B, Kinzel M, Peters N, Freilinger T. A novel frameshift variant in the CADASIL gene NOTCH3: pathogenic or not? J Neurol 2018; 265:1338-1342. [PMID: 29600389 DOI: 10.1007/s00415-018-8844-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/28/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) represents the most common monogenic cause of adult-onset ischemic stroke and vascular dementia. It is caused by heterozygous missense mutations in the NOTCH3 gene, encoding a transmembrane receptor protein on vascular smooth muscle cells. Classical CADASIL mutations affect conserved cysteine residues of the Notch3 protein. By contrast, the role of non-canonical genetic variation in NOTCH3, in particular of variants causing a hypomorphic Notch3 protein, is subject to an ongoing scientific debate. In this context, we here report a novel NOTCH3 frameshift variant in exon 18 (NM_000435.2: c.2853_2857delTCCCG), causing a frameshift and introducing a premature stop codon, which was detected in a 43-year-old woman and her father. Both carriers of the variant were carefully evaluated, including serial follow-up in the index. Neither clinical nor imaging features provided convincing evidence for a classical CADASIL phenotype, thus reinforcing the concept of hypomorphic NOTCH3 variants most likely not being causative for CADASIL. Our finding, which is discussed in the light of the published literature, has practical implications for interpreting results of NOTCH3 molecular genetic testing as well as patient counseling.
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Affiliation(s)
- V Schubert
- Zentrum für Neurologie, Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - B Bender
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - M Kinzel
- Medizinische Genetik, MedizinZentrum Lichtenberg, Berlin, Germany
| | - N Peters
- Neurologische Klinik, Universitätsspital Basel, Basel, Switzerland
| | - T Freilinger
- Zentrum für Neurologie, Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
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De Marchis GM, Katan M, Barro C, Fladt J, Traenka C, Seiffge DJ, Hert L, Gensicke H, Disanto G, Sutter R, Peters N, Sarikaya H, Goeggel-Simonetti B, El-Koussy M, Engelter S, Lyrer PA, Christ-Crain M, Arnold M, Kuhle J, Bonati LH. Serum neurofilament light chain in patients with acute cerebrovascular events. Eur J Neurol 2018; 25:562-568. [PMID: 29281157 DOI: 10.1111/ene.13554] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Serum neurofilaments are markers of axonal injury. We addressed their diagnostic and prognostic role in acute ischemic stroke (AIS) and transient ischemic attack (TIA). METHODS Nested within a prospective cohort study, we compared levels of serum neurofilament light chain (sNfL) drawn within 24 h from symptom onset in patients with AIS or TIA. Patients without magnetic resonance imaging on admission were excluded. We assessed whether sNfL was associated with: (i) clinical severity on admission, (ii) diagnosis of AIS vs. TIA, (iii) infarct size on admission magnetic resonance diffusion-weighted imaging (MR-DWI) and (iv) functional outcome at 3 months. RESULTS We analyzed 504 patients with AIS and 111 patients with TIA. On admission, higher National Institutes of Health Stroke Scale (NIHSS) scores were associated with higher sNfL: NIHSS score < 7, 13.1 pg/mL [interquartile range (IQR), 5.3-27.8]; NIHSS score 7-15, 16.7 pg/mL (IQR, 7.4-34.9); and NIHSS score > 15, 21.0 pg/mL (IQR, 9.3-40.4) (P = 0.01). Compared with AIS, patients with TIA had lower sNfL levels [9.0 pg/mL (95% confidence interval, 4.0-19.0) vs. 16.0 pg/mL (95% confidence interval, 7.3-34.4), P < 0.001], also after adjusting for age and NIHSS score (P = 0.006). Among patients with AIS, infarct size on admission MR-DWI was not associated with sNfL, either in univariate analysis (P = 0.15) or after adjusting for age and NIHSS score on admission (P = 0.56). Functional outcome 3 months after stroke was not associated with sNfL after adjusting for established predictors. CONCLUSIONS In conclusion, among patients admitted within 24 h of AIS or TIA onset, admission sNfL levels were associated with clinical severity on admission and TIA diagnosis, but not with infarct size on MR-DWI acquired on admission or functional outcome at 3 months.
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Affiliation(s)
- G M De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - M Katan
- Department of Neurology, University Hospital Zurich, Zurich
| | - C Barro
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - J Fladt
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - C Traenka
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - D J Seiffge
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - L Hert
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - H Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - G Disanto
- Department of Neurology, Neurocenter of Southern Switzerland, Lugano
| | - R Sutter
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel.,Department of Intensive Care Medicine, University Hospital Basel, University of Basel, Basel
| | - N Peters
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - H Sarikaya
- Department of Neurology, Inselspital, Bern
| | - B Goeggel-Simonetti
- Department of Neurology, Inselspital, Bern.,Department of Pediatrics, San Giovanni Hospital, Bellinzona
| | - M El-Koussy
- Department of Neuroradiology, Inselspital, Bern
| | - S Engelter
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - P A Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - M Christ-Crain
- Department of Internal Medicine and Department of Clinical Research, Division of Endocrinology, Diabetology and Metabolism, University Hospital Basel, University of Basel, Basel, Switzerland
| | - M Arnold
- Department of Neurology, Inselspital, Bern
| | - J Kuhle
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - L H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
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Sau A, Sikkel MB, Luther V, Wright I, Guerrero F, Koa-Wing M, Lefroy D, Linton N, Qureshi N, Whinnett Z, Lim PB, Kanagaratnam P, Peters N, Davies DW. 148The sawtooth EKG pattern of typical atrial flutter is not related to differences in conduction velocity around the flutter circuit. Europace 2017. [DOI: 10.1093/europace/eux283.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gensicke H, Wicht A, Bill O, Zini A, Costa P, Kägi G, Stark R, Seiffge DJ, Traenka C, Peters N, Bonati LH, Giovannini G, De Marchis GM, Poli L, Polymeris A, Vanacker P, Sarikaya H, Lyrer PA, Pezzini A, Vandelli L, Michel P, Engelter ST. Impact of body mass index on outcome in stroke patients treated with intravenous thrombolysis. Eur J Neurol 2016; 23:1705-1712. [DOI: 10.1111/ene.13071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- H. Gensicke
- Stroke Centre and Neurology; University Hospital Basel; Basel Switzerland
| | - A. Wicht
- Stroke Centre and Neurology; University Hospital Basel; Basel Switzerland
| | - O. Bill
- Department of Neurology; Centre Hospitalier Universitaire Vaudois and University of Lausanne; Lausanne Switzerland
| | - A. Zini
- Stroke Unit; Department of Neuroscience; Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena; Modena Italy
| | - P. Costa
- Department of Clinical and Experimental Sciences; Neurology Clinic; University of Brescia; Brescia Italy
| | - G. Kägi
- Department of Neurology; Kantonsspital St Gallen; St Gallen Switzerland
| | - R. Stark
- Department of Neurology; Kantonsspital St Gallen; St Gallen Switzerland
| | - D. J. Seiffge
- Stroke Centre and Neurology; University Hospital Basel; Basel Switzerland
| | - C. Traenka
- Stroke Centre and Neurology; University Hospital Basel; Basel Switzerland
| | - N. Peters
- Stroke Centre and Neurology; University Hospital Basel; Basel Switzerland
| | - L. H. Bonati
- Stroke Centre and Neurology; University Hospital Basel; Basel Switzerland
| | - G. Giovannini
- Stroke Unit; Department of Neuroscience; Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena; Modena Italy
| | - G. M. De Marchis
- Stroke Centre and Neurology; University Hospital Basel; Basel Switzerland
| | - L. Poli
- Department of Clinical and Experimental Sciences; Neurology Clinic; University of Brescia; Brescia Italy
| | - A. Polymeris
- Stroke Centre and Neurology; University Hospital Basel; Basel Switzerland
| | - P. Vanacker
- Department of Neurology; Centre Hospitalier Universitaire Vaudois and University of Lausanne; Lausanne Switzerland
- Department of Neurology; University Hospital Antwerp; Edegem Belgium
| | - H. Sarikaya
- Department of Neurology; University Hospital Berne; Berne Switzerland
| | - P. A. Lyrer
- Stroke Centre and Neurology; University Hospital Basel; Basel Switzerland
| | - A. Pezzini
- Department of Clinical and Experimental Sciences; Neurology Clinic; University of Brescia; Brescia Italy
| | - L. Vandelli
- Stroke Unit; Department of Neuroscience; Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena; Modena Italy
| | - P. Michel
- Department of Neurology; Centre Hospitalier Universitaire Vaudois and University of Lausanne; Lausanne Switzerland
| | - S. T. Engelter
- Stroke Centre and Neurology; University Hospital Basel; Basel Switzerland
- Neurorehabilitation Unit; University Centre for Medicine of Aging and Rehabilitation; Felix Platter Hospital; Basel Switzerland
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Affiliation(s)
- N Peters
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-Universität, Munich, Germany
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Baruth M, Schlaff RA, Kerr G, Adams VJ, Goldufsky T, Peters N, Boggs A, Ewald A. Effects of a Group-based Behavioral Physical Activity Intervention in Older Adults. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000485370.72563.02] [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: 11/21/2022]
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Peters N, Laurain E, Frimat L, Filipozzi P, Chapelet A, Martin A, Dekeyser M, Cridlig J. Quelles cibles pour adapter la posologie de fer en hémodialyse. Étude pharmaco-épidémiologique. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.173] [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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38
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Collette C, Frimat L, Ayav C, Clerc-Urmes I, Martin A, Agrinier N, Laborde-Castérot H, Peters N, Thilly N. Risque hémorragique associé aux pratiques de prescription des antiagrégants plaquettaires et des anticoagulants oraux chez les hémodialysés chroniques. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.215] [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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Martin A, Thilly N, Ayav C, Clerc-Urmes I, Held P, Frimat L, Peters N. Étude T2HD, anticoagulants oraux et antiagrégants plaquettaires : pratiques, bénéfices et risques chez l’hémodialysé chronique. Données observationnelles. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.020] [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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von Hessling A, Peters N, Stippich C. [Reperfusion of an incidental aneurysm in mechanical stroke treatment with "stent retriever"]. ROFO-FORTSCHR RONTG 2015; 187:936-7. [PMID: 26019051 DOI: 10.1055/s-0034-1399428] [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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41
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Gensicke H, Ahlhelm F, Jung S, von Hessling A, Traenka C, Goeggel Simonetti B, Peters N, Bonati LH, Fischer U, Broeg-Morvay A, Seiffge DJ, Gralla J, Stippich C, Baumgartner RW, Lyrer PA, Arnold M, Engelter ST. New ischaemic brain lesions in cervical artery dissection stratified to antiplatelets or anticoagulants. Eur J Neurol 2015; 22:859-65, e61. [DOI: 10.1111/ene.12682] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
Affiliation(s)
- H. Gensicke
- Department of Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - F. Ahlhelm
- Department of Neuroradiology; University Hospital Basel; Basel Switzerland
| | - S. Jung
- Department of Neurology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - A. von Hessling
- Department of Neuroradiology; University Hospital Basel; Basel Switzerland
| | - C. Traenka
- Department of Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - B. Goeggel Simonetti
- Department of Neurology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - N. Peters
- Department of Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - L. H. Bonati
- Department of Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - U. Fischer
- Department of Neurology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - A. Broeg-Morvay
- Department of Neurology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - D. J. Seiffge
- Department of Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - J. Gralla
- Department of Neuroradiology; University Hospital Bern; Bern Switzerland
| | - C. Stippich
- Department of Neuroradiology; University Hospital Basel; Basel Switzerland
| | - R. W. Baumgartner
- Neuro Center; Swiss Neuro Institute; Clinic Hirslanden; Zurich Switzerland
| | - P. A. Lyrer
- Department of Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - M. Arnold
- Department of Neurology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - S. T. Engelter
- Department of Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
- Neurorehabilitation Unit; University Center for Medicine of Aging and Rehabilitation; Felix Platter Hospital; Basel Switzerland
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Alayoubi S, Al-Aidarous S, Pinto Ricardo C, Dias P, Zaman J, Kane C, Camelliti P, Peters N, Yacoub M, Terracciano C. P379Slowed conduction velocity in spontaneously hypertensive rat hearts is due to disease related remodelling. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu091.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Seiffge DJ, Traenka C, Gensicke H, Tsakiris DA, Bonati LH, Peters N, Lyrer P, Engelter ST. Intravenous thrombolysis in stroke patients receiving rivaroxaban. Eur J Neurol 2013; 21:e3-4. [DOI: 10.1111/ene.12285] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D. J. Seiffge
- Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - C. Traenka
- Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - H. Gensicke
- Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - D. A. Tsakiris
- Diagnostic Haematology; University Hospital Basel; Basel Switzerland
| | - L. H. Bonati
- Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - N. Peters
- Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - P. Lyrer
- Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
| | - S. T. Engelter
- Neurology and Stroke Center; University Hospital Basel; Basel Switzerland
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Lee G, Hunter R, Lovell M, Finlay M, Sawhney V, Ullah W, Diab I, Dhinoja M, Earley M, Sporton S, Schilling RJ, Williams SE, Linton NWF, Harrison J, Wright M, O'Neill M, Jamil-Copley S, Linton N, Koa-Wing M, Lim PB, Hayat S, Qureshi N, Whinnett Z, Davies W, Peters N, Francis D, Kanagaratnam P, Jamil-Copley S, Ryan B, Kojodjojo P, Qureshi N, Koa-Wing M, Hayat S, Kyriacou A, Sandler B, Sohaib A, Wright I, Davies W, Peters N, Whinnett Z, Kanagaratnam P, Lim PB, Qureshi NA, Bai W, Ariff B, Williams A, Monro C, Kim S, Jamil-Copley S, Hayat S, Kao-Wing M, Kyriacou A, Sandler B, Fu NS, Kanagaratnam P, Whinnett Z, Davies DW, Lefroy D, Peters NS, Lim PB, Ryan MJ, Ezzat VA, O'Leary J, Bull C, Chow A, Lambiase P, Lowe MD, Anwar AS, Collitt S, Iddon P, Rice N, Dodd M, Dunsdale A, Petkar S, Mudd J, Linker N, Fitzpatrick AP, Fraser S, Choo WK, Padfield G, Rushworth G, Bloe C, Forsyth P, Cross SJ, Leslie SJ, Phan TT, Dewhurst M, Lee D, Williams D, James S, Thornley A, de Belder M, Linker N, Turley A, Campbell NG, Cantor E, Sawhney V, Duncan ER, Demartini C, Baker V, Diab IG, Dhinoja M, Earley MJ, Sporton S, Davies LC, Schilling RJ, Pettit SJ, Randles DA, Shaw M, Hawkins NM, Wright DJ, Lambiase PD, Barr C, Knops R, Neuzil P, Theuns D, Johansen JB, Hood M, Pederson S, Reeve HL, Boersma L. ABSTRACTS FOR ORAL PRESENTATION, SESSION 3, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fabritz L, Fortmuller L, Vloumidi E, Yue TY, Syeda F, Kirchhof P, Leube R, Krusche C, Chin SH, Winter J, Brack KE, Ng GA, Ng FS, Holzem KM, Koppel AC, Janks D, Wit AL, Peters NS, Efimov IR, Chowdhury RA, El-Harasis MA, Dupont E, Terracciano CMN, Peters NS, Mellor GJ, Raju H, de Noronha SV, Papadakis M, Sharma S, Behr ER, Sheppard MN, Jamil-Copley S, Bai W, Ariff B, Lim PB, Koa-Wing M, Kyriacou A, Hayat S, Sohaib A, Qureshi N, Sandler B, O'Regan D, Whinnett Z, Davies W, Rueckert D, Kanagaratnam P, Peters N, Lambiase PD, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J, Dhaliwal M, Mfuko C, Ng A, Sandilands A, Paisey J, Roberts P, Morgan JM, McCready J, Yue A, Ullah W, Hunter R, Lovell M, Dhinoja M, Sporton S, Earley M, Schilling R, Ghosh J, Martin A, Keech A, Chan KH, Gomes S, Singarayar S, McGuire M, Lee G, Hunter R, Berriman T, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Unsworth B, Mayet J, Abrams D, Dhinoja M, Sporton S, Earley M, Schilling RJ, Bowers RW, Mulholland V, Balasubramaniam RN, Paisey JR, Sopher SM, Chu GS, Chin SH, Winter J, Armstrong S, Masca N, Almeida TP, Brown PD, Sandilands AJ, Schlindwein FS, Ng GA. ABSTRACTS FOR ORAL PRESENTATION, SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Seiffge DJ, Karagiannis A, Strbian D, Gensicke H, Peters N, Bonati LH, Kotisaari K, Leppä M, Kejda-Scharler J, Tränka C, Ginsbach P, Tatlisumak T, Lyrer PA, Engelter ST. Simple variables predict miserable outcome after intravenous thrombolysis. Eur J Neurol 2013; 21:185-91. [PMID: 24010545 DOI: 10.1111/ene.12254] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 07/26/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE To test the predictability of miserable outcome amongst ischaemic stroke patients receiving intravenous thrombolysis (IVT) based on a simple variables model (SVM) and to compare the model's predictive performance with that of an existing score which includes imaging and laboratory parameters (DRAGON). METHODS The SVM consists of the parameters age, independence before stroke, normal Glasgow coma verbal score, able to lift arms and able to walk. In a derivation cohort (n = 1346) and a validation cohort (n = 638) of consecutive IVT-treated stroke patients, the probability estimated by SVM and the observed occurrence of miserable 3-month outcome (modified Rankin score 5-6) were compared. The performances of SVM and the DRAGON score were compared. The area under the receiver operating curve (AUC) (95% confidence interval, CI) and the bootstrapping approach were used to compare the predictive performance. RESULTS The AUCs to predict miserable outcome in the derivation cohort were 0.807 (95% CI 0.774-0.838) using the SVM and 0.822 (0.790-0.850) using the DRAGON score (P = 0.3). For the validation cohort, AUCs were 0.786 (0.742-0.829) for the SVM and 0.809 (0.774-0.845) for the DRAGON score (P = 0.23). Only one patient with an SVM probability of >70% for miserable outcome in either cohort had a good outcome whilst 83% had a miserable outcome. An online SVM calculator to estimate the probability of miserable outcome for individual patients is available under http://www.unispital-basel.ch/SVM-Tool. CONCLUSION The SVM was similar in accuracy to the DRAGON score for predicting miserable outcome after IVT. As these simple variables are available already at the pre-hospital stage, the SVM may facilitate and accelerate pre-hospital triage of patients at high risk for miserable outcome after IVT towards endovascular treatment.
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Affiliation(s)
- D J Seiffge
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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Diercks BP, Hauschildt I, Stäb F, Wenck H, Döring O, Peters N. IL-10 promotes secretion of S100A8/A9 from human monocytes trough an inclusion in plasma membranes. Scand J Immunol 2013; 77:169-70. [PMID: 23216137 DOI: 10.1111/sji.12015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gensicke H, Seiffge DJ, Polasek AE, Peters N, Bonati LH, Lyrer PA, Engelter ST. Long-term outcome in stroke patients treated with IV thrombolysis. Neurology 2013; 80:919-25. [DOI: 10.1212/wnl.0b013e3182840c35] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kiyotani C, Uno T, Ogiwara H, Morota N, Nakazawa A, Tsutsumi Y, Masaki H, Mori T, Sanz JAS, Guibelalde M, Tavera A, Herandez I, Ibanez J, Brell M, Mas A, Muller HL, Gebhardt U, Warmuth-Metz M, Pietsch T, Sorensen N, Kortmann RD, Stapleton S, Gonzalez I, Steinbrueck S, Rodriguez L, Tuite G, Krzyzankova M, Mertsch S, Jeibmann A, Kordes U, Wolff J, Paulus W, Hasselblatt M, Nonaka Y, Hara S, Fukazawa S, Shimizu K, Ben-Arush M, Postovsky S, Toledano H, Peretz-Nahum M, Fujimura J, Sakaguchi S, Kondo A, Saito Y, Shimoji K, Ohara Y, Arakawa A, Saito M, Shimizu T, Benesch M, von Bueren AO, Dantonello T, von Hoff K, Pietsch T, Leuschner I, Claviez A, Bierbach U, Kropshofer G, Korinthenberg R, Graf N, Suttorp M, Kortmann RD, Friedrich C, Klingebiel T, Koscielniak E, Rutkowski S, Mesa M, Sanchez M, Mejia J, Pena G, Dussan R, Cabeza M, Storino A, Dincer F, Roffidal T, Powell M, Berrak S, Wolff JE, Fouyssac F, Delaunay C, Vignaud JM, Schmitt E, Klein O, Mansuy L, Chastagner P, Cruz O, Guillen A, Garcia G, Alamar M, Candela S, Roussos I, Garzon M, Sunol M, Muchart J, Rebollo M, Mora J, Wolff J, Diez B, Muggeri A, Arakaki N, Meli F, Sevlever G, Tsitouras V, Pettorini B, Fellows G, Blair J, Didi M, Daousi C, Steele C, Javadpour M, Sinha A, Hishii M, Kondo A, Fujimura J, Sakaguchi S, Ishii H, Shimoji K, Miyajima M, Arai H, Dvir R, Sayar D, Levin D, Ben-Sirah L, Constantini S, Elhasid R, Gertsch E, Foreman N, Valera ET, Brassesco MS, Machado HR, Oliveira RS, Santos AC, Terra VC, Barros MV, Scrideli CA, Tone LG, Merino D, Pienkowska M, Shlien A, Tabori U, Gilbertson R, Malkin D, Jeeva I, Chang B, Long V, Picton S, Burton D, Clark S, Kwok C, Mokete B, Rafiq O, Simmons I, Shing MMK, Li CK, Chan GCF, Ha SY, Yuen HL, Luk CW, Li CK, Ling SC, Li RCH, Yoon JH, Park HJ, Shin HJ, Park BK, Kim JY, Jung HL, Ra YS, Ghim TT, Wolff J, Hasselblatt M, Hartung S, Powell M, Garami M, Traunecker H, Thall P, Mahajan A, Kordes U, Sumerauer D, Grillner P, Orrego A, Mosskin M, Gustavsson B, Holm S, Peters N, Rogers M, Chowdry S, Selman W, Mitchell A, Bangert B, Ahuja S, Laschinger K, Gold D, Stearns D, Wright K, Gupta K, Klimo P, Ellison D, Keating G, Eckel L, Giannini C, Wetjen N, Patton A, Zaky W, McComb G, Finlay J, Grimm J, Wong K, Dhall G, Zaky W, Gilles F, Grimm J, Dhall G, Finlay J, Ormandy D, Alston R, Estlin E, Gattamaneni R, Birch J, Kamaly-Asl I, Hemenway M, Foreman N, Rush S, Reginald YA, Nicolin G, Bartel U, Buncic JR, Aguilera D, Flamini R, Mazewski C, Schniederjan M, Hayes L, Boydston W, MacDonald T, Fleming A, Jabado N, Saint-Martin C, Albrecht S, Ramsay DA, Farmer JP, Bendel A, Hansen M, Dugan S, Mendelsohn N. RARE TUMORS. Neuro Oncol 2012; 14:i148-i156. [PMCID: PMC3483354 DOI: 10.1093/neuonc/nos108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
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Abstract
CLINICAL/METHODICAL ISSUE Minimally invasive treatment procedures, such as image-guided local tumour ablation have gained increasing relevance in oncologic concepts. Limitations of thermal ablation procedures have led to the development of percutaneous, computed tomography (CT) guided brachytherapy. STANDARD RADIOLOGICAL METHODS Thermal ablation procedures, such as radiofrequency ablation (RFA) and laser-induced thermotherapy (LITT) show limitations regarding maximum tumour size (<5 cm), cooling effects of adjacent vessels and surrounding risk structures. METHODICAL INNOVATIONS The image-guided interstitial brachytherapy allows the single application of high-dose rate (HDR) irradiation with an extensive protracted cytotoxic effect. Adjacent risk structures play a minor role due to the steep dose gradient outside the clinical target volume. PERFORMANCE Studies using CT-guided brachytherapy resulted in a local tumour control rate of approximately 90% after 12 months in the treatment of hepatocellular carcinoma (HCC) and 70-90% in the treatment of colorectal metastases or cholangiocellular carcinoma (CCC). Similar response rates were also seen in the treatment of metastases of renal cell carcinoma (RCC), non-small cell lung cancer (NSCLC) or neuroendocrine tumours. In colorectal liver metastases and HCC the method has proven to have a positive impact on prognosis. ACHIEVEMENTS In contrast to thermal ablation the method can be used without restriction with respect to tumour location. Cooling effects do not play a role. It has already been applied in more than 5,000 cases and it is used in clinical routine. PRACTICAL RECOMMENDATIONS Image-guided brachytherapy is safe and effective and has found its way into the clinical routine.
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Affiliation(s)
- T Bretschneider
- Zentrum für Radiologie, Klinik für Radiologie und Nuklearmedizin, Klinikum A.ö.R. der Otto-von-Guericke-Universität, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
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