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Fitzpatrick P, Bhardwaj N, Masalkhi M, Lyons A, Frazer K, McCann A, Syed S, Niranjan V, Kelleher CC, Brennan S, Kavanagh P, Fox P. Provision of smoking cessation support for patients following a diagnosis of cancer in Ireland. Prev Med Rep 2023; 32:102158. [PMID: 36875512 PMCID: PMC9982599 DOI: 10.1016/j.pmedr.2023.102158] [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: 11/16/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
There is growing evidence that smoking cessation (SC) improves outcomes following diagnosis of cancer. Notwithstanding adverse outcomes, a significant number of those diagnosed with cancer continue to smoke. Our objective was to document the SC services provided for patients with cancer by specialist adult cancer hospitals across Ireland, a country with a stated tobacco endgame goal. A cross-sectional survey based on recent national clinical guidelines was used to determine SC care delivery across eight adult cancer specialist hospitals, and one specialist radiotherapy centre. Qualtrics was used. The response rate was 88.9% with data reported from seven cancer hospitals and one specialist radiotherapy centre, all indicating they had some SC related provision (100%). Stop smoking medications were provided to cancer inpatients in two hospitals, at outpatients and attending day ward services in one hospital. Smokers with cancer were referred automatically to the SC service in two hospitals at diagnosis. While stop smoking medications were available 24 h a day in five hospitals, most did not stock all three (Nicotine Replacement Therapy, Bupropion, Varenicline). One hospital advised they had data on uptake of SC services for smokers with cancer but were unable to provide detail. There is considerable variation in SC information and services provided to cancer patients across adult cancer specialist centres in Ireland, reflecting the suboptimal practice of smoking cessation for patients with cancer found in the limited international audits. Such audits are essential to demonstrate service gaps and provide a baseline for service improvement.
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Affiliation(s)
- P Fitzpatrick
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - N Bhardwaj
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - M Masalkhi
- School of Medicine, University College Dublin, Belfield Dublin 4, Ireland
| | - A Lyons
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland
| | - K Frazer
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield Dublin 4, Ireland
| | - A McCann
- School of Medicine, University College Dublin, Belfield Dublin 4, Ireland.,UCD Conway Institute of Biomolecular and Biomedical Research and UCD School of Medicine, Ireland
| | - S Syed
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland
| | - V Niranjan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - C C Kelleher
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland.,College of Health and Agricultural Science (CHAS), University College Dublin, Belfield Dublin 4, Ireland
| | - S Brennan
- St Luke's Hospital, Rathgar Dublin 6, Ireland
| | - P Kavanagh
- Health Service Executive Tobacco Free Ireland Programme, Strategy and Research, 4th Floor, Jervis House, Jervis Street, Dublin 1, D01 W596, Ireland
| | - P Fox
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield Dublin 4, Ireland
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Makar D, Nazemi A, Gong SG, Bhardwaj N, De Guzman R, Sessle BJ, Cioffi I. Development of a model to investigate the effects of prolonged ischaemia on the muscles of mastication of male Sprague Dawley rats. Arch Oral Biol 2023; 146:105602. [PMID: 36543038 DOI: 10.1016/j.archoralbio.2022.105602] [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: 05/20/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aims of this study were to develop a novel rodent model of masticatory muscle ischaemia via unilateral ligation of the external carotid artery (ECA), and to undertake a preliminary investigation to characterize its downstream effects on mechanosensitivity and cellular features of the masseter and temporalis muscles. DESIGN The right ECA of 18 male Sprague-Dawley rats was ligated under general anaesthesia. Mechanical detection thresholds (MDTs) at the masseter and temporalis bilaterally were measured immediately before ECA ligation and after euthanasia at 10-, 20-, and 35-days (n = 6 rats/timepoint). Tissue samples from both muscles and sides were harvested for histological analyses and for assessing changes in the expression of markers of hypoxia and muscle degeneration (Hif-1α, VegfA, and Fbxo32) via real time PCR. Data were analyzed using mixed effect models and non-parametric tests. Statistical significance was set at p < 0.05. RESULTS MDTs were higher in the right than left hemiface (p = 0.009) after 20 days. Histological changes indicative of muscle degeneration and fibrosis were observed in the right muscles. Hif-1α, VegfA, and Fbxo32 were more highly expressed in the masseter than temporalis muscles (all p < 0.05). Hif-1α and, VegfA did not change significantly with time in all muscles (all p > 0.05). Fbxo32 expression gradually increased in the right masseter (p = 0.024) and left temporalis (p = 0.05). CONCLUSIONS ECA ligation in rats induced hyposensitivity in the homolateral hemiface after 20 days accompanied by tissue degenerative changes. Our findings support the use of this model to study pathophysiologic mechanisms of masticatory muscle ischaemia in larger investigations.
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Affiliation(s)
- D Makar
- University of Toronto, Faculty of Dentistry, Centre for Multimodal Sensorimotor and Pain Research, Toronto, ON, Canada; University of Toronto, Faculty of Dentistry, Graduate Orthodontics, Toronto, ON, Canada
| | - A Nazemi
- University of Toronto, Faculty of Dentistry, Centre for Multimodal Sensorimotor and Pain Research, Toronto, ON, Canada
| | - S G Gong
- University of Toronto, Faculty of Dentistry, Graduate Orthodontics, Toronto, ON, Canada
| | - N Bhardwaj
- University of Toronto, Faculty of Medicine, Department of Comparative Medicine, Toronto, ON, Canada; Peter Gilgan Centre for Research and Learning, Sickkids Hospital, Toronto, ON, Canada
| | - R De Guzman
- University of Toronto, Faculty of Medicine, Department of Comparative Medicine, Toronto, ON, Canada
| | - B J Sessle
- University of Toronto, Faculty of Dentistry, Toronto, ON, Canada; University of Toronto, Faculty of Medicine, Department of Physiology, Toronto, ON, Canada
| | - I Cioffi
- University of Toronto, Faculty of Dentistry, Centre for Multimodal Sensorimotor and Pain Research, Toronto, ON, Canada; Mount Sinai Hospital, Department of Dentistry, Toronto, ON, Canada; University of Toronto, Faculty of Dentistry, Graduate Orthodontics, Toronto, ON, Canada.
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Mavragani A, Cecchetti AA, Bhardwaj N, Muto BS, Murughiyan U. Understanding Emergency Room Visits for Nontraumatic Oral Health Conditions in a Hospital Serving Rural Appalachia: Dental Informatics Study. JMIR Form Res 2022; 6:e31433. [PMID: 36563041 PMCID: PMC9823565 DOI: 10.2196/31433] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 03/31/2022] [Accepted: 11/05/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND In the Appalachian region, a variety of factors will impact the ability of patients to maintain good oral health, which is essential for overall health and well-being. Oral health issues have led to high costs within the Appalachian hospital system. Dental informatics examines preventable dental conditions to understand the problem and suggest cost containment. OBJECTIVE We aimed to demonstrate the value of dental informatics in dental health care in rural Appalachia by presenting a research study that measured emergency room (ER) use for nontraumatic dental conditions (NTDCs) and the associated economic impact in a hospital system that primarily serves rural Appalachia. METHODS The Appalachian Clinical and Translational Science Institute's oral health data mart with relevant data on patients (n=8372) with ER encounters for NTDC between 2010 and 2018 was created using Appalachian Clinical and Translational Science Institute's research data warehouse. Exploratory analysis was then performed by developing an interactive Tableau dashboard. Dental Informatics provided the platform whereby the overall burden of these encounters, along with disparities in burden by age groups, gender, and primary payer, was assessed. RESULTS Dental informatics was essential in understanding the overall problem and provided an interactive and easily comprehensible visualization of the situation. We found that ER visits for NTDCs declined by 40% from 2010 to 2018, but a higher percentage of visits required inpatient care and surgical intervention. CONCLUSIONS Dental informatics can provide the necessary tools and support to health care systems and state health departments across Appalachia to address serious dental problems. In this case, informatics helped identify that although inappropriate ER use for NTDCs diminished due to ER diversion efforts, they remain a significant burden. Through its visualization and data extraction techniques, dental informatics can help produce policy changes by promoting models that improve access to preventive care.
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Affiliation(s)
| | - Alfred A Cecchetti
- Department of Clinical and Translational Science, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Niharika Bhardwaj
- Department of Clinical and Translational Science, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Bobbi Steele Muto
- Department of Dentistry, Oral & Maxillofacial Surgery, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Usha Murughiyan
- Department of Clinical and Translational Science, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
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Fitzpatrick P, Bhardwaj N, Syed S, Fox P, Frazer K, Niranjan V, Lyons A, McCann A, Brennan S, Guerin S. Smoking cessation for cancer patients through the lens of cancer specialists: challenges & solutions. Eur J Public Health 2022. [PMCID: PMC9594757 DOI: 10.1093/eurpub/ckac131.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The benefits of smoking cessation (SC) for cancer patients are widely recognised. However, there has been a limited emphasis on SC in this context and it continues to be a challenge for cancer patients. As part of a larger feasibility study aiming to develop a structured SC pathway for cancer patients in Ireland, this qualitative study explored the SC practices, experiences and opinions of oncology healthcare professionals (HCPs). Methods Semi-structured interviews were conducted with 18 HCPs from lung, breast, cervical, head and neck and general oncology, across 4 specialist adult cancer hospitals in Ireland. Interview transcripts were analysed using thematic analysis. Results Four key themes emerged: (1) Frequently ask and advise but infrequently assist: most HCPs ask about smoking and many advise about available supports, but few refer patients to SC services. Where offered, referrals were to hospital SC services and/or nicotine replacement therapy was prescribed; no HCP prescribed varenicline or bupropion. Barriers included lack of time, ill-defined referral pathways and lack of knowledge. (2) Increased willingness but differing ability to quit: most patients were interested in quitting post diagnosis and had varying support needs, linked to cancer stage, social circumstances and stress levels. (3) Need for an integrated or parallel service: all HCPs suggested that a structured and defined referral pathway will facilitate SC. (4) Motivational counselling and pharmacotherapy combination: many HCPs suggested face to face as the best mode of intervention initially, with regular follow ups and ongoing support virtually, started pre-treatment, with an empathetic and empowering approach with provision of both motivational counselling and SC pharmacotherapy. Conclusions Smoking post cancer diagnosis has serious implications for cancer treatment and prognosis but is frequently overlooked. These findings will inform the design of a SC pathway for cancer patients. Key messages • Despite increased willingness to quit, there is inadequate and inconsistent SC support provision for cancer patients. • Tailored SC support should be an integral part of comprehensive cancer care.
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Affiliation(s)
- P Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - N Bhardwaj
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
| | - S Syed
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - P Fox
- School of Nursing, Midwifery & Health Systems, University College Dublin , Dublin, Ireland
| | - K Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin , Dublin, Ireland
| | - V Niranjan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
| | - A Lyons
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - A McCann
- Biomolecular & Biomedical Research Institute, University College Dublin , Dublin, Ireland
| | - S Brennan
- Department of Radiation Oncology, St. Luke’s Radiation Oncology Network , Dublin, Ireland
| | - S Guerin
- School of Psychology, University College Dublin , Dublin, Ireland
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Frazer K, Bhardwaj N, Fox P, Niranjan V, Quinn S, Kelleher C, Fitzpatrick P. Rapid systematic review of smoking cessation interventions for people who smoke and have cancer. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Higher rates of cancer are reported in smokers compared to non-smokers, and continued smoking following a cancer diagnosis is associated with reduced health outcomes and survival. Despite international evidence of increased risks, a substantial percentage of people with a cancer diagnosis continue to smoke. Patients may be unaware of the additional risks associated with continued smoking, and health care professionals may not engage with quit supports. As part of a larger feasibility study to develop a smoking cessation pathway in cancer services in Ireland, a rapid review of the evidence was completed.
Methods
Systematic searches of PubMed, Embase, and CINAHL 2015 to December 2020 were conducted; with studies restricted to adults with a cancer diagnosis [lung, breast, cervical, head and neck] and published in English. No restriction was placed on study designs. 6404 studies were identified and uploaded into COVIDENCE platform, Cochrane's systematic review methods were adopted throughout, PRISMA reporting guidelines were used, and narrative data synthesis was completed (CRD 42020214204).
Results
The twenty-three-studies report evidence from USA, Canada, England, Lebanon, and Australia. The setting for all interventions was hospitals and cancer clinics. Evidence identifies high dropout rates, inconsistencies in approaches and duration of smoking cessation interventions with varied outcomes. A wide-ranging number of critical components emerged associated with optimal quit support- including the timing of and frequency of quit conversations, use of electronic records, in-person support meetings, provision of nicotine replacement therapy and extended use of Varenicline, smoking cessation services embedded in oncology depts, and engaging with families wanting to quit at the same time.
Conclusions
Developing tailored smoking cessation interventions are needed for smokers diagnosed with cancer to enable engagement.
Key messages
• Continued smoking following a cancer diagnosis is associated with reduced health outcomes.
• Smoking cessation programmes for cancer patient should be tailored to meet needs.
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Affiliation(s)
- K Frazer
- Nursing, Midwifery and Health Systems, University College Dublin , Dublin, Ireland
| | - N Bhardwaj
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
| | - P Fox
- Nursing, Midwifery and Health Systems, University College Dublin , Dublin, Ireland
| | - V Niranjan
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
| | - S Quinn
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
| | - C Kelleher
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
- Department Preventive Medicine and Health Promotion, St Vincent's University Hospital , Dublin, Ireland
| | - P Fitzpatrick
- Public Health, Physiotherapy, Sports Science, University College Dublin , Dublin, Ireland
- Department Preventive Medicine and Health Promotion, St Vincent's University Hospital , Dublin, Ireland
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6
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Veluswamy R, Bhalla S, Samstein R, Marron T, Gomez J, Doroshow D, Sabari J, Shum E, Saxena A, Namakydoust A, Chachoua A, Wisnivesky J, Mandeli J, Bhardwaj N, Hirsch F, Merad M, Reddy E. 1018P Phase I/II trial of rigosertib and nivolumab for KRAS mutated non-small cell lung cancer (NSCLC) patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1144] [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: 11/01/2022] Open
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7
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Singhi A, Chen T, Madison R, Bhardwaj N, Jin D, Fleischmann Z, Newberg J, Moore J, Frampton G, Hegde P, Fabrizio D, He J, Schrock A, Ebot E, Sokol E. 1300P Exploration of a novel HRD signature (HRDsig) as a biomarker of first line FOLFIRINOX benefit in metastatic pancreatic cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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8
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Charuvila S, Lloyd A, Bhardwaj N, Lloyd D. 542 Laparoscopic Division of a Congenital Splenogonadal Portosystemic Shunt: A Case Report. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.136] [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: 11/05/2022]
Abstract
Abstract
We describe a rare congenital portosystemic shunt. A 37-year-old woman was found to have a previously unreported congenital shunt following investigations into secondary causes of hypertension. The abnormal venous shunt connected the splenic vein to the left ovarian vein. The patient underwent a laparoscopic procedure to successfully divide the shunt. She made a full recovery without complications. To our knowledge, this is the first presentation of a congenital portosystemic shunt involving the splenic and ovarian veins to be reported. This case demonstrates that such a shunt can be amenable for laparoscopic management. The case report shows preoperative scans and intraoperative images.
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Affiliation(s)
- S Charuvila
- University Hospitals Leicester , Leicester , United Kingdom
| | - A Lloyd
- Hull York Medical School , Hull , United Kingdom
| | - N Bhardwaj
- University Hospitals Leicester , Leicester , United Kingdom
| | - D Lloyd
- University Hospitals Leicester , Leicester , United Kingdom
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Bhardwaj N, Joshi A, Kataria DS, Katariya D. Analysis of Perception of Students and Faculty on Case Based Early Clinical Exposure in First Year Medical Students. Mymensingh Med J 2022; 31:841-847. [PMID: 35780372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Early clinical exposure (ECE) is a novel strategy for medical colleges to bridge the gap between basic and clinical sciences. There are few studies that explain student's and faculty's perspective on ECE. This study compares the ECE models (Case-based and Video-based case) in terms of benefits and challenges. This cross-over comparative study with 120 medical students of MBBS Batch 2019 and 8 facilitators was conducted in Government medical college, Pali, Rajasthan, India from September 2020 to March 2021. Entire batch was divided into two groups. In a hospital environment, one group was taught by an actual case (patient) of a specific topic, while another group was taught in a classroom setting by a video-based case. The students' and faculty's perspectives on Case-Based Early Clinical Exposure (CBECE) were documented using a pre-tested questionnaire and evaluated on a Likert scale. Finally, both groups were given assessment questions and the process was repeated in the following session of case based early clinical exposure, but with switched groups. Majority of the students (98.3%) agreed CBECE as more effective for attentiveness, retention, correlation of clinical knowledge with theoretical knowledge and communication. Most of the students (43.0%) believed that learning is limited due to lack of repeatability as compare with video-based case. Most of the facilitators found CBECE as effective tool for the development of attitude and communication skills of the students. CBECE can be implemented with limited sessions for sensitization of students about health care setup, importance of empathetic behavior, communication skill and better correlation of preclinical subjects in the context of disease.
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Affiliation(s)
- N Bhardwaj
- Dr Nikha Bhardwaj, Associate Professor, Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India; E-mail:
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10
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Bhardwaj N, Fitzpatrick P. Breast self-examination among older women in Ireland: The Irish Longitudinal Study on Ageing -TILDA. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.524] [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: 11/15/2022] Open
Abstract
Abstract
Background
Regular breast self-examination (BSE) is a simple, cost-effective way of early breast cancer detection, particularly for women outside eligible screening age and for interval cancers. Although mammographic screening is the current most effective breast screening tool, the importance of regular BSE and breast awareness may be overlooked. The study aimed to identify socio-demographic, lifestyle and health-related factors associated with BSE practice among women in Ireland.
Methods
This study was conducted using Wave 4 data from The Irish Longitudinal Study on Ageing (TILDA), which collects health-related information from people aged 50 plus in biennial data collection waves. Those women aged 50-64 (eligible breast screening age in 2016) were selected. Following univariate analysis, logistic regression analysis was performed on selected variables to determine the factors independently associated with BSE practice.
Results
The prevalence of BSE was 70.7%. There was no significant association found between socio-demographic, lifestyle or health related factors and BSE. On logistic regression analysis, family history of cancer was not found to be associated with increased practice of BSE (Adjusted Odds Ratio (OR) 1.02, 95% Confidence Interval (CI) 0.79-1.31, p = 0.86). Having attended for mammogram showed a non-significant reduction in the likelihood of doing BSE (Adjusted OR 0.77, 95% CI 0.58-1.02, p = 0.07).
Conclusions
There are few studies on BSE from developed countries and this is the first from Ireland. BSE prevalence was 61%, 22.6% and 46.8% from Canada, United Kingdom and United States respectively, and was considerably lower from Asian and African countries. Women in this study were more educated than the general population counterparts, this might have overestimated BSE prevalence and obscured true associations. While we did not identify significant associations there is a suggestion that attending for mammography reduces women's interest in BSE.
Key messages
Being ‘Breast Aware’ and BSE are important alongside mammography for early detection of breast cancer. In countries where screening mammography is unavailable, BSE is an important detection tool.
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Affiliation(s)
- N Bhardwaj
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - P Fitzpatrick
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
- Department of Preventive Medicine & Health Promotion, St Vincent's University Hospital, Dublin, Ireland
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11
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Bhardwaj N, Fox P, Frazer K, Lyons A, Doherty K, Fitzpatrick P. Has the national fall in smoking rate in Ireland been replicated in cancer patients? a 5-year report. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Population smoking rates are falling in Ireland, however many cancer patients continue smoking post diagnosis, despite its association with poorer treatment and clinical outcomes. As part of a feasibility study of smoking cessation for cancer patients in Ireland, a review of smoking rates in cancer patients was undertaken.
Methods
The Hospital Inpatient Enquiry system (HIPE), a national database which collects administrative, demographic & clinical data on discharges from public hospitals in Ireland, provided data (2014-2018) on smoking status of adult discharges with a cancer diagnosis (overall, breast, lung, cervical and head & neck (H&N). Smoking trends were compared with Healthy Ireland data (2015-2018), from a national survey for adults on health & wellbeing.
Results
During 2014-18, current smoking rose for all cancers (10.5%-11.4%), cervical cancer (11%-19.8%) and initially (2014-2016) for H&N (3%-12.7%) and lung (24.7%-27.2%), which dropped to 7.6% and 24% respectively in 2018; breast was stable at 6 ± 0.6%. Rates are lower than the general population (23%-20%). During 2014-17, past smoking rates demonstrated an upward trend among all cancers and specific cancers, with the highest prevalence among lung (30.3-39%) and lowest among breast (7.3-11%); comparative general population data was 23-28%. Current smoking rates for all cancers were highest among 50-59-year-olds (14-16%), which contrasts with the general population (24-35 years at 32-28%). Current and past smoking rates for all cancers were consistently higher among males, similar to the general population.
Conclusions
HIPE data is limited by duplicate episodes of care, and it is recognised that smoking documentation may be an underestimate. However, it is useful to analyse trends, as these limitations should be stable over the 5-year study period. Rates remain high; our further research will document barriers and facilitators to smoking cessation among cancer patients.
Key messages
Smoking rates in cancer patients are high despite proven benefits of smoking cessation. Supportive smoking cessation services as part of routine cancer care are indicated.
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Affiliation(s)
- N Bhardwaj
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - P Fox
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - K Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - A Lyons
- Department of Preventive Medicine & Health Promotion, St Vincent's University Hospital, Dublin, Ireland
| | - K Doherty
- Department of Preventive Medicine & Health Promotion, St Vincent's University Hospital, Dublin, Ireland
| | - P Fitzpatrick
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
- Department of Preventive Medicine & Health Promotion, St Vincent's University Hospital, Dublin, Ireland
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12
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Isherwood J, Karki BB, Chung WY, AlSaoudi T, Wolff J, Malde D, Bhardwaj N, Garcea G, Dennison A. 228 Outcomes of Gallstone Complications During the COVID Pandemic. Br J Surg 2021. [PMCID: PMC8524580 DOI: 10.1093/bjs/znab259.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background The Intercollegiate General Surgery Guidance on COVID-19 recommended either non-surgical management or cholecystostomy drains for the management of acute biliary disease replacing gold standard practice of early laparoscopic cholecystectomy within 1 week of index admission with drainage reserved for high-risk patients where surgery is not appropriate. Method This is the retrospective study presenting the impact of gallstone disease in our unit during five months of the COVID- 19 pandemic (March 2020-August 2020) compared with the equivalent period in 2019. Results Patients presenting to the HPB unit with a coded diagnosis of gallstones were included and during the study period 1447 patients presented compared with 1413 in 2019. In 2020 compared with 2019 there was a significant decrease in patients presenting with cholecystitis (240 vs 313; p = 0.031) but no significant difference in patients presenting due to gallbladder perforation (44 vs 51). Interestingly the numbers of cholecystostomies were comparable, with 11 in 2020 and 15 in 2019 representing significantly less than the 7.2% figure published by Peckham-Cooper et al. Conclusions In our study there was a decrease in patients with cholecystitis and perforation and there was an increase in patients with gallstone pancreatitis, increase waiting lists with increase in the incidence of serious complications. In our trust we currently have 656 patients awaiting cholecystectomy compared to 280 in august 2019. With the recent elevation of the alert level to 4 and increased government restrictions, a consistent National approach is required to mitigate these risks.
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Affiliation(s)
- J Isherwood
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - B B Karki
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - W Y Chung
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - T AlSaoudi
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - J Wolff
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - D Malde
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - N Bhardwaj
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - G Garcea
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - A Dennison
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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13
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Bernstein E, Bhardwaj N, Pfoh ER, Yudelevich E. A Nationwide Survey of Educational Resource Utilization and Perception Among Internal Medicine Residents. J Gen Intern Med 2021; 36:1598-1604. [PMID: 33506391 PMCID: PMC7840077 DOI: 10.1007/s11606-020-06441-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND New virtual resources ("novel resources") have been incorporated into medical education. No recent large studies about their use and perception among internal medicine (IM) residents exist. OBJECTIVE Characterize the use and perceived helpfulness of educational resources. DESIGN Nationwide survey from December 2019 to March 2020. PARTICIPANTS IM residents in the USA. MAIN MEASURES Residents were surveyed on their use and their perceived helpfulness of resources for both attaining general medical knowledge and for point-of-care (POC) learning. Traditional resources included board review resources, clinical experience, digital clinical resources (e.g., UpToDate), journal articles, pocket references, professional guidelines, textbooks, and residency curricula. Novel resources included Twitter, video streaming platforms (e.g., YouTube), online blogs, podcasts, and Wikipedia. KEY RESULTS We had 662 respondents from 55 residency programs across 26 states. On average, residents used 9 total resources (7 traditional and 2 novel). Digital clinical resources and clinical experience were used by all residents and found helpful by the highest percentage of residents (96% and 94%, respectively). Journal articles were next (used by 90%), followed by board review resources and residency curricula (both used by 85%). Their perceived helpfulness varied, from 90% for board review resources, to 66% for journal articles and 64% for residency curricula, the lowest perceived helpfulness of any traditional resource. Podcasts and video streaming platforms were used as frequently as textbooks (58-59%), but were rated as helpful more frequently (75% and 82% vs 66%, respectively). CONCLUSIONS Digital clinical resources, video streaming platforms, and podcasts were perceived as helpful, underscoring the importance of ensuring their integration into medical education to complement clinical experience and other traditional resources which remain highly valued by residents. IMPORTANCE Our findings can inform residency programs as they transition to virtual curricula in the wake of the COVID-19 pandemic.
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Affiliation(s)
- E Bernstein
- Department of Internal Medicine and Geriatrics, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - N Bhardwaj
- Department of Internal Medicine and Geriatrics, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - E R Pfoh
- Center for Value Based Care, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - E Yudelevich
- Department of Internal Medicine and Geriatrics, Cleveland Clinic Foundation, Cleveland, OH, USA.
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14
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Layton GR, Chung WY, Isherwood J, Fraser RE, Issa E, Robertson GS, Garcea G, Bhardwaj N, Dennison AR. Endoscopic retrograde cholangiopancreatography in the COVID era: considerations for hepatobiliary and pancreatic surgery units. Br J Surg 2021; 108:e290-e291. [PMID: 34000030 DOI: 10.1093/bjs/znab161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/14/2021] [Indexed: 01/28/2023]
Affiliation(s)
- G R Layton
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - W Y Chung
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - R E Fraser
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - E Issa
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - G S Robertson
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - G Garcea
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - N Bhardwaj
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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15
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Alsaoudi T, Slavin D, Khasawneh F, Chung WY, Eltweri A, Sahloul M, Bhardwaj N, Malde D, Dennison AR, Garcea G. Selective impact of COVID-19 in patients presenting with non-specific abdominal pain. Br J Surg 2021; 108:e150-e151. [PMID: 33792638 PMCID: PMC8083566 DOI: 10.1093/bjs/znaa152] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022]
Affiliation(s)
- T Alsaoudi
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - D Slavin
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - F Khasawneh
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - W Y Chung
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - A Eltweri
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - M Sahloul
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - N Bhardwaj
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - D Malde
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - A R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - G Garcea
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
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16
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Isherwood J, Karki B, Chung WY, AlSaoudi T, Wolff J, Malde D, Bhardwaj N, Garcea G, Dennison AR. Outcomes of gallstone complications during the COVID pandemic. Br J Surg 2021; 108:e29-e30. [PMID: 33640947 DOI: 10.1093/bjs/znaa068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 12/31/2022]
Abstract
As data and metadata from the SARS-CoV-2 pandemic mature, the true impact on non-cancer, non-emergency surgical practice is becoming apparent. The authors present data on the impact of gallstone disease in their unit during 5 months of the COVID-19 pandemic (March 2020 to August 2020) compared with the equivalent period in 2019. Although the total number of patients presenting with gallstone disease was comparable, there was a decrease in patients with cholecystitis and perforation (although it is possibly too early for these to have presented), and there was a small but worrying increase in patients with gallstone pancreatitis. With the recent increase in alert level to 4 and increased government restrictions in an attempt to avoid a second national lockdown, a consistent national approach is required to mitigate these risks.
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Affiliation(s)
- J Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - B Karki
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - W Y Chung
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - T AlSaoudi
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - J Wolff
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - D Malde
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - N Bhardwaj
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - G Garcea
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - A R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
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17
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NAVEEN V, D'Cruz S, Kashyap J, Bhardwaj N. POS-280 CORRELATION OF AMBULATORY BLOOD PRESSURE MEASUREMENT (ABPM) WITH OFFICE BLOOD PRESSURE MEASUREMENT IN PATIENTS OF CHRONIC KIDNEY DISEASE (CKD). Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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18
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Alsaoudi T, Chung WY, Isherwood J, Bhardwaj N, Malde D, Dennison AR, Garcea G. HPB surgery in the time of COVID. Br J Surg 2020; 107:e588-e589. [PMID: 32936449 DOI: 10.1002/bjs.12030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Affiliation(s)
- T Alsaoudi
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - W Y Chung
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - J Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - N Bhardwaj
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - D Malde
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - A R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - G Garcea
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
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19
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Cecchetti AA, Bhardwaj N, Murughiyan U, Kothakapu G, Sundaram U. Fueling Clinical and Translational Research in Appalachia: Informatics Platform Approach. JMIR Med Inform 2020; 8:e17962. [PMID: 33052114 PMCID: PMC7593861 DOI: 10.2196/17962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Appalachian population is distinct, not just culturally and geographically but also in its health care needs, facing the most health care disparities in the United States. To meet these unique demands, Appalachian medical centers need an arsenal of analytics and data science tools with the foundation of a centralized data warehouse to transform health care data into actionable clinical interventions. However, this is an especially challenging task given the fragmented state of medical data within Appalachia and the need for integration of other types of data such as environmental, social, and economic with medical data. OBJECTIVE This paper aims to present the structure and process of the development of an integrated platform at a midlevel Appalachian academic medical center along with its initial uses. METHODS The Appalachian Informatics Platform was developed by the Appalachian Clinical and Translational Science Institute's Division of Clinical Informatics and consists of 4 major components: a centralized clinical data warehouse, modeling (statistical and machine learning), visualization, and model evaluation. Data from different clinical systems, billing systems, and state- or national-level data sets were integrated into a centralized data warehouse. The platform supports research efforts by enabling curation and analysis of data using the different components, as appropriate. RESULTS The Appalachian Informatics Platform is functional and has supported several research efforts since its implementation for a variety of purposes, such as increasing knowledge of the pathophysiology of diseases, risk identification, risk prediction, and health care resource utilization research and estimation of the economic impact of diseases. CONCLUSIONS The platform provides an inexpensive yet seamless way to translate clinical and translational research ideas into clinical applications for regions similar to Appalachia that have limited resources and a largely rural population.
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Affiliation(s)
- Alfred A Cecchetti
- Department of Clinical and Translational Science, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Niharika Bhardwaj
- Department of Clinical and Translational Science, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Usha Murughiyan
- Department of Clinical and Translational Science, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Gouthami Kothakapu
- Department of Clinical and Translational Science, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Uma Sundaram
- Department of Clinical and Translational Science, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
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20
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Bhardwaj N, Cecchetti AA, Murughiyan U, Neitch S. Analysis of Benzodiazepine Prescription Practices in Elderly Appalachians with Dementia via the Appalachian Informatics Platform: Longitudinal Study. JMIR Med Inform 2020; 8:e18389. [PMID: 32749226 PMCID: PMC7435704 DOI: 10.2196/18389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 01/22/2023] Open
Abstract
Background Caring for the growing dementia population with complex health care needs in West Virginia has been challenging due to its large, sizably rural-dwelling geriatric population and limited resource availability. Objective This paper aims to illustrate the application of an informatics platform to drive dementia research and quality care through a preliminary study of benzodiazepine (BZD) prescription patterns and its effects on health care use by geriatric patients. Methods The Maier Institute Data Mart, which contains clinical and billing data on patients aged 65 years and older (N=98,970) seen within our clinics and hospital, was created. Relevant variables were analyzed to identify BZD prescription patterns and calculate related charges and emergency department (ED) use. Results Nearly one-third (4346/13,910, 31.24%) of patients with dementia received at least one BZD prescription, 20% more than those without dementia. More women than men received at least one BZD prescription. On average, patients with dementia and at least one BZD prescription sustained higher charges and visited the ED more often than those without one. Conclusions The Appalachian Informatics Platform has the potential to enhance dementia care and research through a deeper understanding of dementia, data enrichment, risk identification, and care gap analysis.
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Affiliation(s)
- Niharika Bhardwaj
- Department of Clinical and Translational Science, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Alfred A Cecchetti
- Department of Clinical and Translational Science, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Usha Murughiyan
- Department of Clinical and Translational Science, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Shirley Neitch
- Department of Internal Medicine, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
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21
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Bajpai V, Singh P, Chakraborty R, Bhardwaj N, Mathur P. Anti-microbial-resistance and profile of exotoxins of invasive beta-haemolytic-streptococci infections in trauma patients. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2020.01.140] [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: 10/25/2022] Open
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22
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Acosta G, Amro A, Aguilar R, Abusnina W, Bhardwaj N, Koromia GA, Studeny M, Irfan A. Clinical Determinants of Myocardial Injury, Detectable and Serial Troponin Levels among Patients with Hypertensive Crisis. Cureus 2020; 12:e6787. [PMID: 32140347 PMCID: PMC7045977 DOI: 10.7759/cureus.6787] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction There is a high prevalence of hypertensive crisis with myocardial injury, as evidenced by elevation in cardiac troponin levels. The risk factors predisposing patients to developing a myocardial injury, detectable troponin, and increase in serial troponin in this population are not known. Methods A retrospective study was designed to include all patients, presenting to the emergency room, diagnosed with hypertensive crisis, using International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes between 2016-2018 (n=467). Logistic regression was used to determine the important predictors of myocardial injury evidenced by troponin elevation >99th percentile of upper reference level (URL), detectable troponin (> 0.015 ng/ml), and increase in serial troponin levels. Results The 99th percentile of the initial troponin level among all patients was 0.433 ng/ml. A total of 15% had a myocardial injury, and the significant risk factors associated with it were body mass index (BMI) < 30 kg/m2 (odds ratio [OR] 0.50, confidence interval [CI] 0.28-0.89), congestive heart failure (CHF; OR 4.28, CI 2.21-8.25) and prior use of aspirin (OR 1.98, CI 1.08-3.63). About 35% had detectable troponin, and BMI < 30 kg/m2 (OR 0.62, CI 0.40-0.97), CHF (OR 3.49, CI 2.06-5.9), elevated creatinine (OR 1.17, CI 1.02-1.34) and age <61 years (OR 0.59, CI 0.38-0.94) were associated with it. The factors associated with an increase in serial troponin were BMI < 30 Kg/m2 (OR 0.56, CI 0.36-0.87), CHF (OR 1.78, CI 1.06-3.0), coronary artery disease (CAD; OR 2.08, CI 1.28-3.36) and non-Caucasian race (OR 0.52, CI 0.29-0.93). Conclusion About one-third of patients with the hypertensive crisis have detectable troponin. Still, among these, less than half have troponin levels >99th percentile URL, and the majority of these patients have minimal changes in serial troponin. Low BMI was associated with higher initial and serial troponin levels, and this obesity paradox was stronger among females and older patients.
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Affiliation(s)
| | - Ahmed Amro
- Cardiology, Marshall University, Huntington, USA
| | - Rodrigo Aguilar
- Internal Medicine, Marshall University, Joan C. Edwards School of Medicine, Huntington, USA
| | | | - Niharika Bhardwaj
- Clinical and Translational Science, Marshall University, Joan C. Edwards School of Medicine, Huntington, USA
| | | | - Mark Studeny
- Cardiology, Marshall University, Huntington, USA
| | - Affan Irfan
- Cardiology, Marshall University, Huntington, USA
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Marron T, Wolf A, Flores R, Veluswamy R, Gomez J, Beasley M, Yankelevitz D, Leader A, Lowy I, Miller E, Thurston G, Jankovic V, Deering R, Brown B, Rahman A, Gnjatic S, Hirsch F, Bhardwaj N, Merad M. EP1.04-15 NSCLC Response Determinants to Chemoimmunotherapy: Deep Profiling of Tumors Following Neoadjuvant Cemiplimab and Chemotherapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2143] [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: 11/17/2022]
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24
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Mathew P, Banoth R, Bhardwaj N, Yaddanappudi S, Sharma R. Evaluation of upper airway obstruction and ultrasonographic posterior tongue thickness in children scheduled for cleft lip/palate repair. Br J Anaesth 2019. [DOI: 10.1016/j.bja.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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25
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Orfanelli T, Roudko V, Bozkus CC, Greenbaum B, Blank S, Bhardwaj N. Shared tumor antigens in uterine cancers with microsatellite instability: Putative targets for immunotherapeutic approaches. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.214] [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: 11/25/2022]
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26
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Amro A, Baez GA, Koromia GA, Bhardwaj N, Aguilar R, El-Hamdani M, Irfan A. ALBUMIN LEVEL AS A RISK MARKER AND PREDICTOR OF PERIPARTUM CARDIOMYOPATHY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The efficacy of scalp nerve block using 0.5% bupivacaine with adrenaline for postoperative pain relief in craniotomy patients was evaluated in 40 ASA I or II adult patients undergoing supratentorial craniotomy. A standard general anaesthesia technique was followed. Patients were randomly divided into two groups. Group B received 0.5% bupivacaine with 1:400,000 adrenaline and group S received normal saline with 1:400,000 adrenaline, both after skin closure. Postoperative pain was assessed at 30 seconds and 1, 2, 4, 6, 8 and 12 hours using a numerical rating scale. Diclofenac IM was administered as rescue analgesia if patients reported a numerical rating scale of 40 or more. Tramadol TV was administered as second rescue analgesia. Sixty per cent of patients in group S experienced moderate to severe pain (numerical rating scale of 40 or more) at some time during the first 12 postoperative hours in comparison to 25% patients in group B. Median pain scores were significantly lower in group B for up to 6 hours. Significantly more patients were pain free up to four hours in group B. Median duration for the requirement of first dose of diclofenac was longer in group B compared to group S (360 min vs 30 min, P<0.01). The number of doses of diclofenac (5 vs 19) was significantly lower in group B compared to group S (P<0.01). Tramadol was required by six patients in group S only. Scalp nerve block using 0.5% bupivacaine with 1:400,000 adrenaline decreases the incidence and severity of postoperative pain in patients undergoing supratentorial craniotomy.
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Affiliation(s)
- I Bala
- Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sharma J, Sango C, Kaur P, Bhardwaj N. Crude cellulase treatment for reactivity enhancement of pre-hydrolysed kraft dissolving pulp for viscose. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.1089] [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: 11/15/2022]
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30
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Ott P, Govindan R, Naing A, Friedlander T, Margolin K, Lin J, Bhardwaj N, Hellman M, Srinivasan L, Greshock J, Moles M, Gaynor R, Goldstein M, Hu-Lieskovan S. A personal neoantigen vaccine, NEO-PV-01, with anti-PD1 induces broad de novo anti-tumor immunity in patients with metastatic melanoma, NSCLC, and bladder cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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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31
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Bhardwaj N, Ragonnet-Cronin M, Murrell B, Chodavarapu K, Martin R, Chang S, Miller MD, Feld JJ, Sulkowski M, Mangia A, Wertheim JO, Osinusi A, McNally J, Brainard D, Mo H, Svarovskaia ES. Intrapatient viral diversity and treatment outcome in patients with genotype 3a hepatitis C virus infection on sofosbuvir-containing regimens. J Viral Hepat 2018; 25:344-353. [PMID: 29112331 DOI: 10.1111/jvh.12825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/02/2017] [Indexed: 12/27/2022]
Abstract
Treatment with the direct-acting antiviral agent (DAA) sofosbuvir (SOF), an NS5B inhibitor, and velpatasvir (VEL), an NS5A inhibitor, demonstrates viral cure rates of ≥95% in hepatitis C virus (HCV) genotypes (GT) 1-6. Here, we investigated intrapatient HCV diversity in NS5A and NS5B using Shannon entropy to examine the relationship between viral diversity and treatment outcome. At baseline, HCV diversity was lowest in patients infected with HCV GT3 as compared to the other GTs, and viral diversity was greater in NS5A than NS5B (P < .0001). Treatment outcome with SOF/VEL or the comparator regimen of SOF with ribavirin (RBV) was not correlated with baseline diversity. However, among persons treated with SOF/VEL, a decrease in diversity from baseline was observed at relapse in the majority virologic failures, consistent with a viral bottleneck event at relapse. In contrast, an increase in diversity was observed in 27% of SOF+RBV virologic failures. We investigated whether the increase in diversity was due to an increase in the transition rate, one mode of potential RBV-mediated mutagenesis; however, we found no evidence of this mechanism. Overall, we did not observe that viral diversity at baseline influenced treatment outcome, but the diversity changes observed at relapse can improve our understanding of RBV viral suppression in vivo.
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Affiliation(s)
- N Bhardwaj
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | | | - B Murrell
- University of California San Diego, San Diego, CA, USA
| | - K Chodavarapu
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - R Martin
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - S Chang
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - M D Miller
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - J J Feld
- Toronto Centre for Liver Disease, University of Toronto, Toronto, ON, Canada
| | - M Sulkowski
- Johns Hopkins University, Baltimore, MD, USA
| | - A Mangia
- Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - J O Wertheim
- University of California San Diego, San Diego, CA, USA
| | - A Osinusi
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - J McNally
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - D Brainard
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
| | - H Mo
- Clinical Virology, Gilead Sciences, Foster City, CA, USA
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Ahuja P, Jain D, Bhardwaj N, Jain K, Gainder S, Kang M. Airway changes following labor and delivery in preeclamptic parturients: a prospective case control study. Int J Obstet Anesth 2018; 33:17-22. [DOI: 10.1016/j.ijoa.2017.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022]
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Sastri S, Pant S, Lewis S, Rajamanickam K, Naga P, Bhardwaj N, Dandpani E, Mahantshetty U, Engineer R, Menachery S, Swamidas J, Ghosh J, Gupta S, Shrivastava S. Hematological Toxicity during Pelvic IMRT Versus 3DCRT: Secondary Analysis from Phase 3 RCT. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bhardwaj N, Pereda B, Kriplani A, Sehgal R, Espey E, Singh R. Perceptions of reversible and permanent contraception in India. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Norton TD, Miller EA, Bhardwaj N, Landau NR. Vpx-containing dendritic cell vaccine induces CTLs and reactivates latent HIV-1 in vitro. Gene Ther 2015; 22:227-36. [PMID: 25567537 PMCID: PMC4698816 DOI: 10.1038/gt.2014.117] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/25/2014] [Accepted: 11/17/2014] [Indexed: 12/20/2022]
Abstract
Eradication of HIV-1 from an infected individual requires a means of inducing production of virus from latently infected cells and stimulating an immune response against the infected cells. We report the development of lentiviral vectors that transduce dendritic cells (DCs) to both induce production of virus from latently infected cells and stimulate antigen-specific CTLs. The vectors package Vpx, a lentiviral accessory protein that counteracts the SAMHD1-mediated block to DC transduction, allowing for long-term expression of vector-encoded proteins. The vectors encode influenza or HIV-1-derived epitopes fused via a self-cleaving peptide to CD40L that releases the peptide into the endoplasmic reticulum for entry into the antigen presentation pathway. Expression of CD40L caused transduced DCs to mature and produce Th1-skewing cytokines. The DCs presented antigen to CD8 T cells, enhancing antigen-specific CTLs. Coculture of the transduced DCs with latently infected cells induced high level virus production, an effect that was mediated by TNF-α. The ability of a DC vaccine to reactivate latent HIV-1 and stimulate an adaptive immune response provides a means to reduce the size of the latent reservoir in patients. This strategy can also be applied to develop DC vaccines for other diseases.
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Affiliation(s)
- T D Norton
- 1] Department of Medicine, NYU School of Medicine, New York, NY, USA [2] Department of Microbiology, NYU School of Medicine, New York, NY, USA
| | - E A Miller
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N Bhardwaj
- Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N R Landau
- Department of Microbiology, NYU School of Medicine, New York, NY, USA
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Punia P, Bhardwaj N, Mathur P, Gupta G, Misra MC. Profile of fatal Streptococcal bacteraemia at a tertiary care Indian hospital. Indian J Med Microbiol 2015; 33:148-51. [DOI: 10.4103/0255-0857.148424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kotwal A, Biswas D, Kakati B, Thakuria B, Bhardwaj N. Efficacy of anti-pseudomonal antibiotics: need to reconsider the empirical use of cefepime. Indian J Med Res 2014; 140:560-2. [PMID: 25488453 PMCID: PMC4277145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- A. Kotwal
- Department of Microbiology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun 248 140, India
| | - D. Biswas
- Department of Microbiology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun 248 140, India,For correspondence:
| | - B. Kakati
- Department of Microbiology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun 248 140, India
| | - B. Thakuria
- Department of Microbiology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun 248 140, India,Present address: Department of Microbiology, AIIMS Bhopal, Saket Nagar, Bhopal 462 024, India
| | - N. Bhardwaj
- Department of Microbiology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun 248 140, India
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Kapur A, Chawla HS, Gauba K, Goyal A, Bhardwaj N. Effect of oral-transmucosal midazolam sedation on anxiety levels of 3-4 years old children during a Class II restorative procedure. Contemp Clin Dent 2014; 5:334-9. [PMID: 25191069 PMCID: PMC4147809 DOI: 10.4103/0976-237x.137933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM A double-blind randomized control trial was conducted to assess the effect of oral-transmucosal midazolam sedation on changes in anxiety levels of precooperative children during a Class II amalgam restorative procedure. METHODOLOGY A sample of 40 healthy, American Society of Anesthesiologists I, children aged 3-4 years having at least one carious primary mandibular molar requiring a Class II amalgam restoration with no previous dental history were randomly divided into experimental and control groups comprising of 20 children each. The children in the experimental group (Group I) received 0.5 mg/kg body weight of midazolam mixed in strawberry syrup and those in the control group (Group II) received the same syrup mixed in saline, 15 min prior to the restorative procedure. Routine nonpharmacological behavior management techniques were used in both groups. The anxiety levels were recorded using Venham's anxiety scale at the start and end of each procedural step. RESULTS There was a significant (P < 0.001) reduction in the anxiety levels of children in the experimental group on entry into the operatory compared with the control group. Introduction of each fear evoking stimuli showed a somewhat similar increase in anxiety levels in the two groups. In spite of a similar trend, the anxiety levels remained much lower in Group I than in Group II. CONCLUSION Midazolam in conjunction with behavior management is more helpful in relaxing the child initially than behavior management alone, thus increasing the chances of successful and easy accomplishment of further treatment steps.
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Affiliation(s)
- Aditi Kapur
- Department of Pediatric Dentistry, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - H S Chawla
- Department of Anesthesia, Sukhiqbal Dental Centre, Chandigarh, India
| | - K Gauba
- Department of Pediatric Dentistry, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Goyal
- Department of Pediatric Dentistry, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - N Bhardwaj
- Department of Anesthesia, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Bhardwaj N, Kanhere H, Lord A, Maddern G. Handheld modification of the laparoscopic hook using the Trewavis(©) arthroscopic lateral release hook. Ann R Coll Surg Engl 2014; 96:318-9. [PMID: 24780034 DOI: 10.1308/rcsann.2014.96.4.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- N Bhardwaj
- Queen Elizabeth Hospital, Woodville, SA, Australia
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Mathur P, Bhardwaj N, Gupta G, Punia P, Tak V, Misra MC. Beta-hemolytic streptococcal infections in trauma patients. Eur J Trauma Emerg Surg 2014; 40:175-81. [PMID: 26815898 DOI: 10.1007/s00068-013-0326-y] [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: 02/12/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE β-hemolytic streptococci (βHS) causes a diverse array of human infections. The molecular epidemiology of β-hemolytic streptococcal infections in trauma patients has not been studied. This study reports the molecular and clinical epidemiology of β-hemolytic streptococcal infections at a level 1 trauma centre of India. METHODS A total of 117 isolates of βHS were recovered from clinical samples of trauma patients. The isolates were identified to species level and subjected to antimicrobial susceptibility testing. Polymerase chain reaction (PCR) assay was done to detect exotoxin virulence genes. The M protein gene (emm gene) types of GAS strains were ascertained by sequencing. RESULTS Group A Streptococcus (GAS) was the most common isolate (64 %), followed by group G Streptococcus (23 %). A large proportion of GAS produced speB (99 %), smeZ (91 %), speF (95 %) and speG (87 %). smeZ was produced by 22 % of GGS. A total of 25 different emm types/subtypes were seen in GAS, with emm 11 being the most common. Resistance to tetracycline (69 %) and erythromycin (33 %) was commonly seen in GAS. CONCLUSIONS β-hemolytic streptococcal infections in Indian trauma patients are caused by GAS and non-GAS strains alike. A high diversity of emm types was seen in GAS isolates, with high macrolide and tetracycline resistance. SpeA was less commonly seen in Indian GAS isolates. There was no association between disease severity and exotoxin gene production.
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Affiliation(s)
- P Mathur
- Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - N Bhardwaj
- Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - G Gupta
- Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - P Punia
- Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - V Tak
- Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - M C Misra
- Department of Surgery, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Bhardwaj N, Davidson A, Martins S, Whitaker A. Knowledge of long-acting reversible contraception among women presenting for induced abortion. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Müller TD, Müller A, Habegger K, Yi CX, Meyer CW, Gaylinn BD, Finan B, Heppner K, Trivedi C, Bielohuby M, Abplanalp W, Meyer F, Piechowski CL, Pratzka J, Stemmer K, Holland J, Hembree J, Bhardwaj N, Raver C, Ottaway N, Krishna R, Sah R, Sallee FR, Woods SC, Perez-Tilve D, Bidlingmaier M, Thorner MO, Krude H, Smiley D, DiMarchi R, Hofmann S, Pfluger PT, Kleinau G, Biebermann H, Tschöp MH. The orphan receptor GPR83 regulates systemic energy metabolism via ghrelin-dependent and -independent mechanisms. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sehi M, Bhardwaj N, Chung YS, Greenfield DS. Evaluation of baseline structural factors for predicting glaucomatous visual-field progression using optical coherence tomography, scanning laser polarimetry and confocal scanning laser ophthalmoscopy. Eye (Lond) 2012; 26:1527-35. [PMID: 23060026 DOI: 10.1038/eye.2012.203] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The objective of this study is to assess whether baseline optic nerve head (ONH) topography and retinal nerve fiber layer thickness (RNFLT) are predictive of glaucomatous visual-field progression in glaucoma suspect (GS) and glaucomatous eyes, and to calculate the level of risk associated with each of these parameters. METHODS Participants with ≥28 months of follow-up were recruited from the longitudinal Advanced Imaging for Glaucoma Study. All eyes underwent standard automated perimetry (SAP), confocal scanning laser ophthalmoscopy (CSLO), time-domain optical coherence tomography (TDOCT), and scanning laser polarimetry using enhanced corneal compensation (SLPECC) every 6 months. Visual-field progression was assessed using pointwise linear-regression analysis of SAP sensitivity values (progressor) and defined as significant sensitivity loss of >1 dB/year at ≥2 adjacent test locations in the same hemifield at P<0.01. Cox proportional hazard ratios (HR) were calculated to determine the predictive ability of baseline ONH and RNFL parameters for SAP progression using univariate and multivariate models. RESULTS Seventy-three eyes of 73 patients (43 GS and 30 glaucoma, mean age 63.2±9.5 years) were enrolled (mean follow-up 51.5±11.3 months). Four of 43 GS (9.3%) and 6 of 30 (20%) glaucomatous eyes demonstrated progression. Mean time to progression was 50.8±11.4 months. Using multivariate models, abnormal CSLO temporal-inferior Moorfields classification (HR=3.76, 95% confidence interval (CI): 1.02-6.80, P=0.04), SLPECC inferior RNFLT (per -1 μm, HR=1.38, 95% CI: 1.02-2.2, P=0.02), and TDOCT inferior RNFLT (per -1 μm, HR=1.11, 95% CI: 1.04-1.2, P=0.001) had significant HRs for SAP progression. CONCLUSION Abnormal baseline ONH topography and reduced inferior RNFL are predictive of SAP progression in GS and glaucomatous eyes.
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Affiliation(s)
- M Sehi
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Palm Beach Gardens, FL, USA.
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Frleta D, Ochoa CE, Kramer HB, Khan SA, Stacey AR, Borrow P, Kessler BM, Haynes BF, Bhardwaj N. Apoptotic microparticles generated during acute HIV-1 infection inhibit human dendritic cells via CD44. Retrovirology 2012. [PMCID: PMC3441553 DOI: 10.1186/1742-4690-9-s2-p183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Manches O, Fernandez MV, Plumas J, Chaperot L, Bhardwaj N. HIV triggers immunoregulatory dendritic cells and regulatory T cells through the non-canonical NF-kB pathway. Retrovirology 2012. [PMCID: PMC3441636 DOI: 10.1186/1742-4690-9-s2-p184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Angiomyolipoma (AML) are benign tumours composed of varying amounts of thick-walled dysplastic blood vessels, smooth muscle and mature adipose tissue derived from epithelioid cells. We present a previously unreported occurrence of multi-focal pancreatic and hepatic AMLs in a patient and discuss the diagnostic and management difficulties associated with this rare disease. In addition relevant case studies are also reviewed.
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Affiliation(s)
- N Bhardwaj
- Leicester General Hospital, Leicester, UK
| | - G Garcea
- Leicester General Hospital, Leicester, UK
| | - Dm Lloyd
- Leicester General Hospital, Leicester, UK
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Bhardwaj N, Ghaffari G. Biomarkers for Eosinophilic Esophagitis: A Systematic Review. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- N Bhardwaj
- Department of Surgery, Leicester General Hospital, Leicester, UK.
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Affiliation(s)
- N Bhardwaj
- Department of Surgery Leicester General Hospital, Leicester, UK
| | - DM Lloyd
- Department of Surgery Leicester General Hospital, Leicester, UK
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Kandimalla RJL, Prabhakar S, Binukumar BK, Wani WY, Gupta N, Sharma DR, Sunkaria A, Grover VK, Bhardwaj N, Jain K, Gill KD. Apo-Eε4 allele in conjunction with Aβ42 and tau in CSF: biomarker for Alzheimer's disease. Curr Alzheimer Res 2011; 8:187-96. [PMID: 21222606 DOI: 10.2174/156720511795256071] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 07/07/2010] [Indexed: 11/22/2022]
Abstract
The objective of this study was to elucidate an association between Apo- Eε4 allele and CSF biomarkers Aβ42 and tau for the diagnosis of Alzheimer's Disease (AD) patients. Aβ42 and tau protein concentrations in CSF were measured by using ELISA assays. The levels of Aβ42 were found to be decreased where as tau levels increased in AD patients. Moreover in AD patients Apo-Eε4 allele carriers have shown low Aβ42 levels (328.86 ± 99.0 pg/ml) compared to Apo-Eε4 allele non-carriers (367.52 ± 5 7.37 pg/ml), while tau levels were higher in Apo-Eε4 allele carriers (511 ± 44.67 pg/ml) compared to Apo-Eε4 allele non-carriers (503.75 ± 41.08 pg/ml). Combination of Aβ42 and tau resulted in sensitivity of 75.38% and specificity of 94.82% and diagnostic accuracy of 84.30% for AD compared with the controls. Therefore low Aβ42 and elevated tau concentrations in CSF may prove to be a better diagnostic marker for AD along with the Apo-Eε4 allele.
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Affiliation(s)
- R J L Kandimalla
- Department of Biochemistry, Postgraduate Institute of Medical, Education and Research, Chandigarh-160 012, India
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