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Semitala FC, Kadota JL, Musinguzi A, Welishe F, Nakitende A, Akello L, Kunihira Tinka L, Nakimuli J, Ritar Kasidi J, Bishop O, Nakasendwa S, Baik Y, Patel D, Sammann A, Nahid P, Belknap R, Kamya MR, Handley MA, Phillips PPJ, Katahoire A, Berger CA, Kiwanuka N, Katamba A, Dowdy DW, Cattamanchi A. Comparison of 3 optimized delivery strategies for completion of isoniazid-rifapentine (3HP) for tuberculosis prevention among people living with HIV in Uganda: A single-center randomized trial. PLoS Med 2024; 21:e1004356. [PMID: 38377166 PMCID: PMC10914279 DOI: 10.1371/journal.pmed.1004356] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/05/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Expanding access to shorter regimens for tuberculosis (TB) prevention, such as once-weekly isoniazid and rifapentine taken for 3 months (3HP), is critical for reducing global TB burden among people living with HIV (PLHIV). Our coprimary hypotheses were that high levels of acceptance and completion of 3HP could be achieved with delivery strategies optimized to overcome well-contextualized barriers and that 3HP acceptance and completion would be highest when PLHIV were provided an informed choice between delivery strategies. METHODS AND FINDINGS In a pragmatic, single-center, 3-arm, parallel-group randomized trial, PLHIV receiving care at a large urban HIV clinic in Kampala, Uganda, were randomly assigned (1:1:1) to receive 3HP by facilitated directly observed therapy (DOT), facilitated self-administered therapy (SAT), or informed choice between facilitated DOT and facilitated SAT using a shared decision-making aid. We assessed the primary outcome of acceptance and completion (≥11 of 12 doses of 3HP) within 16 weeks of treatment initiation using proportions with exact binomial confidence intervals (CIs). We compared proportions between arms using Fisher's exact test (two-sided α = 0.025). Trial investigators were blinded to primary and secondary outcomes by study arm. Between July 13, 2020, and July 8, 2022, 1,656 PLHIV underwent randomization, with equal numbers allocated to each study arm. One participant was erroneously enrolled a second time and was excluded in the primary intention-to-treat analysis. Among the remaining 1,655 participants, the proportion who accepted and completed 3HP exceeded the prespecified 80% target in the DOT (0.94; 97.5% CI [0.91, 0.96] p < 0.001), SAT (0.92; 97.5% CI [0.89, 0.94] p < 0.001), and Choice (0.93; 97.5% CI [0.91, 0.96] p < 0.001) arms. There was no difference in acceptance and completion between any 2 arms overall or in prespecified subgroup analyses based on sex, age, time on antiretroviral therapy, and history of prior treatment for TB or TB infection. Only 14 (0.8%) participants experienced an adverse event prompting discontinuation of 3HP. The main limitation of the study is that it was conducted in a single center. Multicenter studies are now needed to confirm the feasibility and generalizability of the facilitated 3HP delivery strategies in other settings. CONCLUSIONS Short-course TB preventive treatment was widely accepted by PLHIV in Uganda, and very high levels of treatment completion were achieved in a programmatic setting with delivery strategies tailored to address known barriers. TRIAL REGISTRATION ClinicalTrials.gov NCT03934931.
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Affiliation(s)
- Fred C. Semitala
- Makerere University, Department of Medicine, College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala Uganda
| | - Jillian L. Kadota
- Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | | | - Fred Welishe
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Anne Nakitende
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Lydia Akello
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Jane Nakimuli
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Opira Bishop
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Suzan Nakasendwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Yeonsoo Baik
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Devika Patel
- The Better Lab and Department of Surgery, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Amanda Sammann
- The Better Lab and Department of Surgery, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Payam Nahid
- Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Robert Belknap
- Denver Health and Hospital Authority and Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, Colorado, United States of America
| | - Moses R. Kamya
- Makerere University, Department of Medicine, College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Margaret A. Handley
- Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Patrick PJ Phillips
- Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Anne Katahoire
- Child Health and Development Center, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Christopher A. Berger
- Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Achilles Katamba
- Clinical Epidemiology & Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
| | - David W. Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Adithya Cattamanchi
- Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, California, United States of America
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Rehal S, Cro S, Phillips PPJ, Fielding K, Carpenter JR. Handling intercurrent events and missing data in non-inferiority trials using the estimand framework: A tuberculosis case study. Clin Trials 2023; 20:497-506. [PMID: 37277978 PMCID: PMC10504812 DOI: 10.1177/17407745231176773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The ICH E9 addendum outlining the estimand framework for clinical trials was published in 2019 but provides limited guidance around how to handle intercurrent events for non-inferiority studies. Once an estimand is defined, it is also unclear how to deal with missing values using principled analyses for non-inferiority studies. METHODS Using a tuberculosis clinical trial as a case study, we propose a primary estimand, and an additional estimand suitable for non-inferiority studies. For estimation, multiple imputation methods that align with the estimands for both primary and sensitivity analysis are proposed. We demonstrate estimation methods using the twofold fully conditional specification multiple imputation algorithm and then extend and use reference-based multiple imputation for a binary outcome to target the relevant estimands, proposing sensitivity analyses under each. We compare the results from using these multiple imputation methods with those from the original study. RESULTS Consistent with the ICH E9 addendum, estimands can be constructed for a non-inferiority trial which improves on the per-protocol/intention-to-treat-type analysis population previously advocated, involving respectively a hypothetical or treatment policy strategy to handle relevant intercurrent events. Results from using the 'twofold' multiple imputation approach to estimate the primary hypothetical estimand, and using reference-based methods for an additional treatment policy estimand, including sensitivity analyses to handle the missing data, were consistent with the original study's reported per-protocol and intention-to-treat analysis in failing to demonstrate non-inferiority. CONCLUSIONS Using carefully constructed estimands and appropriate primary and sensitivity estimators, using all the information available, results in a more principled and statistically rigorous approach to analysis. Doing so provides an accurate interpretation of the estimand.
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Affiliation(s)
| | - Suzie Cro
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Patrick PJ Phillips
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | - James R Carpenter
- London School of Hygiene and Tropical Medicine, London, UK
- Medical Research Council Clinical Trials Unit, University College London, London, UK
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Pham TM, Tweed CD, Carpenter JR, Kahan BC, Nunn AJ, Crook AM, Esmail H, Goodall R, Phillips PPJ, White IR. Rethinking intercurrent events in defining estimands for tuberculosis trials. Clin Trials 2022; 19:522-533. [PMID: 35850542 PMCID: PMC9523802 DOI: 10.1177/17407745221103853] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND/AIMS Tuberculosis remains one of the leading causes of death from an infectious disease globally. Both choices of outcome definitions and approaches to handling events happening post-randomisation can change the treatment effect being estimated, but these are often inconsistently described, thus inhibiting clear interpretation and comparison across trials. METHODS Starting from the ICH E9(R1) addendum's definition of an estimand, we use our experience of conducting large Phase III tuberculosis treatment trials and our understanding of the estimand framework to identify the key decisions regarding how different event types are handled in the primary outcome definition, and the important points that should be considered in making such decisions. A key issue is the handling of intercurrent (i.e. post-randomisation) events (ICEs) which affect interpretation of or preclude measurement of the intended final outcome. We consider common ICEs including treatment changes and treatment extension, poor adherence to randomised treatment, re-infection with a new strain of tuberculosis which is different from the original infection, and death. We use two completed tuberculosis trials (REMoxTB and STREAM Stage 1) as illustrative examples. These trials tested non-inferiority of new tuberculosis treatment regimens versus a control regimen. The primary outcome was a binary composite endpoint, 'favourable' or 'unfavourable', which was constructed from several components. RESULTS We propose the following improvements in handling the above-mentioned ICEs and loss to follow-up (a post-randomisation event that is not in itself an ICE). First, changes to allocated regimens should not necessarily be viewed as an unfavourable outcome; from the patient perspective, the potential harms associated with a change in the regimen should instead be directly quantified. Second, handling poor adherence to randomised treatment using a per-protocol analysis does not necessarily target a clear estimand; instead, it would be desirable to develop ways to estimate the treatment effects more relevant to programmatic settings. Third, re-infection with a new strain of tuberculosis could be handled with different strategies, depending on whether the outcome of interest is the ability to attain culture negativity from infection with any strain of tuberculosis, or specifically the presenting strain of tuberculosis. Fourth, where possible, death could be separated into tuberculosis-related and non-tuberculosis-related and handled using appropriate strategies. Finally, although some losses to follow-up would result in early treatment discontinuation, patients lost to follow-up before the end of the trial should not always be classified as having an unfavourable outcome. Instead, loss to follow-up should be separated from not completing the treatment, which is an ICE and may be considered as an unfavourable outcome. CONCLUSION The estimand framework clarifies many issues in tuberculosis trials but also challenges trialists to justify and improve their outcome definitions. Future trialists should consider all the above points in defining their outcomes.
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Affiliation(s)
| | | | - James R Carpenter
- MRC Clinical Trials Unit at UCL, London, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Patrick PJ Phillips
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
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Nunn AJ, Rusen ID, Van Deun A, Torrea G, Phillips PPJ, Chiang CY, Squire SB, Madan J, Meredith SK. Evaluation of a standardized treatment regimen of anti-tuberculosis drugs for patients with multi-drug-resistant tuberculosis (STREAM): study protocol for a randomized controlled trial. Trials 2014; 15:353. [PMID: 25199531 PMCID: PMC4164715 DOI: 10.1186/1745-6215-15-353] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/28/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In contrast to drug-sensitive tuberculosis, the guidelines for the treatment of multi-drug-resistant tuberculosis (MDR-TB) have a very poor evidence base; current recommendations, based on expert opinion, are that patients should be treated for a minimum of 20 months. A series of cohort studies conducted in Bangladesh identified a nine-month regimen with very promising results. There is a need to evaluate this regimen in comparison with the currently recommended regimen in a randomized controlled trial in a variety of settings, including patients with HIV-coinfection. METHODS/DESIGN STREAM is a multi-centre randomized trial of non-inferiority design comparing a nine-month regimen to the treatment currently recommended by the World Health Organization in patients with MDR pulmonary TB with no evidence on line probe assay of fluoroquinolone or kanamycin resistance. The nine-month regimen includes clofazimine and high-dose moxifloxacin and can be extended to 11 months in the event of delay in smear conversion. The primary outcome is based on the bacteriological status of the patients at 27 months post-randomization. Based on the assumption that the nine-month regimen will be slightly more effective than the control regimen and, given a 10% margin of non-inferiority, a total of 400 patients are required to be enrolled. Health economics data are being collected on all patients in selected sites. DISCUSSION The results from the study in Bangladesh and cohorts in progress elsewhere are encouraging, but for this regimen to be recommended more widely than in a research setting, robust evidence is needed from a randomized clinical trial. Results from the STREAM trial together with data from ongoing cohorts should provide the evidence necessary to revise current recommendations for the treatment for MDR-TB. TRIAL REGISTRATION This trial was registered with clincaltrials.gov (registration number: ISRCTN78372190) on 14 October 2010.
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Affiliation(s)
- Andrew J Nunn
- />Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH UK
| | - ID Rusen
- />International Union Against Tuberculosis and Lung Disease, 68, bd Saint-Michel, 75006 Paris, France
| | - Armand Van Deun
- />International Union Against Tuberculosis and Lung Disease, 68, bd Saint-Michel, 75006 Paris, France
- />Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Gabriela Torrea
- />Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Patrick PJ Phillips
- />Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH UK
| | - Chen-Yuan Chiang
- />International Union Against Tuberculosis and Lung Disease, 68, bd Saint-Michel, 75006 Paris, France
- />Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, No 111, Section 3, Hsin-Long Road, Taipei City, 116 Taiwan
| | - S Bertel Squire
- />Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA UK
| | - Jason Madan
- />Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - Sarah K Meredith
- />Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH UK
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Phillips PPJ, Crook A, Nunn AJ. The evolution of and challenges in defining the clinical endpoint in tuberculosis treatment trials with non-inferiority designs. Trials 2011. [PMCID: PMC3287746 DOI: 10.1186/1745-6215-12-s1-a31] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Affiliation(s)
- T X Aufiero
- Department of Surgery, University Hospital, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033, USA
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Abstract
The records of 126 patients with recurrent pleomorphic adenoma of the parotid gland treated at our institution from 1965 to 1985 were retrospectively reviewed. Multiple variables were analyzed to determine tumor behavior and treatment results. Of the study patients, 61% were female and 39% male, with a mean age of 35.6 years at the time of treatment at our institution. The average follow-up period was 14.5 years. Tumor recurrence was 32.5% after one operation at our institution, 7.1% after two operations, and 1.6% after three. Malignant disease occurred in 9 (7.1%) patients. After all surgical procedures, partial facial nerve paralysis was noted in 13.5% and total paralysis in 5.5%. These results suggest low morbidity and good success in tumor eradication with an aggressive surgical approach.
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Affiliation(s)
- P P Phillips
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
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Affiliation(s)
- N C Restrepo
- Department of Surgery (Division of Urology), Milton S. Hershey Medical Center, Pennsylvania State University, Hershey
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Abstract
Using computerized microphotometry, we studied the effects of prostaglandin E2 (PGE2), the prostacyclin analog Iloprost, and the thromboxane A2 analog U46619 on the ciliary beat frequency (CBF) of human nasal mucosa. Thirty-two normal subjects underwent nasal cytologic brushing of the inferior meatus to obtain ciliary samples, and a total of 5,640 ciliated cell clusters were analyzed. Each subject served as their own control. PGE2, 10(-10) to 10(-6) M, produced a significant dose dependent increase in CBF of up to 12% versus control. This increase was not significantly inhibited by the addition of the cyclooxygenase inhibitor indomethacin (10(-6) M). Iloprost, 10(-12) to 10(-6) M, also significantly increased CBF by 12.7% at 10(-8) M. This ciliostimulatory effect, however, was abolished by indomethacin. The thromboxane A2 analog, 10(-10) to 10(-6) M, did not significantly effect CBF. The present study demonstrates that a thromboxane A2 analog has no effect on ciliary motility, PGE2 has a direct ciliostimulatory effect, and a prostacyclin analog has a ciliostimulatory effect likely mediated by stimulation of the cyclooxygenase pathway within human cells.
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Affiliation(s)
- S R Bonin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
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Phillips PP, McCaffrey TV, Kern EB. Third place--Resident Clinical Science Award 1990. The in vivo and in vitro effect of phenylephrine (Neo Synephrine) on nasal ciliary beat frequency and mucociliary transport. Otolaryngol Head Neck Surg 1990; 103:558-65. [PMID: 2123313 DOI: 10.1177/019459989010300406] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Twenty volunteers with normal noses were studied to determine the effect of phenylephrine on nasal ciliary function. In vivo study of this drug was performed in 15 patients and revealed a significant increase in their ciliary beat frequency from a control of 11 Hz to 12.03 Hz (p = 0.001). Mucociliary transit times in these volunteers were also studied, revealing a mean of 9.9 minutes prestimulation and 10.2 minutes poststimulation, which was not statistically significant (p = 0.77). Five additional subjects donated ciliated mucosal samples for in vitro analysis of varying concentrations of this agent that showed a significant ciliostimulatory effect at lower concentrations (0.01%), with a progressive cilioinhibitory effect at higher concentrations (0.25%, 0.5%). The 0.05% concentration showed no significant change in ciliary activity compared to control measurements. These data demonstrate that phenylephrine has a ciliostimulatory effect in vivo, as well as in appropriate concentrations in vitro, and should be safe and relatively nontoxic to the mucociliary apparatus for short-term use.
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Affiliation(s)
- P P Phillips
- Department of Otolaryngology, Mayo Clinic-Rochester, MN 55901
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Rosborough TK, Bank CH, Cummings MK, Phillips PP, Pierach CA. MRFIT after 10.5 years. JAMA 1990; 264:1534-5. [PMID: 2395192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
A new computerized technique for the assessment of human nasal ciliary beat frequency is described. Thirty normal volunteers underwent nasal cytologic brushing to obtain ciliary samples. In each subject, 150 ciliary beats were analyzed from each of 50 separate ciliated cell clusters. The ciliary beat frequency for each area was determined with fast Fourier transformation. The results were plotted on a histogram to determine the ciliary beat distribution. The mean frequency for these samples was 11.29 Hz, with a standard deviation of 0.96 Hz. The median frequency for these samples was 11.25 Hz. These results show a marked improvement over hand-counting microphotometry techniques because of the much larger sampling size and elimination of much human error. We believe this method of ciliary analysis represents a significant advancement in the evaluation of ciliary function and should assist in the diagnosis of patients with congenital and acquired forms of ciliary dysmotility.
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Affiliation(s)
- P P Phillips
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN 55905
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Phillips PP, Gustafson RO, Facer GW. The clinical behavior of inverting papilloma of the nose and paranasal sinuses: report of 112 cases and review of the literature. Laryngoscope 1990; 100:463-9. [PMID: 2184302 DOI: 10.1288/00005537-199005000-00004] [Citation(s) in RCA: 156] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Between 1944 and 1987, 112 patients with inverting papilloma of the nasal cavity were treated. The average duration of follow-up for this population was 6.2 years. The most common symptoms were nasal obstruction and history of previous surgery for nasal "polyps". Recurrence rates were lower when treatment consisted of lateral rhinotomy with medial maxillectomy (14%) vs. transnasal operation with a sinus procedure (35%) or transnasal operation alone (58%). Recurrence rates between men and women were not significantly different when treatment methods were analyzed; however, a higher-than-expected association with tobacco usage was noted. Eight (7%) of the 112 patients had associated nasal carcinoma. Current treatment is lateral rhinotomy with medial maxillectomy to prevent troublesome and potentially malignant recurrent disease.
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Affiliation(s)
- P P Phillips
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minn. 55905
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Phillips PP, Halpin G. Language impairment evaluation in aphasic patients: developing more efficient measures. Arch Phys Med Rehabil 1978; 59:327-30. [PMID: 687041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Two short forms of the Porch Index of Communicative Ability (PICA) were derived using data from 50 adult aphasic patients. Subtest, modality and overall intercorrelations, internal consistency reliability estimates, means and standard deviations were computed for both forms and full-length test. Results indicate that the short forms are equivalent. Further, they seem to be measuring the same traits as the long form, have only slightly lower reliability, and have practically identical means and standard deviations across all subtest, modality and overall scores.
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