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Baumbour J, Nyirigira G, Wilson R, Nsabiyumva W, Parlow J, Johnson AP, Egan R. A collaboration to improve perioperative acute pain care at the University Teaching Hospital of Butare, Rwanda. rmj 2022. [DOI: 10.4314/rmj.v79i3.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND: A perioperative acute pain care program integrating standardized assessment and treatment forms into pain care was developed and implemented at an urban hospital in Rwanda through a collaboration between Rwandan and Canadian experts. This study evaluated the perioperative acute pain care program using a quality improvement lens.
METHODS: Using the Model for Improvement: Plan, Do, Study, Act (PDSA) cycle, a mixed methods evaluation was performed. Over one year, 519 randomized patient chart audits were conducted and analyzed through control charts. Through purposeful sampling, focus groups comprised ofsurgeons and nurses (N=34) involved in pain care in surgery, obstetrics, and anesthesiology were performed and analyzed via thematic coding.
RESULTS: The average attempted form completion rate across all forms varied monthly between 56-93% (mean=79%; median=81%). Across all forms, both the mean and median total number of errors per form were 12.5. Enablers of form use included improved pain care for patients and feelings of professional satisfaction. Program implementation was challenged by resource constraints, form integration, and health care provider training.
CONCLUSION: Future quality improvement collaborations should identify and address improved pain care while working with local experts to ensure PDSA cycles are continuous, and evidence based.
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Wallace J, Soanes K, Roberts S, Moss L, Scott-Coombes D, Egan R. 917 Metaplastic Thymic Sarcoma of The Thyroid: A Case Report and A Review of The Literature. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.340] [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]
Abstract
Abstract
In this paper, the authors present a case diagnosed as ‘metaplastic thymic sarcoma’. Tumours of the thymus are extremely rare: there is a disparity in terminology and histology observed, although there have been efforts to make classification clearer. The reported case concerns a seventy-eight-year-old woman, who presented with a rapidly enlarging neck mass. Histological diagnosis was made challenging by the unusual characteristics of the tumour; the diagnosis of ‘metaplastic thymic sarcoma’ was eventually established, following consultation with an internationally renowned soft tissue pathologist. Review of the relevant literature demonstrated no comparable cases; the presentation of a thymic tumour within the thyroid is also considered unusual. The tumour observed did not conform to any previously sub type of thymic tumour and is therefore believed to be a distinct entity. The patient suffered aggressive recurrence of the disease shortly after her surgery. Genetic testing indicated the tumour was BRAF positive, and there was a dramatic clinical response to Dabrafenib/ Trametinib treatment. The successful use of immunotherapy is encouraging finding, however the diagnosis of another distinct sub type of thymic tumour, further demonstrates the diagnostic and therapeutic challenges presented by this rare and heterogenous group.
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Affiliation(s)
- J Wallace
- Morriston Hospital, Swansea, United Kingdom
| | - K Soanes
- Morriston Hospital, Swansea, United Kingdom
| | - S Roberts
- Singleton Hospital, Swansea, United Kingdom
| | - L Moss
- Velindre Cancer Centre, Cardiff, United Kingdom
| | | | - R Egan
- Morriston Hospital, Swansea, United Kingdom
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Smith A, Egan R, Boyle MA, McElligott F. The Use of Caffeine for Apnoea Associated with Trisomy 13 and Trisomy 18. Ir Med J 2021; 114:429. [PMID: 35863070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- A Smith
- Department of Neonatology, The Rotunda Hospital, Dublin
| | - R Egan
- Department of Neonatology, The Rotunda Hospital, Dublin
| | - M A Boyle
- Department of Neonatology, The Rotunda Hospital, Dublin
| | - F McElligott
- Department of Neonatology, The Rotunda Hospital, Dublin
- Department of Palliative Care, Children's Health Ireland at Temple Street, Dublin
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Egan R, Smith A, McElligott F. Palliative Care Within Neonatology. Ir Med J 2020; 113:137. [PMID: 35603433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- R Egan
- Department of Neonatology, The Rotunda Hospital, Dublin
| | - A Smith
- Department of Neonatology, The Rotunda Hospital, Dublin
| | - F McElligott
- Department of Neonatology, The Rotunda Hospital, Dublin
- Department of Palliative Care, Children's Health Ireland at Temple Street, Dublin
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Robinson DBT, Powell AGMT, Hopkins L, James OP, Abdelrahman T, Egan R, Lewis WG. Proof of surgical publication prowess: prospective observational study of factors associated with surrogate markers of academic reach. BJS Open 2020; 4:724-729. [PMID: 32490575 PMCID: PMC7397360 DOI: 10.1002/bjs5.50307] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/05/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In the UK, general surgery higher surgical trainees (HSTs) must publish at least three peer-reviewed scientific articles (as first, second or corresponding author) to qualify for certification of completion of training (CCT). This study aimed to identify the factors associated with success in this arena. METHODS Deanery rosters supplemented with data from the Intercollegiate Surgical Curriculum Programme, PubMed and ResearchGate were used to identify the profiles of consecutive HSTs. Primary outcomes were publication numbers at defined points in higher training (speciality training year (ST) 3-8); secondary outcomes were the Hirsch index and ResearchGate scores. RESULTS Fifty-nine consecutive HSTs (24 women, 35 men) were studied. The median publication number was 3 (range 0-30). At least three published articles were obtained by 30 HSTs (51 per cent), with 19 (38 per cent) of 50 HSTs achieving this by ST4 (of whom 15 (79 per cent) had undertaken out of programme for research (OOPR) time) and 24 (80 per cent) by ST6. Thirteen HSTs (22 per cent) (ST3, 6; ST4, 4; ST5, 2; ST8, 1) had yet to publish at the time of writing. OOPR was associated with achieving three publications (24 of 35 (69 per cent) versus 6 of 24 (25 per cent) with no formal research time; P = 0·001), higher overall number of publications (median 6 versus 1 respectively; P < 0·001), higher ResearchGate score (median 23·37 versus 5·27; P < 0·001) and higher Hirsch index (median 3 versus 1; P < 0·001). In multivariable analysis, training grade (odds ratio (OR) 1·89, 95 per cent c.i. 0·01 to 3·52; P = 0·045) and OOPR (OR 6·55, 2·04 to 21·04; P = 0·002) were associated with achieving three publications. CONCLUSION If CCT credentials are to include publication profiles, HST programmes should incorporate research training in workforce planning.
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Affiliation(s)
- D B T Robinson
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - L Hopkins
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - O P James
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - T Abdelrahman
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - R Egan
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - W G Lewis
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
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Linford G, Egan R, Coderre-Ball A, Dalgarno N, Stone CJL, Robinson A, Robinson D, Wakeham S, Digby GC. Patient and physician perceptions of lung cancer care in a multidisciplinary clinic model. ACTA ACUST UNITED AC 2020; 27:e9-e19. [PMID: 32218663 DOI: 10.3747/co.27.5499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Lung cancer (lc) is a complex disease requiring coordination of multiple health care professionals. A recently implemented lc multidisciplinary clinic (mdc) at Kingston Health Sciences Centre, an academic tertiary care hospital, improved timeliness of oncology assessment and treatment. This study describes patient, caregiver, and physician experiences in the mdc. Methods We qualitatively studied patient, caregiver, and physician experiences in a traditional siloed care model and in the mdc model. We used purposive sampling to conduct semi-structured interviews with patients and caregivers who received care in one of the models and with physicians who worked in both models. Thematic design by open coding in the ATLAS.ti software application (ATLAS.ti Scientific Software Development, Berlin, Germany) was used to analyze the data. Results Participation by 6 of 72 identified patients from the traditional model and 6 of 40 identified patients from the mdc model was obtained. Of 9 physicians who provided care in both models, 8 were interviewed (2 respirologists, 2 medical oncologists, 4 radiation oncologists). Four themes emerged: communication and collaboration, efficiency, quality of care, and effect on patient outcomes. Patients in both models had positive impressions of their care. Patients in the mdc frequently reported convenience and a positive effect of family presence at appointments. Physicians reported that the mdc improved communication and collegiality, clinic efficiency, patient outcomes and satisfaction, and consistency of information provided to patients. Physicians identified lack of clinic space as an area for mdc improvement. Conclusions This qualitative study found that a lc mdc facilitated patient communication and physician collaboration, improved quality of care, and had a perceived positive effect on patient outcomes.
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Affiliation(s)
- G Linford
- Department of Oncology, Cancer Centre of Southeastern Ontario
| | - R Egan
- School of Nursing, Queen's University
| | - A Coderre-Ball
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University
| | - N Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University
| | - C J L Stone
- Department of Medicine, Kingston Health Sciences Centre
| | - A Robinson
- Department of Oncology, Cancer Centre of Southeastern Ontario
| | | | - S Wakeham
- School of Medicine, Queen's University
| | - G C Digby
- Department of Oncology, Cancer Centre of Southeastern Ontario.,Department of Medicine, Kingston Health Sciences Centre.,Division of Respirology, Kingston Health Sciences Centre, Queen's University, Kingston, ON
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Dwamena S, Patel N, Egan R, Stechman M, Scott-Coombes D. Impact of the change from the seventh to eighth edition of the AJCC TNM classification of malignant tumours and comparison with the MACIS prognostic scoring system in non-medullary thyroid cancer. BJS Open 2019; 3:623-628. [PMID: 31592514 PMCID: PMC6773661 DOI: 10.1002/bjs5.50182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/23/2018] [Accepted: 04/11/2019] [Indexed: 12/11/2022] Open
Abstract
Background In 2018, AJCC TNM staging changed for differentiated (DTC) and anaplastic (ATC) thyroid carcinoma. The impact of this change on mortality rates was investigated and compared with the MACIS prognostic score. Methods Analysis of a prospective database of DTC/ATC was undertaken. Patients were staged according to TNM7 and TNM8 criteria, and MACIS scores calculated. Five‐year disease‐specific mortality rates were determined. Proportions were compared with Fisher's exact and χ2 goodness‐of‐fit tests. Results Between August 2002 and December 2016, 310 patients had primary surgery for thyroid cancer. After exclusions, 159 patients (154 DTC, 5 ATC) remained to be studied. The MACIS score was less than 6 in 105 patients (66·0 per cent), 6–6·99 in 19 (11·9 per cent), 7–7·99 in 14 (8·8 per cent) and 8 or more in 21 (13·2 per cent), with corresponding disease‐specific 5‐year mortality rates of 0, 5, 14 and 86 per cent. For TNM7 the distribution was stage I in 53·5 per cent (85 patients), stage II in 10·1 per cent (16), stage III in 14·5 per cent (23) and stage IV in 22·0 per cent (35), and differed from that for TNM8: 76·7 per cent (122), 10·7 per cent (17), 4·4 per cent (7) and 8·2 per cent (13) respectively (P < 0·001). Overall disease‐specific 5‐year mortality rates by stage for TNM7 versus TNM8 were: stage I, 0 of 85 versus 3 of 100 (P = 0·251); stage II, 0 of 16 versus 6 of 16 (P = 0·018); stage III, 3 of 23 versus 2 of 7 (P = 0·565); stage IV, 20 of 32 versus 11 of 11 (P = 0·020). Conclusion Compared with TNM7, TNM8 downstaged more patients to stage I and accurately reflected worse prognosis for stage IV disease. TNM8 is an inferior predictor of mortality compared with MACIS.
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Affiliation(s)
- S Dwamena
- Department of Endocrine Surgery University Hospital of Wales Heath Park Cardiff CF14 4XW UK
| | - N Patel
- Department of Endocrine Surgery University Hospital of Wales Heath Park Cardiff CF14 4XW UK
| | - R Egan
- Department of Endocrine Surgery University Hospital of Wales Heath Park Cardiff CF14 4XW UK
| | - M Stechman
- Department of Endocrine Surgery University Hospital of Wales Heath Park Cardiff CF14 4XW UK
| | - D Scott-Coombes
- Department of Endocrine Surgery University Hospital of Wales Heath Park Cardiff CF14 4XW UK
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9
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Jones HG, Qasem E, Dilaver N, Egan R, Bodger O, Kokelaar R, Evans MD, Davies M, Beynon J, Harris D. Inflammatory cell ratios predict major septic complications following rectal cancer surgery. Int J Colorectal Dis 2018; 33:857-862. [PMID: 29705942 DOI: 10.1007/s00384-018-3061-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Accepted: 04/19/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The inflammatory response is known to have an important role in tumourigenesis and the response to treatment. Previous studies have demonstrated that inflammatory cell ratios such as the neutrophil-to-lymphocyte ratio (NLR) can predict survival and recurrence following surgery for various cancers. The objective of this study was to demonstrate if pre-operative NLR has a role in predicting post-operative septic complications in patients undergoing rectal cancer surgery. METHODOLOGY Consecutive patients undergoing scheduled resection for rectal cancer in a tertiary centre from July 2007 to Dec 2015 were included. Data was gathered from a prospectively held database of rectal cancer. Normally distributed data were compared with paired t tests (mean ± standard error in the mean (SEM)), and proportions were compared with Fisher's exact test. A p value of < 0.05 was considered statistically significant. RESULTS Three hundred fourteen patients were identified in this study. Sixty nine (22.0%) patients had a major septic complication following surgery for rectal cancer, which was associated with a poor survival outcome (p < 0.01) Both pre and post-operative NLR and PLR (platelet lymphocyte ratio) were associated with post-operative septic complications (both p < 0.01). A pre-operative NLR threshold level of 4 was chosen from ROC analysis, and this provided a relatively specific test to predict post-operative septic complications in these patients (specificity = 83.7%, negative predictive value (NPV) = 74.8%). DISCUSSION In this study, the pre-operative NLR and PLR were both predictive of major post-operative septic complications. A pre-operative NLR of less than 4 was strongly negative predictor of post-operative complications in rectal cancer surgery. It can be regarded as a predictive and prognostic factor for these patients.
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Affiliation(s)
- H G Jones
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK.
| | - E Qasem
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - N Dilaver
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - R Egan
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - O Bodger
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - R Kokelaar
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - M D Evans
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - M Davies
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - J Beynon
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - D Harris
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
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Yousuf H, Aleem U, Egan R, Maheshwari P, Mohamad J, McNamara D. Elevated Faecal Calprotectin Levels are a Reliable Non-Invasive Screening Tool for Small Bowel Crohn's Disease in Patients Undergoing Capsule Endoscopy. Dig Dis 2018; 36:202-208. [PMID: 29466790 DOI: 10.1159/000485375] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Approximately 10% of Crohn's disease (CD) patients have this disease affecting the small bowel (SB) beyond the reach of Ileo-colonoscopy. Capsule endoscopy (SBCE) is the recommended investigation for SB disease. An accurate and inexpensive biomarker would help identify at-risk patients. AIM To examine the efficacy of faecal calprotectin (FC) and C-reactive protein (CRP) as predictors of SBCE findings in suspected and known CD. METHODS A prospective observational study. Consecutive patients referred for SBCE gave FC and CRP samples. The diagnostic accuracy for SB CD based on SBCE result was calculated for both FC and CRP. RESULTS Of 100 invitees, FC and SBCE results were available in 64 cases. Correlation between FC >50 µg/g and SBCE result was poor К = 0.163; sensitivity, specificity, positive predictive value (PPV) and negative predictive values for ileitis were 60, 61, 32 and 83% respectively. PPV and specificity improved at FC >100 µg/g, 76 and 40%, correlation remained fair, К = 0.259. Receiver operating characteristic analysis had a sensitivity of 47% and specificity of 90% for FC >194 µg/g. CRP alone or in combination was an inaccurate predictor of ileitis. CONCLUSION Our study suggests that FC level >194 µg/g may be a useful SBCE filter test, identifying patients at risk of SB CD.
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Affiliation(s)
- Hamid Yousuf
- Department of Gastroenterology, Tallaght Hospital, Dublin, Ireland
| | - Umair Aleem
- Department of Gastroenterology, Tallaght Hospital, Dublin, Ireland
| | - Roisin Egan
- Department of Gastroenterology, Tallaght Hospital, Dublin, Ireland
| | | | - Jafaar Mohamad
- Department of Gastroenterology, Tallaght Hospital, Dublin, Ireland
| | - Deidre McNamara
- Department of Gastroenterology, Tallaght Hospital, Dublin, Ireland.,Trinity Academic Gastroenterology Group, Department of Clinical Medicine, Trinity College, Dublin, Ireland
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Dilaver N, Ansell J, Brown C, Egan R, Leaman C, Arunachalam S, Williamson J, Turner J. Does the use of Local Anaesthetic (LA) Spray Combined With IV Sedation for Diagnostic OGD (Oesophagogastroduodenoscopy) Affect 8-Day Re-Admission and 30-Day Mortality? Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Anwer S, Egan R, Cross N, Guru Naidu S, Somasekar K. Management of choledocholithiasis after previous gastrectomy. Ann R Coll Surg Engl 2017; 99:e213-e215. [PMID: 28853602 DOI: 10.1308/rcsann.2017.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Common bile duct stones in patients with a previous gastrectomy can be a technical challenge because of the altered anatomy. This paper presents the successful management of two such patients using non-traditional techniques as conventional endoscopic retrograde cholangiopancreatography was not possible.
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Affiliation(s)
- S Anwer
- Aneurin Bevan University Health Board , UK
| | - R Egan
- Cardiff and Vale University Health Board , UK
| | - N Cross
- Aneurin Bevan University Health Board , UK
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Richards R, McNoe B, Iosua E, Reeder AI, Egan R, Marsh L, Robertson L, Maclennan B, Dawson A, Quigg R, Petersen AC. Changes in awareness of cancer risk factors among adult New Zealanders (CAANZ): 2001 to 2015. Health Educ Res 2017; 32:153-162. [PMID: 28334909 DOI: 10.1093/her/cyx036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 02/06/2017] [Indexed: 05/21/2023]
Abstract
Behaviour change, specifically that which decreases cancer risk, is an essential element of cancer control. Little information is available about how awareness of risk factors may be changing over time. This study describes the awareness of cancer risk behaviours among adult New Zealanders in two cross-sectional studies conducted in 2001 and 2014/5.Telephone interviews were conducted in 2001 (n = 436) and 2014/5 (n = 1064). Participants were asked to recall things they can do to reduce their risk of cancer. They were then presented with a list of potential risk behaviours and asked if these could increase or decrease cancer risk.Most New Zealand adults could identify at least one action they could take to reduce their risk of cancer. However, when asked to provide specific examples, less than a third (in the 2014/5 sample) recalled key cancer risk reduction behaviours such as adequate sun protection, physical activity, healthy weight, limiting alcohol and a diet high in fruit. There had been some promising changes since the 2001 survey, however, with significant increases in awareness that adequate sun protection, avoiding sunbeds/solaria, healthy weight, limiting red meat and alcohol, and diets high in fruit and vegetables decrease the risk of developing cancer.
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Affiliation(s)
- R Richards
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - B McNoe
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - E Iosua
- Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - A I Reeder
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - R Egan
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - L Marsh
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - L Robertson
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - B Maclennan
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - A Dawson
- Kohatu - Centre for Hauora Maori, Division of Health Sciences, University of Otago, PO Box 56, Dunedin 9016, New Zealand
| | - R Quigg
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
| | - A-C Petersen
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine
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Egan R, Philippe M, Wera L, Fagnard JF, Vanderheyden B, Dennis A, Shi Y, Cardwell DA, Vanderbemden P. A flux extraction device to measure the magnetic moment of large samples; application to bulk superconductors. Rev Sci Instrum 2015; 86:025107. [PMID: 25725888 DOI: 10.1063/1.4907903] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report the design and construction of a flux extraction device to measure the DC magnetic moment of large samples (i.e., several cm(3)) at cryogenic temperature. The signal is constructed by integrating the electromotive force generated by two coils wound in series-opposition that move around the sample. We show that an octupole expansion of the magnetic vector potential can be used conveniently to treat near-field effects for this geometrical configuration. The resulting expansion is tested for the case of a large, permanently magnetized, type-II superconducting sample. The dimensions of the sensing coils are determined in such a way that the measurement is influenced by the dipole magnetic moment of the sample and not by moments of higher order, within user-determined upper bounds. The device, which is able to measure magnetic moments in excess of 1 A m(2) (1000 emu), is validated by (i) a direct calibration experiment using a small coil driven by a known current and (ii) by comparison with the results of numerical calculations obtained previously using a flux measurement technique. The sensitivity of the device is demonstrated by the measurement of flux-creep relaxation of the magnetization in a large bulk superconductor sample at liquid nitrogen temperature (77 K).
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Affiliation(s)
- R Egan
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - M Philippe
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - L Wera
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - J F Fagnard
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - B Vanderheyden
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
| | - A Dennis
- Bulk Superconductivity Group, Engineering Department, Cambridge University, Cambridge CB2 1PZ, United Kingdom
| | - Y Shi
- Bulk Superconductivity Group, Engineering Department, Cambridge University, Cambridge CB2 1PZ, United Kingdom
| | - D A Cardwell
- Bulk Superconductivity Group, Engineering Department, Cambridge University, Cambridge CB2 1PZ, United Kingdom
| | - P Vanderbemden
- SUPRATECS and Department of Electrical Engineering and Computer Science B28, Sart-Tilman, B-4000 Liège, Belgium
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15
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Harris H, Egan R, Gupta A, Minshew N, Bonneh Y, Heeger DJ, Sagi D, Behrmann M. Over-specific perceptual learning in ASD. J Vis 2014. [DOI: 10.1167/14.10.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
BACKGROUND Recent reports indicate that there is a trend toward the use of models and simulators to teach basic orthopaedic operative skills. We describe a high-fidelity model for teaching basic orthopaedic fracture manipulation. METHODS A model of a distal radial fracture was developed and validated by orthopaedic surgeons with different levels of experience, who examined and manipulated the model and then completed a structured questionnaire. RESULTS The participants mostly agreed (designated as 4 in the questionnaire) that the model performed well on the degree to which the manipulation represented real life. The participants agreed (designated as 5 in the questionnaire) that the model scored high on the appearance and feel of the fracture and its ability to be used as a teaching tool. There was no difference between perceptions of participants with regard to different levels of occupational experience or model use. CONCLUSIONS We believe that this model could be used to teach the skill of closed reduction of a distal radial fracture in the preclinical setting.
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Affiliation(s)
- Ciara Egan
- Department of Trauma and Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland.
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17
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Kane J, Jasperse M, Egan R, Pullon S, McBain L, McKinley E. EP-1111: The role of General Practitioners in supportive care of cancer patients after completion of specialist oncology care. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Said C, Egan R, Behrmann M, Heeger D. Normal binocular rivalry in autism. J Vis 2012. [DOI: 10.1167/12.9.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Abstract
Abstract
Background
Parathyroidectomy is the standard treatment for renal hyperparathyroidism although controversy exists about the optimal surgical procedure. Total parathyroidectomy without either autotransplantation or thymectomy is one suggested approach. This study reviewed the medium- to long-term results of this procedure.
Methods
A retrospective review was undertaken of patients undergoing total parathyroidectomy between August 2000 and March 2009. The procedure was performed by a single surgeon and median follow-up was 31 (range 1–120) months.
Results
Data were obtained on 115 patients with no re-explorations for bleeding or clinical recurrent laryngeal nerve injuries. The rate of postoperative hypocalcaemia on the day after surgery was 15·7 per cent. Thirty-three patients (28·7 per cent) had an undetectable parathyroid hormone level at the end of follow-up. Fourteen patients (12·2 per cent) developed recurrent hyperparathyroidism with a median parathyroid hormone level of 35·4 (range 5·4–200·0) pmol/l. The reoperation rate was 3·5 per cent. Thymectomy tissue, taken if all four glands could not be identified, revealed no parathyroid glands.
Conclusion
Total parathyroidectomy alone has minimal associated morbidity or mortality, and a good medium- to long-term clinical outcome with a low recurrence rate.
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Affiliation(s)
- J E Coulston
- Department of Endocrine Surgery, North Bristol NHS Trust, Bristol BS10 5NS, UK
| | - R Egan
- Department of Endocrine Surgery, North Bristol NHS Trust, Bristol BS10 5NS, UK
| | - E Willis
- Department of Endocrine Surgery, North Bristol NHS Trust, Bristol BS10 5NS, UK
| | - J D Morgan
- Department of Endocrine Surgery, North Bristol NHS Trust, Bristol BS10 5NS, UK
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20
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Hickman S, Kupersmith M, Straga J, Egan R, Kraker R, Lefton D, Miszkiel K, Miller D, Plant G. Upper temporal visual field depressions in the fellow eye in posterior acute optic neuritis: ‘knee’ or no ‘knee’, Wilbrand’s concept remains clinically significant. Neuroophthalmology 2009. [DOI: 10.1076/noph.28.2.69.23738] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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21
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Moratz CM, Egan R, Zacharia A, Simovic M, Gist I, Dalle Lucca J, Tsokos GC. Delineation of hypoxia versus inflammatory contributions to tissue injury by attenuation of G-alpha-i signaling (93.7). The Journal of Immunology 2009. [DOI: 10.4049/jimmunol.182.supp.93.7] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
The complement dependent pathology resulting from mesenteric ischemia/reperfusion insult instigates tissue injury in mesenteric and systemic organs. In this study the contribution of G-protein receptor signaling through G[alpha]i to stages of tissue injury is delineated. Global G[alpha]i inhibition, by PTX, attenuated mesenteric injury and production of lipid modulators such as leukotriene B4. Systemic inflammation was inhibited as assessed by lung tissue injury scores and monitoring cellular infiltrates. To delineate the role of G[alpha]i signaling in mesenteric versus systemic inflammatory responses, an inhibitor of pulmonary inflammatory chemotactic G[alpha]i signaling, anti-CXCR2 was used. As expected PTX and anti-CXCR2, abrogated pulmonary inflammation. In contrast, anti-CXCR2 was not effective in mitigating mesenteric injury. The results from global versus specific G[alpha]i inhibition in local and systemic injury indicate multiple mechanisms by which G[alpha]i signaling facilitate tissue injury. The G[alpha]i linked signaling effects of complement activation and chemokine induced migratory control are distinct and can be mitigated independently. Delineating which signals govern particular components of tissue injury will be useful in developing therapeutics which can control specific deleterious aspects of systemic inflammation after trauma while maintaining the protective aspects of complement activation.
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Affiliation(s)
- Chantal M Moratz
- 1CI/MCR, Walter Reed Army Institute of Research, Sliver Spring, MD
| | - R Egan
- 2APG, Uniform Services University of the Health Sciences, Bethesda, MD
| | - A Zacharia
- 2APG, Uniform Services University of the Health Sciences, Bethesda, MD
- 2APG, Uniform Services University of the Health Sciences, Bethesda, MD
| | - M Simovic
- 1CI/MCR, Walter Reed Army Institute of Research, Sliver Spring, MD
| | - I Gist
- 1CI/MCR, Walter Reed Army Institute of Research, Sliver Spring, MD
| | - J Dalle Lucca
- 1CI/MCR, Walter Reed Army Institute of Research, Sliver Spring, MD
| | - G C Tsokos
- 3Rheumatology Division, Harvard Medical School, Boston, MA
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22
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List MA, Haraf D, Egan R, Bilir P, Stenson K, Karrison T, Vokes EE. The impact of induction chemotherapy on subsequent concurrent chemoradiotherapy (CRT) related side effects, function & quality of life (QOL) in head and neck cancer (HNC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5537] [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: 11/20/2022] Open
Affiliation(s)
| | - D. Haraf
- University of Chicago, Chicago, IL
| | - R. Egan
- University of Chicago, Chicago, IL
| | - P. Bilir
- University of Chicago, Chicago, IL
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Grosskreutz C, Egan R, Scigliano E, Fruchtman S, Isola L. Thalidomide maintenance after autologous stem cell transplantation for multiple myeloma. Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2003.12.092] [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: 10/26/2022]
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Abstract
PURPOSE To report an association of posterior subcapsular cataract with Degos disease. METHOD Case report of a 42-year-old man. RESULTS A posterior subcapsular cataract developed in the patient's left eye at age 43 years, 1 year before his death. The diagnosis of Degos disease was confirmed pathologically by skin biopsy and at necropsy. CONCLUSION Posterior subcapsular cataract may be associated with Degos disease in addition to previously reported findings, including visual field defects, third cranial nerve palsies, blepharoptosis, and optic atrophy.
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Affiliation(s)
- R Egan
- Neuro-ophthalmology Unit, Casey Eye Institute, Portland, Oregon, USA
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26
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Egan R, Pomeranz H. Sildenafil (Viagra) associated anterior ischemic optic neuropathy. Arch Ophthalmol 2000; 118:291-2. [PMID: 10676804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- R Egan
- Casey Eye Institute, Portland, OR 97201, USA.
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Abstract
Visual dysfunction, including visual loss and diplopia, may occur in association with ocular surgery. Strabismus may be the most common abnormal eye movement seen as a complication of local anesthesia. Local anesthesia also may cause direct and indirect traumatic optic neuropathy. Vitrectomy is associated with visual-field loss from direct manipulation of the nerve fiber layer during suctioning of the vitreous or by direct compression of intraocular gas. Trabeculectomy may be complicated by visual-field loss. Patients may be at higher risk if their eye is hypotonous after surgery, but the duration or severity of hypotony that places the eye at risk is unknown. The only neuroophthalmic complication directly related to cataract surgery itself is AION. Complications of ONSD include motility disorders, pupillary dysfunction, and vascular compromise. Neuroophthalmic complications are uncommon after blepharoplasty. They include ocular motility disorders, transient pupil dilation, and vision loss.
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Affiliation(s)
- R Egan
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston 02114, USA
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28
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Egan R, Lutsep HL, Clark WM, Quinn J, Kearns K, Lockfeld A, Ireland S, Goins S, Buchholz G. Open label tissue plasminogen activator for stroke: The Oregon experience. J Stroke Cerebrovasc Dis 1999; 8:287-90. [PMID: 17895176 DOI: 10.1016/s1052-3057(99)80001-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/1998] [Accepted: 03/10/1999] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Tissue plasminogen activator (t-PA) is the first effective treatment for stroke. This study sought to explore the outcome of patients treated with t-PA in the community after approval of its use in the treatment of stroke in June, 1996. METHODS All patients with acute stroke within the 6-hospital Oregon Stroke Center network were screened for potential t-PA treatment. Baseline and 24-hour outcome assessments were performed with the use of the National Institutes of Health Stroke Scale (NIHSS) and computed tomography (CT); 3-month outcome was evaluated by using the Modified Rankin scale. RESULTS Thirty-three patients who met the criteria for t-PA therapy were treated within 3 hours of symptom onset. All but 2 strokes were in the anterior circulation; 48.5% were cardioembolic. The NIHSS scores at 24 hours after administration of t-PA (mean, 14.7) showed modest gains from baseline NIHSS scores (mean, 16.6). Twelve patients (36%) had minimal or no deficits at 3 months. Three patients (9%), all of whom had baseline NIHSS scores of 20 or more, had symptomatic intracranial hemorrhages, 2 of which were fatal (6%). CONCLUSION This study shows the feasibility of treating acute stroke with t-PA in the community. The percentage of fully recovered patients at 3 months mirrored those in the National Institute of Neurologic Disorders and Stroke (NINDS) trial.
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29
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Egan R, Clark W, Lutsep H, Nesbit G, Barnwell S, Kellogg J. Efficacy of intraarterial thrombolysis of basilar artery stroke. J Stroke Cerebrovasc Dis 1999; 8:22-7. [PMID: 17895133 DOI: 10.1016/s1052-3057(99)80035-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/1998] [Accepted: 09/16/1998] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Stroke from basilar artery (BA) occlusion is a devastating neurological event with reported mortality rates of up to 90%. This series reports our experience in 15 cases using intraarterial (IA) thrombolysis to treat basilar artery stroke at the Oregon Stroke Center. METHODS Over a 4-year period, consecutive cases of basilar artery stroke were treated with IA urokinase (UK) if they met the following criteria: had a baseline National Institutes of Health Stroke Scale (NIHSS) score greater than 6; symptoms began within 48 hours; had no or minimal early infarct signs on computed tomography (CT) scan; and angiogram confirmed basilar occlusion. Patients were treated with UK infused via a microcatheter directly into the clot. Angiographic efficacy was assessed by a repeat angiogram at the end of infusion and clinical efficacy was determined by NIHSS evaluation at 48 hours and 3 months. RESULTS Fifteen patients, mean age 59 (16 to 78) and baseline NIHSS of 30 (7 to 40), were treated at a mean of 12 hours (4 to 48). An average dose of 500,000 (150,000 to 1,250,000) units of UK was given over 1 to 2 hours. Excellent vessel recanalization occurred in 12 of 15 (80%) patients. All three cases without recanalization died within 48 hours (100%). Of the 12 patients with recanalization, 2 died (16.7%), whereas the 9 of 10 remaining had mild or moderate neurological deficits (mean NIHSS of 5) at 3 months. CONCLUSION IA thrombolysis has the potential to decrease mortality and improve outcome in cases with severe basilar artery stroke even when administered after 6 hours.
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31
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Wong-Riley M, Antuono P, Ho KC, Egan R, Hevner R, Liebl W, Huang Z, Rachel R, Jones J. Cytochrome oxidase in Alzheimer's disease: biochemical, histochemical, and immunohistochemical analyses of the visual and other systems. Vision Res 1997; 37:3593-608. [PMID: 9425533 DOI: 10.1016/s0042-6989(96)00210-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Defects in oxidative metabolism have been implicated in Alzheimer's disease (AD). The present study evaluated the level of cytochrome oxidase (C.O.), an indicator of neuronal oxidative capacity, in various brain regions of post-mortem AD and control patients. We found a statistically significant reduction in C.O. levels in all cortical areas examined, including the primary and secondary visual cortices. In addition, all layers of the dorsal lateral geniculate nucleus and sublaminae of the primary visual cortex in AD cases examined suffered a reduction in their relative C.O. activity and protein amount. Our results suggest a generalized suppression of oxidative metabolism throughout the cortex, as well as in a major subcortical visual center in AD. Such hypometabolism may form the basis for not only deficits in higher cortical functions, but also a variety of visual dysfunctions known to occur in AD.
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Affiliation(s)
- M Wong-Riley
- Department of Cellular Biology and Anatomy, Medical College of Wisconsin, Milwaukee 53226, USA.
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32
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Yang J, Torio A, Donoff RB, Gallagher GT, Egan R, Weller PF, Wong DT. Depletion of eosinophil infiltration by anti-IL-5 monoclonal antibody (TRFK-5) accelerates open skin wound epithelial closure. Am J Pathol 1997; 151:813-9. [PMID: 9284830 PMCID: PMC1857851] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Wound healing is critical to the survival of the species after injury. Using hamsters as an experimental model, we have shown that eosinophils infiltrate prominently into skin wounds and that they express transforming growth factor-alpha and -beta 1 mRNAs and proteins. We hypothesized that eosinophils are important in wound healing. As no animal model is genetically deficient in eosinophils, a suitable way to test the hypothesis is to selectively reduce and/or deplete the influx of eosinophils into the wound sites. In this study, we report that anti-interleukin-5 monoclonal antibody (TRFK-5) treatment can deplete eosinophils in cutaneous healing wounds. We found that wound closure by re-epithelialization in the experimental group was 4 days faster than in the control group (P < 0.01). The density of eosinophils in day-9 wounds was significantly lower in the experimental group (P < 0.01). Wound-associated eosinophils in each of the TRFK-5-treated hamsters were depleted to the level comparable to unwounded hamster skin. These results demonstrate that anti-interleukin-5 monoclonal antibody treatment can effectively decrease eosinophil infiltration into hamster cutaneous healing wounds and indicate a role for eosinophils in negatively affecting wound re-epithelialization.
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Affiliation(s)
- J Yang
- Department of Oral Medicine and Diagnostic Sciences, Harvard School of Dental Medicine, Boston, MA 02115, USA
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33
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Wang T, Walden S, Egan R. Development and validation of a general non-digestive method for the determination of palladium in bulk pharmaceutical chemicals and their synthetic intermediates by graphite furnace atomic absorption spectroscopy. J Pharm Biomed Anal 1997; 15:593-9. [PMID: 9127271 DOI: 10.1016/s0731-7085(96)01886-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A simple, selective, sensitive, accurate and relatively inexpensive method for the determination of palladium in bulk pharmaceutical chemicals (BPC) and their synthetic intermediates by graphite furnace atomic absorption spectroscopy has been developed and validated. Sample preparation by direct dissolution of sample in 70% nitric acid is simple and effective without adverse effects. The limit of detection and the limit of quantitation of the method were determined to be 0.7 ppm and 2 ppm respectively in BPC.
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Affiliation(s)
- T Wang
- Analytical Research Department, Merck Research Laboratories, Rahway, NJ 07065-0900, USA
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34
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Lin CC, Billah M, Kim HK, Egan R, Anthes J, Gilchrest H, Cayen M. Determination of plasma concentrations of SCH 44643 by a GC method and correlation of plasma concentration and anti-PAF activity in cynomolgus monkeys. J Pharm Biomed Anal 1996; 15:343-7. [PMID: 8951694 DOI: 10.1016/s0731-7085(96)01855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Inhibiting the action of platelet-activating factor (PAF) is a new therapeutic approach for the treatment of allergic disorders. SCH 44643 is a new orally-active antagonist of response to both PAF and histamine. This study was done to determine plasma drug concentrations using a GC method and to compare them to ex-vivo anti-PAF activity in the plasma of cynomolgus monkeys following a single oral (12.5 mg kg-1) administration. The GC method involved organic solvent extraction of monkey plasma followed by a GC analysis in a RTX-1 capillary column with a nitrogen/phosphorus detector. The method showed good precision (RSD < 8%) and accuracy (bias < 9%) with a limit of quantitation of 20 ng ml-1. The plasma profiles of SCH 44643 concentration and anti-PAF activity were very similar in each of the six monkeys. There was an excellent correlation (r = 0.9003) between anti-PAF activity and plasma concentration of SCH 44643, suggesting that the anti-PAF activity in cynomolgus monkeys was primarily due to unchanged SCH 44643, rather than its potential metabolite(s).
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Affiliation(s)
- C C Lin
- Department of Drug and Metabolism and Pharmacokinetics, Schering-Plough Research Institute, Kenilworth, NJ 07033, USA
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35
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Egan R. Turning toward data uniformity: how open systems put healthcare in command. Healthc Inform 1993; 10:36-8. [PMID: 10130472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Recent programming and design techniques result in the benefits of flexibility in system selection and reduced system cost. Open systems and the use of relational database managers with structured query languages allow the healthcare industry to set standards in database design, content and access, if it chooses. Such standards would facilitate creation of applications that could be interchangeable among vendors because basic functions remain constant. This interchangeability equates to flexibility in selecting specific applications, which then can be based on the best match of features required or desired, instead of compatibility with a vendor's system. The goal of reduced costs can be achieved since interface programs would not have to be written to integrate other vendors' software.
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Affiliation(s)
- R Egan
- CMS Management Companies, Inc., Livingston, NJ
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36
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Wong-Riley MT, Hevner RF, Cutlan R, Earnest M, Egan R, Frost J, Nguyen T. Cytochrome oxidase in the human visual cortex: distribution in the developing and the adult brain. Vis Neurosci 1993; 10:41-58. [PMID: 8381019 DOI: 10.1017/s0952523800003217] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cytochrome-oxidase (CO) histochemistry has revealed important functional subdivisions, modules, and processing streams in the macaque visual cortex. The present study is aimed at analyzing the development and characteristics of CO patterns in the human visual cortex by means of histochemistry and immunohistochemistry. At 26 weeks of gestation, both the ventricular and subventricular zones had low levels of CO, while the cortical plate had moderate levels of CO. At birth, supragranular CO-rich zones (puffs) were not clearly organized, indicating that the development of puffs in the neonatal striate cortex lags behind that of the macaque monkey, whose puffs appear weeks before birth. Puffs were more clearly discernible in human cortex at postnatal day 24, and became well organized by the fourth postnatal month. Layer IVc alpha in the neonate exhibited a higher level of activity and amount of CO than the central portion of IVc beta, which contained a dense aggregate of small neurons. The base of IVc beta, however, was often as CO reactive as IVc alpha. In contrast, the majority of specimens available to us from the fourth postnatal month and from adults with no known neurological diseases had significantly greater CO reactivity in layer IVc beta than in IVc alpha. Layer VI was moderately reactive for CO throughout development. In V2, stripes with globular zones of high CO activity were sporadically present at birth, suggesting that their development may parallel or precede that of puffs in V1. These stripes with CO-rich globular zones became more prominent in the adult and radiated orthogonally from the V1/V2 border. They were not, however, clearly organized into alternating thick and thin stripes as they are in the squirrel monkey. Visual cortical areas beyond V2 exhibited high CO activity mainly in layers III and IV and moderate levels in VI, suggesting that sites associated with cortico-cortical pathways may be metabolically most active.
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Affiliation(s)
- M T Wong-Riley
- Department of Cellular Biology and Anatomy, Medical College of Wisconsin, Milwaukee 53226
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37
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Celum CL, Coombs RW, Lafferty W, Inui TS, Louie PH, Gates CA, McCreedy BJ, Egan R, Grove T, Alexander S. Indeterminate human immunodeficiency virus type 1 western blots: seroconversion risk, specificity of supplemental tests, and an algorithm for evaluation. J Infect Dis 1991; 164:656-64. [PMID: 1894929 DOI: 10.1093/infdis/164.4.656] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The human immunodeficiency virus type 1 (HIV-1) Western blot is indeterminate in 10%-20% of sera reactive by EIA. Eighty-nine individuals with prior repeatedly reactive EIA and indeterminate Western blots were followed prospectively to study the risk of seroconversion and specificity of supplemental tests. Four high-risk cases seroconverted within 10 months after enrollment (seroconversion risk, 4.5%, 95% confidence interval, 1.2%-11.1%). Among cases with p24 bands initially, 4 (18.2%) of 22 high-risk individuals seroconverted compared with 0 of 33 low-risk cases (P = .03). Specificities of HIV-1 culture, serum p24 antigen, polymerase chain reaction, and recombinant ENV 9 EIA were 100%, 100%, 98.6%, and 94.4%, respectively. An expedited evaluation protocol is proposed. Low-risk individuals with nonreactive EIAs upon repeat testing do not need further follow-up; high-risk individuals should be followed serologically for at least 6 months, especially those with p24 bands on Western blot.
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Affiliation(s)
- C L Celum
- Department of Medicine, University of Washington, Seattle
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Egan R. [The right to a professional education]. Servir 1986; 34:289. [PMID: 3101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Frankl HD, Egan R, Harris F, McCray RS, Panish JF, Schapiro M. Colonoscopy instrumentation. Questions and answers. Gastrointest Endosc 1975; 21:177-80. [PMID: 1140546 DOI: 10.1016/s0016-5107(75)73851-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Egan R. Should the educable mentally retarded receive driver education? Except Child 1967; 33:323. [PMID: 6039243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Jandrof BJ, Michel HO, Schaffer NK, Egan R, Summerson WH. The mechanism of reaction between esterases and phosphorus-containing anti-esterases. ACTA ACUST UNITED AC 1955. [DOI: 10.1039/df9552000134] [Citation(s) in RCA: 81] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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