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Virani S, Leonidou A, Panagopoulos G, Holmes N, Sforza G, Relwani J, Levy O. Management of glenoid bone loss with impaction and structural bone grafting in reverse shoulder arthroplasty. Musculoskelet Surg 2023; 107:239-252. [PMID: 35598252 DOI: 10.1007/s12306-022-00747-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/11/2022] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Glenoid bone loss is a commonly encountered problem in complex primary and revision shoulder arthroplasty. Addressing glenoid bone loss is critical to avoid complications like early loosening, impingement, notching and instability. A large number of techniques like bone grafting using autograft or allograft, eccentric reaming, augmented base plates, patient-specific instrumentations and custom-made implants are available to tackle bone loss. MATERIALS AND METHODS We prospectively collected the data of all patients with glenoid defects undergoing primary or revision reverse shoulder replacement between 2004 and 2017. This included demographic data, ranges of motion, Constant-Murley score and Subjective Shoulder Value (SSV). A pre-operative CT scan was done as well to plan the surgery and calculate the glenoid version. At each follow-up, the clinical function and shoulder scores were assessed. Additionally, the radiographs were assessed for graft incorporation, evidence of lysis and calculation of glenoid version. RESULTS Between 2004 and 2017, 37 patients underwent glenoid bone grafting during reverse shoulder arthroplasty. Average age was 72 years (range 46-88). Indications for surgery were cuff tear arthropathy (6 patients); revision of failed other prosthesis (23); primary osteoarthritis (4); rheumatoid arthritis (3); and second-stage revision for infection (1). The glenoid defect was contained in 24 patients, and therefore, impaction graft with a combination of bone graft substitute and/or humeral head autograft was performed. In 13 patients the glenoid defect was severe and uncontainable and therefore a graft-implant composite glenoid was implanted using humeral head autograft or allograft. Average follow-up was 3.6 years (range 1-10). Mean Constant score improved from 34 before surgery to 63 after surgery. Mean SSV score improved from 0.9/10 to 8.3/10. Active movements improved significantly with forward elevation increasing from 54° to 123°; abduction from 48° to 123°; external rotation from 24° to 38°; internal rotation from 57° to 70°. Radiographs at final follow-up showed no radiolucencies around the glenoid component and no evidence of loosening of the implant. In 2 cases there was a grade I notching. There was 100% survivorship at the last follow-up. CONCLUSION Impaction bone grafting along with structural grafting when required is an effective and reproducible way of managing severe glenoid bone loss. This technique gives consistent and good clinical and radiological results.
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Affiliation(s)
- S Virani
- Reading Shoulder Unit, Reading, UK.
| | | | | | - N Holmes
- East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - G Sforza
- Reading Shoulder Unit, Reading, UK
| | - J Relwani
- East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - O Levy
- Reading Shoulder Unit, Reading, UK
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Ho D, Virani S, Moghaddam N, Hawkins N. ADHERENCE TO GUIDELINE-DIRECTED MEDICAL THERAPY AMONG PATIENTS FOLLOWED AT AN AMBULATORY HEART FUNCTION CLINIC. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Davis M, Starovoytov A, Campbell C, Hawkins N, Virani S, Luong M, Straatman L, Kiess M, Worsley D, Sathananthan J, Fine N. DEVELOPMENT OF A DIAGNOSTIC SCREENING ALGORITHM FOR THE IDENTIFICATION OF TRANSTHYRETIN AMYLOID CARDIOMYOPATHY IN HIGH-RISK PATIENT POPULATIONS. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.108] [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: 11/02/2022] Open
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Lindsay P, Anderson K, Ducharme A, Lee D, McKelvie R, Poon S, Desmarais O, Desbiens M, Virani S. THE STATE OF HEART FAILURE SERVICES IN CANADA: FINDINGS OF THE HEART & STROKE NATIONAL HEART FAILURE RESOURCES AND SERVICES INVENTORY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.153] [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: 11/02/2022] Open
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Shah H, Ayoub M, Nguyen B, Nagavally S, Mohananey D, Sharma A, Virani S, Al-Kindi S, Sinh P. 466 Coronary Artery Plaque Assessment In Inflammatory Bowel Disease. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Zhang C, Virani S, Mayes T, Carmody T, Croarkin PE, Weinshilboum R, Rush AJ, Trivedi M, Athreya AP, Bobo WV. Toward a Definition of "No Meaningful Benefit" From Antidepressant Treatment: An Equipercentile Analysis With Cross-Trial Validation Across Multiple Rating Scales. J Clin Psychiatry 2022; 83. [PMID: 35771974 DOI: 10.4088/jcp.21m14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Many patients with major depressive disorder (MDD) who experience no meaningful benefit (NMB) from antidepressive treatment go undetected. However, there is a lack of consensus on the definition of NMB from antidepressants. Methods: Equipercentile linking was used to identify a threshold for percent change in 17-item Hamilton Depression Rating Scale (HDRS-17) scores that equated with a Clinical Global Impressions-Improvement (CGI-I) score of 3 (minimally improved), a proxy for NMB, after 4 and 8 weeks of citalopram or escitalopram treatment, using data from the Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS). The NMB threshold for the HDRS-17 was validated by equating a CGI-I rating of 3 with percent change values from the clinician- and patient-rated versions of the Quick Inventory of Depressive Symptomatology (QIDS-C and QIDS-SR) using data from PGRN-AMPS and phase 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. This study was conducted between June 2021 and September 2021. Results: In PGRN-AMPS, a 30% improvement in HDRS-17 score corresponded to a CGI-I rating of 3 at 4 and 8 weeks. The 30% improvement threshold was also observed for QIDS-C and QIDS-SR scores in both PGRN-AMPS and STAR*D. Similar results were observed for percent change in HDRS-17 and QIDS-based measures in lower- and higher-severity groups based on a median split of baseline total scores. Conclusions: Improvement in depressive severity of ≤ 30%, as assessed using the HDRS-17, QIDS-C, and QIDS-SR, may validly define NMB from antidepressants during short-term treatment.
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Affiliation(s)
- Carl Zhang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Sanya Virani
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Taryn Mayes
- Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Thomas Carmody
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Richard Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - A John Rush
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Duke University, Durham, North Carolina.,Duke-National University of Singapore, Singapore
| | - Madhukar Trivedi
- Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Arjun P Athreya
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida.,Corresponding author: William V. Bobo, MD, MPH, 4500 San Pablo Rd, Jacksonville, FL 32224
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Abstract
IMPORTANCE Longitudinal associations between comorbid depression and anxiety with the accumulation of chronic illnesses are unclear, and questions remain about the contributions associated with each condition in the increasing prevalence of multimorbidity. OBJECTIVE To compare the risk and rate of accumulating chronic conditions in people with depression, anxiety, and comorbid depression and anxiety vs individuals with neither depression nor anxiety. DESIGN, SETTING, AND PARTICIPANTS This cohort study used the Rochester Epidemiology Project medical records-linkage system to identify residents of Olmsted County, Minnesota, from January 1, 2005, to December 31, 2014, with follow-up ending December 31, 2017. The sample was divided into cohorts anchored at birthday ages of 20, 40, and 60 years. Individuals were classified at anchoring birthday age as having depression alone, anxiety alone, comorbid depression and anxiety, or neither depression nor anxiety (reference group), using electronically extracted diagnosis codes from the International Classification of Diseases, Ninth Revision (ICD-9) in the 5 years before each anchoring birthday. Data were analyzed from August 2020 through November 2021. EXPOSURES Depression alone, anxiety alone, comorbid depression and anxiety, or neither depression nor anxiety (reference group). MAIN OUTCOMES AND MEASURES The main outcome was sex-specific risk, calculated as hazard ratios (HRs) and rates of accumulation, calculated as mean annual incidence rates per 100 person-years, of 15 common chronic conditions within each birthday age cohort through the end of study. RESULTS Among the 40 360 individuals included across all 3 age cohorts, 21 516 (53.3%) were women. After balancing cohorts on race, Hispanic ethnicity, education level, body mass index, smoking status, and calendar year at index birthday, the risk of accumulating chronic conditions was significantly increased among women with depression alone (cohort aged 20 years: HR, 1.20 [95% CI, 1.02-1.42]; cohort aged 40 years: HR, 1.20 [95% CI, 1.10-1.31]; cohort aged 60 years: HR, 1.09 [95% CI, 1.02-1.16]) and women with comorbid depression and anxiety (cohort aged 20 years: HR, 1.60 [95% CI, 1.28-1.99]; cohort aged 40 years: HR, 1.41 [95% CI, 1.21-1.65]; cohort aged 60 years: HR, 1.29 [95% CI, 1.15-1.44]) compared with referent women in the same birthday cohorts and in men with comorbid depression and anxiety compared with referent men in the cohort aged 20 years (HR, 1.77 [95% CI, 1.08-2.91]). For women, the rates of accumulation of conditions were significantly higher across birthday cohorts in the comorbid depression and anxiety group compared with the depression alone group (eg, cohort aged 20 years: difference, 1.2 [95% CI, 0.2-2.1] per 100 person-years) and reference group (eg, cohort aged 20 years: difference, 1.7 [95% CI, 0.9-2.6] per 100 person-years). For men, compared with the reference group, the rates of accumulation of conditions were significantly higher in men with comorbid depression and anxiety in the cohort aged 20 years (difference, 1.4 [95% CI, 0.1-2.6] per 100 person-years) and in men with depression in the cohort aged 40 years (difference, 2.0 [95% CI, 0.8-3.2] per 100 person-years). CONCLUSIONS AND RELEVANCE In this cohort study, the risk of accumulating chronic conditions was increased with depression and comorbid depression and anxiety in women across the age span and in younger men with comorbid depression and anxiety. Compared with women without depression or anxiety, there was a more rapid rate of accumulation of chronic conditions in women with depression and anxiety individually and an even higher rate when depression and anxiety cooccurred.
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Affiliation(s)
- William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic Florida, Jacksonville
| | - Brandon R. Grossardt
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Sanya Virani
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Jennifer L. St Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Cynthia M. Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Walter A. Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Women’s Health Research Center, Mayo Clinic, Rochester, Minnesota
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Virani S, Handuleh JIM, Pereira-Sanchez V, Wolde-Giorgis DF. Teaching psychiatry in a low-income country during the COVID-19 pandemic: A hybrid collaborative psychiatry course. Asia Pac Psychiatry 2021; 13:e12503. [PMID: 34967115 DOI: 10.1111/appy.12503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
Amoud University in Borama is located in the self-declared state of Somaliland, in the Horn of Africa. Past conflicts and resulting economic hardship have led to a lack of local academic psychiatry faculty and resources. Amoud has been for some years partnering with voluntary faculty in the United Kingdom to teach psychiatry to its medical students through in-person "teaching missions." This was recently led by a Borama-native psychiatry resident in Ethiopia. COVID-19 added further hardships due to restrictions to travel and in-person gatherings. These challenges also created the opportunity for the development of an innovative, international, hybrid (online onsite), self-sustaining partnership model which has been successful in improving psychiatry teaching for undergraduate students in 2020-2021 and will continue in 2021-2022. An international, 'online-connected' department of psychiatry comprising a primary care physician in Somaliland, three postgraduate trainees in Ethiopia and the United States, and three senior psychiatrists in the United Kingdom developed a local faculty-led, hybrid-delivered, dynamic curriculum (bedside teaching, in person and online lecturing) that adapted to the needs, resources, faith and culture of Somaliland. While 2020-2021 has been the pilot year for the program, the overall experience has been enriching for students and faculty, leading to valuable cross-cultural conversations with impact on teaching and research. While learning about Somalilanders' and trauma, the program leads, also the authors of this article, have identified ways to harness the resilience and faith of students to bring about improvements in global mental health.
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Affiliation(s)
- Sanya Virani
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jibril I M Handuleh
- Department of Psychiatry, Saint Paul Millennium Medical College, Addis Ababa, Ethiopia.,Department of Psychiatry, Amoud University, Borama, Somalia
| | - Victor Pereira-Sanchez
- Department of Psychiatry, Amoud University, Borama, Somalia.,Department of Psychiatry, Columbia University, New York, New York, USA.,Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York, USA.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
| | - Daniel Fekadu Wolde-Giorgis
- Department of Psychiatry, Amoud University, Borama, Somalia.,Linn Dara Child & Adolescent Mental Health Services, Dublin, Ireland
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Hashmi N, Ullah I, Tariq SR, de Filippis R, Orsolini L, Pinto da Costa M, Virani S, Pereira-Sanchez V. How is the COVID-19 pandemic affecting women's menstrual cycles and quality of life? A view from South Asia. BJPsych advances 2021. [DOI: 10.1192/bja.2021.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
SUMMARY
The substantial strain that women are facing during the COVID-19 pandemic can affect their menstrual cycle and further impair their quality of life. In low- and middle-income countries, this strain is exacerbated by: cultural taboos and poor education related to menstruation; ‘period poverty’; unavailability of menstrual hygiene products; and poor hygiene facilities. We suggest actions that governments, healthcare professionals and individuals can take to address these factors and minimise the psychological impact of COVID-19 on women's physical and mental health.
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Turgeon R, Dosanjh A, Code J, Bains M, Virani S. PATIENT EDUCATIONAL NEEDS AND TREATMENT PREFERENCES FOR HEART FAILURE MEDICATIONS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mahgoub Y, Makar M, Virani S. When Nothing Stops Catatonia Except Electroconvulsive Therapy and Maybe A New Savior, Clozapine. Prim Care Companion CNS Disord 2021; 23. [PMID: 34297490 DOI: 10.4088/pcc.20l02823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Yassir Mahgoub
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania.,Corresponding author: Yassir Mahgoub, MD, Department of Psychiatry, Penn State College of Medicine, 500 University Dr, Hershey, PA 17033
| | - Mark Makar
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, New York
| | - Sanya Virani
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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Faria G, Virani S, Tadros BJ, Dhinsa BS, Reddy G, Relwani J. COVID-19 - Changes in Workload and Clinical Practice in Trauma and Orthopaedics in a District General Hospital in the United Kingdom. Malays Orthop J 2021; 15:100-104. [PMID: 33880155 PMCID: PMC8043631 DOI: 10.5704/moj.2103.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: COVID-19 has had a significant impact on the entire health system. The trauma and orthopaedic service has been compelled to alter working practices to respond proactively and definitively to the crisis. The aim of this study is to summarise the impact of this outbreak on the trauma and orthopaedic workload and outline the response of the department. Materials and Methods: We retrospectively collected data comparing patient numbers pre-COVID-19, and prospectively during the early COVID-19 pandemic. We have collected the numbers and nature of outpatient orthopaedic attendances to fracture clinics and elective services, inpatient admissions and the number of fracture neck of femur operations performed. Results: The number of outpatient attendances for a musculoskeletal complaint to Accident and Emergency and the number of virtual fracture clinic reviews reduced by almost 50% during COVID-19. The number of face-to-face fracture clinic follow-ups decreased by around 67%, with a five-fold increase in telephone consultations. Inpatient admissions decreased by 33%, but the average number of fracture neck of femur operations performed has increased by 20% during COVID-19 compared to pre-COVID-19 levels. Conclusion: We have noted a decrease in some aspects of the trauma and orthopaedic outpatient workload, such as leisure and occupational-related injuries but an increase in others, such as fracture neck of femurs. Many injuries have significantly reduced in numbers and we consider that a model could be developed for treating these injuries away from the acute hospital site entirely, thereby allowing the acute team to focus more appropriate major trauma injuries.
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Affiliation(s)
- G Faria
- Department of Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
| | - S Virani
- Department of Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
| | - B J Tadros
- Department of Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
| | - B S Dhinsa
- Department of Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
| | - G Reddy
- Department of Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
| | - J Relwani
- Department of Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
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Virani S, Mitra S, Grullón MA, Khan A, Kovach J, Cotes RO. International Medical Graduate Resident Physicians in Psychiatry: Decreasing Numbers, Geographic Variation, Community Correlations, and Implications. Acad Psychiatry 2021; 45:7-12. [PMID: 33469891 DOI: 10.1007/s40596-020-01380-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The number of International Medical Graduate (IMG) physicians matching into categorical psychiatry decreased steadily over the past decade. The authors sought to understand if this trend was occurring in other specialties, if US IMG physicians and non-US IMG physicians were equally affected, and if certain regions of the USA were more affected by this decrease than others. Finally, the authors compared the proportion of foreign-born individuals within a US census region to the proportion of non-US IMG physicians within that region. METHODS The authors analyzed data from the National Resident Matching Program from the years 2014-2020. Statewide data was aggregated into nine geographic regions, as per the US Census Bureau. The number of foreign-born individuals within each US census region was calculated from the 2018 American Community Survey data. RESULTS In comparison to eight other specialties, psychiatry saw the greatest decrease (46.3%) in IMG physicians matching into PGY-1 positions. Both US IMG physicians and non-US IMG physicians were equally affected. The percentage of IMG physicians decreased in each of the nine US census regions. In six out of nine geographic regions, non-US IMG physicians were under-represented when comparing their proportion to the number of foreign-born people that lived within that region. CONCLUSIONS Decreasing numbers of IMG physicians in psychiatry training may have long-term implications for cultural competency, serving underserved populations, and fellowship recruitment. We advocate for program directors to recognize IMG physicians as an important source of diversity and to recruit residents that reflect the communities they serve.
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Affiliation(s)
| | | | | | - Ayesha Khan
- American University of Integrative Sciences, School of Medicine, Bridgetown, Barbados
| | - Jessica Kovach
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Awan HA, Aamir A, Diwan MN, Ullah I, Pereira-Sanchez V, Ramalho R, Orsolini L, de Filippis R, Ojeahere MI, Ransing R, Vadsaria AK, Virani S. Internet and Pornography Use During the COVID-19 Pandemic: Presumed Impact and What Can Be Done. Front Psychiatry 2021; 12:623508. [PMID: 33796031 PMCID: PMC8007884 DOI: 10.3389/fpsyt.2021.623508] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/08/2021] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic continues to cause an immense psychosocial strain worldwide. Excessive use of the internet during these psychologically trying times, fueled by physical isolation as a result of lockdowns, has translated into dysfunctional behaviors. A growing body of evidence suggests an unprecedented increase in internet use and consumption of online pornography during the pandemic, and possibly even directly caused by it. In this review, the authors report data from relevant sources to show the rise in pornography use during lockdowns in different countries worldwide. In addition to a brief overview of the neurobiology of internet addiction broadly and problematic online pornography use specifically, similarities with substance use disorders are explained. Further, the current status of the debate about defining diagnostic criteria is discussed. Finally, the review sheds light on the potential detrimental outcomes during the future post-pandemic "re-adaptation," while simultaneously offering preventative and management strategies for harm reduction. The authors conclude that foresightedness with utilizing existing tools and therapies and exercising appropriate amounts of caution could go a long way in addressing the challenges that lie ahead in the post-pandemic era.
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Affiliation(s)
| | - Alifiya Aamir
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Victor Pereira-Sanchez
- Department of Child and Adolescent Psychiatry, School of Medicine, New York University, New York, NY, United States
| | - Rodrigo Ramalho
- Department of Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, School of Medicine and Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Ramdas Ransing
- Bhaktshreshtha Kamalakarpant Laxman Walawalkar Rural Medical College, Kasarwadi, India
| | | | - Sanya Virani
- Veterans Affairs Connecticut Healthcare System, Yale University School of Medicine, West Haven, CT, United States.,School of Medicine Yale University, New Haven, CT, United States
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Cheema K, Raad M, Sehjal R, Virani S, Relwani J. Atypical mycobacterium infection of sternoclavicular joint: A unique case. Shoulder Elbow 2020; 12:349-352. [PMID: 33093873 PMCID: PMC7545528 DOI: 10.1177/1758573219859466] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022]
Abstract
We report a rare case of atypical Mycobacterium intracellulare infection encountered in a left sternoclavicular joint of an immunocompetent patient. The 34-year-old female patient presented with a one-year history of left sternoclavicular joint pain and swelling. The patient had multiple radiological investigations, which were suspicious for an infective cause. The patient had a biopsy of the joint, which returned showing acid-fast bacilli. The patient consequently received a prolonged course of medical treatment for M. intracellulare.
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Affiliation(s)
- K Cheema
- K Cheema, William Harvey Hospital – Trauma and Orthopaedics, Kennington Road, Ashford TN24 0LZ, UK.
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Mikonis D, Ghazzawi A, Hoffman TE, Virani S, Bodic MM. Delayed Diagnosis of a Pituitary Prolactinoma. Prim Care Companion CNS Disord 2020; 22. [DOI: 10.4088/pcc.19l02522] [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: 10/24/2022] Open
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17
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Virani S, Xia T, Brainch N, Mitra S, Ahmed S, Mutasiigwa H, Chaudhari G, Zaveri D. Scaling the great wall: The impact of communication barriers on quality of psychiatric care in Chinese patients. Int J Soc Psychiatry 2020; 66:150-155. [PMID: 31789574 DOI: 10.1177/0020764019888959] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Racial and ethnic minorities (such as Chinese-speaking (CS)) are known to have less equitable access to mental health services than Caucasians. These disparities have a powerful influence on minority groups that already endure a greater burden from mental health needs. AIM The aim was to identify perceived provider barriers to care for CS patients. METHODS The study involved an 11-item web-based survey to multidisciplinary health professionals in the department of psychiatry at a 75-bed teaching community mental health center. RESULTS More than half the respondents agreed that there are disparities in the management of CS versus non-CS patients primarily due to the language barrier (46%). However, older participants and participants who worked fewer hours per week in patient care were less likely to agree (rho = -.27, p = .05 and rho = .33, p = .015, respectively) that these perceived difficulties prevented them from caring for these patients. CONCLUSION The study revealed that certain modifiable factors like the limited availability of interpreters and culturally appropriate services, rendering psychoeducation and forming therapeutic alliances with CS patients, posed the greatest challenges on inpatient units. In light of these findings, we aim to make recommendations to remediate concerns of limited provider availability by proposing ways to efficiently utilize current resources and advocate for better staffing to improve the overall well-being of this challenging patient subset.
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Affiliation(s)
- Sanya Virani
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - Tianxu Xia
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - Navjot Brainch
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - Souparno Mitra
- Department of Psychiatry, BronxCare Health System, Bronx, NY, USA
| | - Saeed Ahmed
- Department of Addiction Psychiatry, Boston University, Boston, MA, USA
| | | | - Gaurav Chaudhari
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deval Zaveri
- Inpatient Psychiatric Unit, Kings County Hospital, Brooklyn, NY, USA
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Katchi T, Virani S, Smithson S, Curry B. DIFFERENCES IN OUTCOMES OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN AFRICAN AMERICAN WOMEN VERSUS WOMEN FROM OTHER RACES: A UNITED STATES NATIONAL STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chavda R, Knott J, Virani S, Zamin S, Saenz A. Abstract No. 677 Reduced right heart dysfunction following pulmonary embolism treated with catheter-directed therapy: a retrospective study. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
This chapter describes recent clinical trials for opioid use disorder (OUD), an area that has rapidly accelerated in response to the opioid overdose crisis in the USA and newly appropriated funding. Trials involve a wide range of compounds including cannabinoids and psychedelics, new and existing compounds targeting domains emerging from addiction neuroscience, agents repurposed from other indications, and novel strategies including vaccines, enzymes, and other biologicals. In parallel, new formulations of existing compounds offer immediate promise, as do a variety of web-based interventions and smartphone-delivered apps. Trials focused on implementing existing effective interventions in mainstream healthcare settings, and others focused on special populations, e.g., adolescents, criminal justice, pregnant women, native Americans, etc., have the potential to vastly expand treatment in the near term. Given the range of ongoing and recent trials, this chapter is not intended to be an exhaustive review but rather to present an overview of approaches within the framework of the opioid treatment cascade and the context of current OUD pharmacotherapies.
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Affiliation(s)
- Esther Blessing
- Department of Psychiatry, NYU School of Medicine, New York, NY, USA.
| | - Sanya Virani
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - John Rotrosen
- Department of Psychiatry, NYU School of Medicine, New York, NY, USA
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Nouraei H, Virani S, Chu C, Davis M, Ignaszewski A, Toma M. APPROPRIATENESS OF ORAL ANTICOAGULATION USE IN A CONTEMPORARY COHORT OF AMBULATORY HEART FAILURE PATIENTS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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22
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Brainch N, Virani S, Torres F, Bodic M, Zaveri D. A Case of Psychosis and Dissociation in a 38-Year-Old Woman. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190716-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
In 2018, Governor Cuomo tasked the Department of Health (DOH) with studying the anticipated impact of legalizing recreational marijuana use in New York State. DOH concluded that the positive effects of a regulated marijuana market outweighed the potential negative impact but that implementation required close monitoring of usage, education of specific populations, and regular and rigorous evaluation. In states where cannabis is legal, studies have shown associated decreases in crime rates and increases in financial resources. Conversely, accidental ingestion in children and accidents following ingestion had increased. The road ahead is fraught with challenges, especially because of the nonuniformity in federal and state laws.
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Affiliation(s)
- Souparno Mitra
- Department of Psychiatry, BronxCare Hospital, New York (Mitra); Department of Psychiatry, Maimonides Medical Center, New York (Virani). Marvin S. Swartz, M.D., is editor of this column
| | - Sanya Virani
- Department of Psychiatry, BronxCare Hospital, New York (Mitra); Department of Psychiatry, Maimonides Medical Center, New York (Virani). Marvin S. Swartz, M.D., is editor of this column
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Sharma P, Virani S, Mitra S, Ahmed S, Desousa A. Trends of Tobacco Consumption Among Women Admitted to and Visiting the Psychiatric Inpatient Unit of a Tertiary Care Center in Mumbai. Prim Care Companion CNS Disord 2019; 21. [DOI: 10.4088/pcc.18m02422] [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] [Received: 12/12/2018] [Accepted: 02/04/2019] [Indexed: 10/26/2022] Open
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Brainch N, Virani S, Atiwannapat P, Mitra S, Mahgoub Y. Is the Concept of Pseudoneurotic Schizophrenia Still Valid? A Case Series and Revisiting the Topic. Cureus 2019; 11:e4227. [PMID: 31123649 PMCID: PMC6510569 DOI: 10.7759/cureus.4227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We describe two cases to emphasize the importance of recognizing symptoms of psychosis underlying a constellation of neurotic symptoms, and to highlight the overlap and potential for misdiagnosis with personality and anxiety disorders. We also provide an overview of pseudoneurotic schizophrenia and familiarize readers about the challenges in making accurate diagnoses in light of this term used in the past. We refer to cases in the literature and point out the implications of this concept on diagnosis, management, and prognosis. Based on the management strategies deployed for the two cases described, we finally recommend that it is imperative to perform accurate and detailed assessments and take into consideration the evolution of the concept of pseudoneurotic schizophrenia to currently accepted DSM-V disorders, in order to effectively treat patients.
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Affiliation(s)
| | - Sanya Virani
- Psychiatry, Maimonides Medical Center, Brooklyn, USA
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Virani S, Bona A, Bodic M, Gomes CADB, Strayer R. Management of Severe Agitation in the Emergency Department of a Community Hospital in Brooklyn, New York. Prim Care Companion CNS Disord 2019; 21. [DOI: 10.4088/pcc.18l02348] [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: 10/27/2022] Open
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27
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Virani S, Brainch N, Albuquerque C, Mitra S, Bodic M, Bazzi L. Exploring the Role of Ketamine in Maintaining the Antidepressant Response. Psychiatr Ann 2018. [DOI: 10.3928/00485713-20180816-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
This column describes the Internet System for Tracking Over-Prescribing (I-STOP), New York State's prescription monitoring program, and its compatibility with HIPAA and Part 2 of Volume 42 of the Code of Federal Regulations (CFR). The authors review use of information that is permitted by I-STOP and CFR for health care operations, including disclosure, and present information from the state Bureau of Narcotics Enforcement about appropriate use of the program. Physicians are permitted, for example, to contact other prescribers in I-STOP, even without explicit permission from the patient, an area in which physicians need more training. Common clinical scenarios encountered while navigating I-STOP are described.
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Affiliation(s)
- Sanya Virani
- Dr. Virani, Dr. Torres, Dr. Brainch, Dr. Gomes, and Dr. Bazzi are with the Department of Psychiatry, Maimonides Medical Center, New York. Dr. Aoun is with the Columbia-Cornell Forensic Fellowship Program, New York State Psychiatric Institute, New York. Dr. Genova is with the Department of Psychiatry, Stony Brook University, Stony Brook, New York. Dr. Ahmed is with the Nassau University Medical Center, East Meadow, New York. Dr. Hurley is with the Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles. Marvin S. Swartz, M.D., is editor of this column
| | - Elie G Aoun
- Dr. Virani, Dr. Torres, Dr. Brainch, Dr. Gomes, and Dr. Bazzi are with the Department of Psychiatry, Maimonides Medical Center, New York. Dr. Aoun is with the Columbia-Cornell Forensic Fellowship Program, New York State Psychiatric Institute, New York. Dr. Genova is with the Department of Psychiatry, Stony Brook University, Stony Brook, New York. Dr. Ahmed is with the Nassau University Medical Center, East Meadow, New York. Dr. Hurley is with the Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles. Marvin S. Swartz, M.D., is editor of this column
| | - Felix Torres
- Dr. Virani, Dr. Torres, Dr. Brainch, Dr. Gomes, and Dr. Bazzi are with the Department of Psychiatry, Maimonides Medical Center, New York. Dr. Aoun is with the Columbia-Cornell Forensic Fellowship Program, New York State Psychiatric Institute, New York. Dr. Genova is with the Department of Psychiatry, Stony Brook University, Stony Brook, New York. Dr. Ahmed is with the Nassau University Medical Center, East Meadow, New York. Dr. Hurley is with the Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles. Marvin S. Swartz, M.D., is editor of this column
| | - Nicholas Genova
- Dr. Virani, Dr. Torres, Dr. Brainch, Dr. Gomes, and Dr. Bazzi are with the Department of Psychiatry, Maimonides Medical Center, New York. Dr. Aoun is with the Columbia-Cornell Forensic Fellowship Program, New York State Psychiatric Institute, New York. Dr. Genova is with the Department of Psychiatry, Stony Brook University, Stony Brook, New York. Dr. Ahmed is with the Nassau University Medical Center, East Meadow, New York. Dr. Hurley is with the Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles. Marvin S. Swartz, M.D., is editor of this column
| | - Navjot Brainch
- Dr. Virani, Dr. Torres, Dr. Brainch, Dr. Gomes, and Dr. Bazzi are with the Department of Psychiatry, Maimonides Medical Center, New York. Dr. Aoun is with the Columbia-Cornell Forensic Fellowship Program, New York State Psychiatric Institute, New York. Dr. Genova is with the Department of Psychiatry, Stony Brook University, Stony Brook, New York. Dr. Ahmed is with the Nassau University Medical Center, East Meadow, New York. Dr. Hurley is with the Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles. Marvin S. Swartz, M.D., is editor of this column
| | - Camila Albuquerque Gomes
- Dr. Virani, Dr. Torres, Dr. Brainch, Dr. Gomes, and Dr. Bazzi are with the Department of Psychiatry, Maimonides Medical Center, New York. Dr. Aoun is with the Columbia-Cornell Forensic Fellowship Program, New York State Psychiatric Institute, New York. Dr. Genova is with the Department of Psychiatry, Stony Brook University, Stony Brook, New York. Dr. Ahmed is with the Nassau University Medical Center, East Meadow, New York. Dr. Hurley is with the Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles. Marvin S. Swartz, M.D., is editor of this column
| | - Saeed Ahmed
- Dr. Virani, Dr. Torres, Dr. Brainch, Dr. Gomes, and Dr. Bazzi are with the Department of Psychiatry, Maimonides Medical Center, New York. Dr. Aoun is with the Columbia-Cornell Forensic Fellowship Program, New York State Psychiatric Institute, New York. Dr. Genova is with the Department of Psychiatry, Stony Brook University, Stony Brook, New York. Dr. Ahmed is with the Nassau University Medical Center, East Meadow, New York. Dr. Hurley is with the Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles. Marvin S. Swartz, M.D., is editor of this column
| | - Brian Hurley
- Dr. Virani, Dr. Torres, Dr. Brainch, Dr. Gomes, and Dr. Bazzi are with the Department of Psychiatry, Maimonides Medical Center, New York. Dr. Aoun is with the Columbia-Cornell Forensic Fellowship Program, New York State Psychiatric Institute, New York. Dr. Genova is with the Department of Psychiatry, Stony Brook University, Stony Brook, New York. Dr. Ahmed is with the Nassau University Medical Center, East Meadow, New York. Dr. Hurley is with the Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles. Marvin S. Swartz, M.D., is editor of this column
| | - Lama Bazzi
- Dr. Virani, Dr. Torres, Dr. Brainch, Dr. Gomes, and Dr. Bazzi are with the Department of Psychiatry, Maimonides Medical Center, New York. Dr. Aoun is with the Columbia-Cornell Forensic Fellowship Program, New York State Psychiatric Institute, New York. Dr. Genova is with the Department of Psychiatry, Stony Brook University, Stony Brook, New York. Dr. Ahmed is with the Nassau University Medical Center, East Meadow, New York. Dr. Hurley is with the Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles. Marvin S. Swartz, M.D., is editor of this column
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Abstract
Ecstasy, a popular drug among the younger generation, the primary psychoactive component of which is 3,4-Methylenedioxymethamphetamine (MDMA), is rarely known to have acute psychiatric effects and when it does, it is usually short term. We describe a patient who presented to the emergency room in a psychotic state after using ecstasy recreationally. Given his aggressive behavior in the community and risk for self-harm, he was emergently hospitalized to ensure safety. He developed persistent psychotic symptoms (delusions) after one dose of recreational MDMA and the team had the opportunity to observe, monitor, and treat his psychosis. This case along with few other documented cases highlights the gaps in research about the chronic, persistent effects and long-term consequences of MDMA. It also suggests that neuropsychiatric symptoms may not be readily reversible after cessation of use. There is an emphasis on the need for physicians to inquire about MDMA use and include it in toxicology screenings and as a potential differential diagnosis.
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Affiliation(s)
- Sanya Virani
- Psychiatry, Maimonides Medical Center, Brooklyn, USA
| | | | | | | | - Deval Zaveri
- Psychiatry, Maimonides Medical Center, New York, USA
| | - Saeed Ahmed
- Behavioral Health Sciences, Nassau University Medical Center, East Meadow, USA
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Brainch N, Virani S, Bazzi L. D-Cycloserine: A Novel Antidepressant to Be Explored? Psychiatr Ann 2018. [DOI: 10.3928/00485713-20180308-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ahmed S, Virani S, Kotapati VP, Bachu R, Adnan M, Khan AM, Zubair A, Begum G, Kumar J, Qureshi M, Ahmed R. Efficacy and Safety of Varenicline for Smoking Cessation in Schizophrenia: A Meta-Analysis. Front Psychiatry 2018; 9:428. [PMID: 30283363 PMCID: PMC6156523 DOI: 10.3389/fpsyt.2018.00428] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/20/2018] [Indexed: 01/22/2023] Open
Abstract
Objective: Smoking represents a major public health problem among patients with schizophrenia. To this end, some studies have investigated the efficacy of varenicline for facilitating smoking cessation in schizophrenia patients. The present review seeks to synthesize the results of these studies as well as document the reported side effects of using this medication. Methods: An electronic search was performed using five major databases: PubMed, Scopus, EMBASE, Web of Science, and Cochrane Library. Included in the current analysis were randomized clinical trials (RCTs) that have investigated the effect of varenicline in promoting smoking cessation in patients with schizophrenia. Risk of bias among included RCTs was assessed using the Cochrane Collaboration's quality assessment tool. Results: Among the 828 screened articles, only four RCTs, which involved 239 participants, were eligible for meta-analysis. In patients with schizophrenia, varenicline treatment when compared to placebo significantly reduced the number of cigarettes consumed per day [SMD (95% CI) = 0.89(0.57-1.22)] and expired carbon monoxide levels [SMD (95% CI) = 0.50 (0.06-0.94)] respectively. Conclusion: Despite a limited number of studies included in the meta-analysis, our results suggest that varenicline is an effective and safe drug to assist smoking cessation in patients with schizophrenia. Future large-scale well-designed RCTs are required to validate these findings.
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Affiliation(s)
- Saeed Ahmed
- Nassau University Medical Center, East Meadow, NY, United States
| | - Sanya Virani
- Maimonides Medical Center, New York, NY, United States
| | | | - Ramya Bachu
- Zucker Hillside Hospital, New York, NY, United States
| | - Mahwish Adnan
- Department of Cognitive Behavioral Science, McMaster University, Hamilton, ON, Canada
| | - Ali M Khan
- Department of Psychiatry, University of Texas Rio Grande Valley, Harlingen, TX, United States
| | - Aarij Zubair
- St. John's University, New York, NY, United States
| | - Gulshan Begum
- Manhattan Psychiatric Center, New York, NY, United States
| | | | - Mustafa Qureshi
- Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Rizwan Ahmed
- Liaquat National Medical College, Karachi, Pakistan
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Neumann JL, Mau LW, Virani S, Denzen EM, Boyle DA, Boyle NJ, Dabney J, De KeselLofthus A, Kalbacker M, Khan T, Majhail NS, Murphy EA, Paplham P, Parran L, Perales MA, Rockwood TH, Schmit-Pokorny K, Shanafelt TD, Stenstrup E, Wood WA, Burns LJ. Burnout, Moral Distress, Work-Life Balance, and Career Satisfaction among Hematopoietic Cell Transplantation Professionals. Biol Blood Marrow Transplant 2017; 24:849-860. [PMID: 29196079 DOI: 10.1016/j.bbmt.2017.11.015] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/13/2017] [Indexed: 11/29/2022]
Abstract
A projected shortage of hematopoietic cell transplantation (HCT) health professionals was identified as a major issue during the National Marrow Donor Program/Be The Match System Capacity Initiative. Work-related distress and work-life balance were noted to be potential barriers to recruitment/retention. This study examined these barriers and their association with career satisfaction across HCT disciplines. A cross-sectional, 90-item, web-based survey was administered to advanced practice providers, nurses, physicians, pharmacists, and social workers in 2015. Participants were recruited from membership lists of 6 professional groups. Burnout (measured with the Maslach Burnout Inventory subscales of emotional exhaustion and depersonalization) and moral distress (measured by Moral Distress Scale-Revised) were examined to identify work-related distress. Additional questions addressed demographics, work-life balance, and career satisfaction. Of 5759 HCT providers who received an individualized invitation to participate, 914 (16%) responded; 627 additional participants responded to an open link survey. Significant differences in demographic and practice characteristics existed across disciplines (P < .05). The prevalence of burnout differed across disciplines (P < .05) with an overall prevalence of 40%. Over one-half of pharmacists had burnout, whereas social workers had the lowest prevalence at less than one-third. Moral distress scores ranged from 0 to 336 and varied by discipline (P < .05); pharmacists had the highest mean score (62.9 ± 34.8) and social workers the lowest (42.7 ± 24.4). In multivariate and univariate analyses, variables contributing to burnout varied by discipline; however, moral distress was a significant contributing factor for all providers. Those with burnout were more likely to report inadequate work-life balance and a low level of career satisfaction; however, overall there was a high level of career satisfaction across disciplines. Burnout, moral distress, and inadequate work-life balance existed at a variable rate in all HCT disciplines, yet career satisfaction was high. These results suggest specific areas to address in the work environment for HCT health professionals, especially the need for relief of moral distress and a greater degree of personal time. As the creation of healthy work environments is increasingly emphasized to improve quality care and decrease costs, these findings should be used by HCT leadership to develop interventions that mitigate work-related distress and in turn foster recruitment and retention of HCT providers.
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Affiliation(s)
- Joyce L Neumann
- Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Lih-Wen Mau
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Sanya Virani
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Ellen M Denzen
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Deborah A Boyle
- Department of Nursing, University of California Irvine Health/Chao Family Comprehensive Cancer Center, Orange, California
| | - Nancy J Boyle
- Knight Cancer Institute, Center for Hematologic Malignancy, Oregon Health & Science University, Portland, Oregon
| | - Jane Dabney
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | | | - Marion Kalbacker
- Pediatric BMT, Duke University Medical Center, Durham, North Carolina
| | - Tippu Khan
- Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, North Carolina
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | | | - Pamela Paplham
- Roswell Park Cancer Institute Nursing Administration, Buffalo, New York
| | - Leslie Parran
- Department of Nursing, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Todd H Rockwood
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | | | | | - Elaine Stenstrup
- Department of Nursing, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - William A Wood
- Division of Hematology/Oncology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
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Catlin B, Bains P, Baker S, Costigan J, Ding L, Harle S, Hennessy C, Hutchison F, McKeen K, Pearce S, Sidsworth M, Swiggum E, Toma M, Vandergriend R, Virani S, Hobson B, Norquist C. THE BRITISH COLUMBIA SACUBITRIL-VALSARTAN REGISTRY: RATIONALE AND BASELINE DEMOGRAPHICS. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Webb J, Catlin B, Chan A, Charania J, Cheung A, Cook R, Della Siega A, Ding L, Latham T, Lauck S, Robinson S, Virani S, Wood D, Ye J, Yu M, Wong D. TRANSCATHETER AORTIC VALVE REPLACEMENT IN BRITISH COLUMBIA. IMPLICATIONS OF VALVE SELECTION ON PACEMAKER RATES, HOSPITAL STAY, AND READMISSION. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Plourde V, Low T, Jadavji Z, Virani S, Barlow K, Yeates K, Brooks B. B-63Do Pre-existing Psychological or Neurodevelopmental Problems Predict Long-term Functioning in Children and Adolescents with Prior Concussions? Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Virani S, Govender P. P109 An uncommon cause of persistent lip swelling for the allergist - orofacial granulomatosa. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Catlin B, Sidsworth M, Hutchison F, Nordquist C, Virani S. The Provincial Heart Failure Strategy at Work: Creating Standardized Resources to Guide Nurse Practitioners’ Practice When Prescribing a New Heart Failure Medication. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ding L, Harle S, Catlin B, Ramsay P, Virani S. TEMPORAL TRENDS IN HEART FAILURE PREVALENCE AND OUTCOMES IN BRITISH COLUMBIA. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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39
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Kiamanesh O, Khosla A, Johansson E, Virani S, Davis M, Cheung A, Bashir J, Munt B, Ignaszewski A, Kaan A, Toma M. The Impact of Donor Origin on Survival after Orthotopic Heart Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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40
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Neumann JL, Mau LW, Denzen EM, Boyle DA, Dabney J, De Kesel Lofthus A, Kalbacker M, Khan T, Majhail NS, Murphy EA, Paplham P, Parran L, Perales MA, Rockwell T, Schmit-Pokorny K, Shanafelt TD, Stenstrup E, Virani S, Wood WA, Burns LJ. Hematopoietic Cell Transplantation Multidisciplinary Care Teams: National Survey of Transplant Provider Burnout, Moral Distress and Career Satisfaction. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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41
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Nazzari H, Bashir J, Tauh K, Virani S, Davis M, Munt B, Kaan A, Ignaszewski A, Cheung A, Toma M. SINGLE CENTER COMPARATIVE ANALYSIS OF HEARTMATE II AND HEARTWARE HVAD CONTINUOUS FLOW DEVICES. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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42
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Giannetti N, Frenette M, Toma M, Zieroth S, DeYoung P, Rajda M, Huynh T, Howlett J, Ezekowitz J, Rinne C, Nguyen V, Orenstein T, Virani S. PHYSICIAN ADHERENCE TO EVIDENCE-BASED PHARMACOTHERAPY IN SYSTOLIC HEART FAILURE: DATA FROM THE CANADIAN QUALIFY SURVEY. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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43
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Catlin B, Virani S, Prentice C, Luehr P, Kerr S, Starzyk M, Young Q, Ross D, Deakin B. THE PROVINCIAL HEART FAILURE STRATEGY AT WORK: CARING FOR THE PSYCHOLOGICAL NEEDS OF OUR HEART PATIENTS AND FAMILIES. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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44
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Cheung C, Virani S, Davis M, Hawkins N, Munt B, Ding L, Ignaszewski A, Toma M. TEMPORAL TRENDS IN HEART FAILURE Outcomes FOLLOWING INDEX HF HOSPITALIZATION IN BRITISH COLUMBIA. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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45
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Kiamanesh O, Khosla A, Johansson E, Virani S, Davis M, Cheung A, Bashir J, Munt B, Kaan A, Ignaszewski A, Toma M. LONG-TERM SURVIVAL AFTER CARDIAC TRANSPLANTATION: THE BRITISH COLUMBIA EXPERIENCE. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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46
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Shah R, Virani S, Shah S. P0192 Sentinel node biopsy in breast cancer using only methylene blue dye: A prospective study in a rural tertiary care centre. Eur J Cancer 2015. [DOI: 10.1016/j.ejca.2015.06.103] [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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47
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Kiamanesh O, Khosla A, Johansson E, Virani S, Davis M, Cheung A, Bashir J, Ignaszewski A, Munt B, Kaan A, Toma M. Comparing Induction Immunosuppression With Basiliximab or Rabbit Anti-Thymocyte Globulin After Cardiac Transplantation: A Contemporary Experience. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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48
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Virani S, De Kesel Lofthus A, Boyle DA, Stenstrup E, Denzen EM, Dabney J, Schmit-Pokorny K, Parran L, Mau LW, Burns LJ, Kalbacker M, Perales MA, Boyle N, Majhail NS, Paplham P, Shanafelt T, Khan T, Wood W, Murphy EA, Neumann J. Hematopoietic Cell Transplantation Multidisciplinary Care Teams: Burnout, Moral Distress and Career Satisfaction. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Pokharel Y, Hira R, Kalra A, Shore S, Kerkar P, Kumar G, Risch S, Vicera V, Oetgen W, Turakhia M, Glusenkamp N, Virani S. Guideline recommended medication use among systolic heart failure patients in India: Insights from the American college of cardiology practice innovation and clinical excellence (PINNACLE)® India Registry. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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Rajala J, Tyldesley S, Pickles T, Virani S. The Prevalence of Cardiac Risk Factors in Men With Localized Prostate Cancer Undergoing Androgren Deprivation Therapy in British Columbia, Canada. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.549] [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] Open
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